Abstract
Background: Stereotactic body radiotherapy (SBRT) in ultra-central (UC) lung tumors, defined in the presence of planning target volume (PTV) overlap or direct tumor abutment to the central bronchial tree or esophagus, may be correlated to a higher incidence of severe adverse events. Outcome and toxicity in oligometastatic (≤3 metastases) non-small-cell lung cancer (NSCLC) patients receiving SBRT for UC tumors were evaluated. Methods: Oligometastatic NSCLC patients treated with SBRT for UC were retrospectively reviewed. Local control (LC), distant metastasis-free survival (DMFS), progression-free survival (PFS) and overall survival (OS) were calculated. Incidence and grade of toxicity were evaluated. Statistical analysis was performed to assess the impact of clinical and treatment-related variables on outcome and toxicity occurrence. Results: Seventy-two patients were treated to a median biologically effective dose (BED) of 105 (75–132) Gy10. Two-year LC, DMFS, PFS, and OS were 83%, 46%, 43%, and 49%. BED>75 Gy10 was correlated to superior LC (p = 0.02), PFS (p = 0.036), and OS (p < 0.001). Grade ≥3 toxicity rate was 7%, including one fatal esophagitis. No variables were correlated to DMFS or to occurrence of overall and grade ≥3 toxicity. Conclusions: SBRT using dose-intensive schedules improves outcome in NSCLC patients. Overall toxicity is acceptable, although rare but potentially fatal toxicities may occur.
Highlights
Lung cancer is among the most frequent malignancies worldwide and is burdened by a high disease-related mortality [1]
The planning target volume (PTV)–esophagus overlap occurred in two patients (2%)
Since the pivotal trials of Stereotactic body radiotherapy (SBRT) for lung tumors, it emerged quite clearly that the incidence of toxicity observed in cases of tumors located within 2 cm around the proximal bronchial tree was significantly higher as compared to peripheral tumors, while using the same doses and number of fractions [13]
Summary
Lung cancer is among the most frequent malignancies worldwide and is burdened by a high disease-related mortality [1]. About 85% of cases are non-small-cell lung cancer (NSCLC) [1,2]. For patients with oligometastatic disease, defined as ≤3 or fewer concurrent metastases [3], use of ablative local treatments may improve outcome: multiple treatment options have been applied in this setting, including surgery, radiofrequency, and stereotactic radiotherapy (SBRT) [4]. Due to its noninvasive character and possibility to treat multiple targets during the same treatment course, SBRT emerged in the last decade as a valuable treatment option, resulting in excellent local control rates and possible survival benefits [11,12]. Outcome and toxicity in oligometastatic (≤3 metastases) non-small-cell lung cancer (NSCLC) patients receiving SBRT for UC tumors were evaluated. Grade ≥3 toxicity rate was 7%, including one fatal esophagitis
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