Risk-adapted stereotactic ablative radiotherapy for central and ultra-central lung tumours. (May 2019)

• Record Type: Journal Article
• Authors: Lenglet, Alexis; Campeau, Marie-Pierre; Mathieu, Dominique; Bahig, Houda; Lambert, Louise; Vu, Toni; Roberge, David; Bilodeau, Laurent; Filion, Edith
• Is Part Of: Radiotherapy and oncology. Volume 134(2019)
• Page Start: 178
• Page End: 184
• Publication Date: 2019-05
• Subjects: C central tumours -- CCI Charlson's Comorbidity Index -- CTCAE Common Terminology Criteria for Adverse Events -- PBT proximal bronchial tree -- R-SABR Robotic Stereotactic Ablative Radiotherapy -- UC ultra-central tumours -- VMAT-SABR Volumetric Modulated Arc Therapy Stereotactic Ablative Radiotherapy; Stereotactic body radiation therapy -- Stereotactic ablative radiotherapy -- Central Tumours -- Non-small-cell lung cancer -- Toxicity; 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.2019.01.035
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: Central tumours have a better median overall survival than ultra-central tumours. Local control is not different between central and ultra-central tumours. No difference of toxicity was observed between central and ultra-central tumours. Cumulative incidence of grade 3–5 toxicity events was 7%. Abstract: Background: SABR is a widely accepted treatment for early-stage lung cancer but there are safety concerns for central and ultra-central tumours. Herein we report our experience using risk-adapted fractionation (prescribed doses: 40–60 Gy in 3–8 fractions) with prioritization of dose to organs at risk. Methods: Patient declining or unsuitable for surgery with primitive or recurrent lung cancer were included. Tumours inside a 2 cm area around proximal bronchial tree (PBT) were classified as central while tumours with PTV overlapping PBT, oesophagus, great vessels and pericardial pleura were classified as ultra-central. We assessed overall survival (OS), disease-free survival (DFS), local control (LC) and toxicities. Results: From 2009 to 2016, 137 patients were treated (median age: 75 years), with 60 central and 77 ultra-central tumours. Median follow-up was 36 months. Median tumour size, GTV and PTV were 2.5 cm (0.9–7), 7.8 cm 3 (0.7–94.2) and 30.6 cm 3 (6.5–274.3), respectively. For the whole population, median OS and DFS were 46 months and 33 months. One- and 2-years LC rates were 95% and 81%. Median OS between central and ultra-central tumours was statistically different with 57 vs 37 months (HR 0.48, p = 0.017), but LC was not different among them. We observed 4 Grade 3 and 6 Grade 5 toxicities (no grade 4). Conclusions: SABR for central and ultra-central tumours is associated with good OS, DFS and LC rates, with 7.3% grade 3–5 toxicities. Central tumours had a better prognosis in our cohort.