Stereotactic ablative radiotherapy (SABR) for central lung tumors: Plan quality and long-term clinical outcomes. Issue 1 (October 2015)

• Record Type: Journal Article
• Authors: Tekatli, Hilâl; Senan, Suresh; Dahele, Max; Slotman, Ben J.; Verbakel, Wilko F.A.R.
• Is Part Of: Radiotherapy and oncology. Volume 117:Issue 1(2015:Oct.)
• Page Start: 64
• Page End: 70
• Publication Date: 2015-10
• Subjects: SABR -- Central lung tumors -- Dosimetry -- Toxicity -- Plan quality; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2015.09.028
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Background and purpose: Central lung SABR is less established due to toxicity concerns. We describe plan quality and clinical outcomes for patients treated with VMAT SABR using 8 × 7.5 Gy. Materials and methods: We studied 80 consecutive patients with primary NSCLC and PTV ⩽2 cm from the proximal bronchial tree (PBT), treated between 2008 and 2013. Dosimetric data were compared with institutional guidelines and study protocols, and long-term clinical outcomes were analyzed. Results: PTV V 95% was 60 Gy in 96% of patients. Dmax was ⩾60 Gy in 40% of patients for PBT, 26.3% for aorta, 55% for heart, and 1.3% for trachea. Esophageal maximum Dmax was 58 Gy. Mean lung V 5Gy / V 20Gy was 21/8%. 54 patients (68%) exceeded RTOG0813 Dmax for ⩾1 organ-at-risk (OAR), with 27 exceeding PBT Dmax. 5 of 78 patients (6.4%) with adequate follow-up information had grade 3 toxicity. Grade 4 toxicity was not observed. Treatment-related death was considered possible ( n = 3) or likely ( n = 3) in 6 patients (7.5%). With median follow-up of 47 months, 3-year survival was 53%, compared with 57% for 252 peripheral tumors treated with 3/5-fractions SABR in the same period ( p = 0.369). Conclusions: Although a substantial proportion of central SABR patients received ⩾60 Gy to OARs, the 3-year survival was no different from peripheral SABR.