Abstract
BackgroundSBRT is standard therapy for early stage lung cancer. Toxicity in central tumors has been a concern. RTOG 0813 showed that central SBRT is safe and effective. We report our experience with central SBRT.MethodsWe reviewed the records of patients treated with SBRT for central lung tumors (< 2 cm of the carina). Patients included primary lung cancer and recurrence following surgery and\\ or conventional radiotherapy. All patients underwent 4DCT simulation and treatment planning was done with IMRT or VMAT techniques. Dose to the PTV was prescribed to the 95% isodose line.ResultsSeventy patients, between 5/09 and 4/13, were treated. Patients had early non-small cell lung cancer (n = 13) or locally recurrent lung cancer (n = 29) and pulmonary oligometastases (n = 28). Fifty-seven percent of the patients received BED of 132 with a schedule of 60Gy in 12 Gy fractions. Median follow up time was 18.3 months, 4/70 patients experienced local failure (6%). Median OS for the whole cohort was 4.6 years (CI 3-7 years). Ten patients had grade 1-2 radiation pneumonitis. One patient developed fatal bronchial bleeding.ConclusionsSBRT for central tumors is safe and effective in patients with central disease, reiradiation, recurrence following surgery and in oligometastes.
Highlights
Stereotactic Body Radiation Therapy (SBRT) is standard therapy for early stage lung cancer
The dose to the planning target volume (PTV) was prescribed to the 95% isodose line covering at least 95% of the PTV
On univariate analysis for predictors of local and regional failures, none of the variables we examined were significantly predictive of Local failure (LF), including sex, age, histology, stage, previous radiation or surgery, dose of radiotherapy or gross tumor volume (GTV) volume while accounting for death as a competing risk
Summary
SBRT is standard therapy for early stage lung cancer. Toxicity in central tumors has been a concern. RTOG 0813 showed that central SBRT is safe and effective. We report our experience with central SBRT. SBRT (Stereotactic Body Radiation Therapy) is a wellestablished treatment for early stage medically inoperable non small cell lung carcinoma (NSCLC). SBRT has proven its place with excellent local control and limited toxicity [1,2,3]. SBRT is the primary treatment option for medically inoperable stage I NSCLC. Treatingumors with central location (within 2 cm of the carina) have been more challenging. Concerns were raised in treating central tumors due to toxicity, bleeding and necrosis as described by Timmerman et al [1]. Patients with centrally located tumors were excluded from the landmark RTOG 0236 trial
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