Abstract
The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. Our objective was to assess toxicities, local control (LC) rate and survival data in patients with ultra-central lung tumours treated with SBRT. We conducted a retrospective and monocentric study about 74 patients with an ultra-central lung tumour, consecutively treated between 2012 and 2018. Ultra-central tumours were defined as tumours whose planning target volume overlapped one of the following organs at risk (OARs): the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart. Median follow-up was 25 months. Two patients (2.7%) showed Grade 3 toxicity. No Grade 4 or 5 toxicity was observed. 11% of patients experienced primary local relapse. LC rate was 96.7% at 1 year and 87.6% at 2 years. Median progression free survival was 12 months. Median overall survival was 31 months. SBRT for ultra-central tumours remains safe and effective as long as protecting organs at risk is treatment-planning priority. The present study is one of the rare to describe exclusively ultra-central tumours through real-life observational case reports. Globally, literature analysis reveals a large heterogeneity in ultra-central lung tumours definition, prescribed dose, number of fractions. In our study, patients treated with SBRT for ultra-central lung tumours experienced few Grade 3 toxicities (2.7%) and no Grade 4 or 5 toxicities, due to the highest compliance with dose constraints to OARs. LC remained efficient.
Highlights
Stereotactic body radiotherapy (SBRT) has become the standard of care for inoperable, early-stage nonsmall cell lung cancers (NSCLC) [1–3]
As the results of ongoing prospective trial have not been published yet, SBRT for ultra-central tumours should be performed with caution
Ultra-central tumours were defined as tumours whose PTV overlapped one of the following organs at risk: the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart
Summary
Stereotactic body radiotherapy (SBRT) has become the standard of care for inoperable, early-stage nonsmall cell lung cancers (NSCLC) [1–3]. It is used for inoperable pulmonary metastases in case of controlled oligometastatic disease [4]. SBRT definitely has a positive efficacy/toxicity ratio for peripheral lung tumours [5]. This was counterbalanced by a prospective study by Timmerman et al showing that using the same 3 fractions schedule for central tumours caused more toxicities than for peripheral tumours. 2-years’ survival with no grade ≥ 3 toxicity was 54% in the central tumours group vs 83% in the peripheral tumours group [6]. Treatment in 5 fractions seems to be better adapted to central lesions regarding toxicity and efficacy
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