Treatment Of Central Tumors Research Articles

Prise en charge des stades précoces des cancers bronchiques non à petites cellules : radiothérapie en conditions stéréotaxiques

Surgery remains the reference treatment for primary non-small cell lung cancer (NSCLC) T1-T2 N0. However, 20-30 % of patients present a surgical contraindication. For these patients who cannot be operated on, stereotactic radiotherapy (SBRT) has been validated as the alternative of choice by learned medical societies. These two treatments are aimed at different populations, with a recognized role for these tumours local control. Radiotherapy remains less risky for fragile patients, but maybe at the cost of a higher risk of lymph node recurrence. The role of systemic treatment in association with stereotactic radiotherapy remains to be determined, particularly for non-operable T3NO tumours.Several complex clinical situations can be identified depending on the location and size of the tumour, the patient’s history of irradiation and co-morbidities. The treatment of central tumours, re-irradiation, which is becoming increasingly frequent with advances in systemic treatments, and treatment of patients with pulmonary fibrosis represent a real technical challenge, requiring a specialized multi-disciplinary assessment to evaluate the benefit-risk ratio.1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved

Abstract 864: Increased rates of radiation pneumonitis in patients receiving stereotactic ablative radiotherapy for central versus peripheral lung tumors

Abstract Purpose: Treatment of central lung tumors with stereotactic ablative radiotherapy (SABR) has been associated with higher rates of toxicities than patients with peripheral tumors. Here we report our institution's experience in treating central lung tumor patients with SABR, compared to patients treated for peripheral lung tumors. Methods: We retrospectively reviewed outcomes in 82 patients with a total of 96 primary or metastatic lung tumors treated by SABR. The cohort included 47 central and 49 peripheral tumors and all were treated with 50 Gy in 4-5 fractions. Outcomes and radiation-associated toxicities were compared between the two groups, not including patients in whom central and peripheral tumors were concurrently treated (8 such patients). Dosimetric analysis was performed on patients with central tumors to determine max point dose (MPD) and volumetric max dose (Vmax) to central structures. Results: Median follow-up time was 15 months (range 1 to 59 months). Median overall survival was 34 and 40 months (p=0.75) for patients with central and peripheral tumors, respectively. We observed no hemoptysis and no grade 5 toxicities. Rates of symptomatic toxicity were higher in patients with central tumors (grade 2+, 38% vs. 11%, p=0.0056) but were equivalent for severe toxicity (grade 3+, 5.4% vs. 5.4%, p=0.93). The vast majority of toxicities were due to radiation pneumonitis, incidence of which was significantly greater in patients with central tumors (grade 2+, 30% vs. 2.7%, p=0.0021; grade 3+, 5.4% vs. 0%, p=0.15). Dosimetric analysis of 36 central tumor treatment plans revealed that 23 (64%) exceeded at least one of the dose constraints used in RTOG 0813, most commonly for central airway. Rates of grade 2+ pneumonitis were not significantly different between patients exceeding RTOG 0813 central airway dosing constraints vs. those meeting them (24% vs. 20%, p=0.69), but trended towards significance for grade 3+ radiation pneumonitis, with patients exceeding RTOG 0813 central airway dosing constraints experiencing higher rates (0% vs. 13%, p=0.095). Conclusions: Central lung tumor patients treated with SABR appear to have greater risk for symptomatic radiation pneumonitis than patients with peripheral tumors. Exceeding RTOG 0813 dosimetric constraints for central airway may predispose to higher risk for severe radiation pneumonitis. Citation Format: Aadel A. Chaudhuri, Chad Tang, Nicholas Trakul, Jacob Wynne, Billy Loo, Maximilian Diehn. Increased rates of radiation pneumonitis in patients receiving stereotactic ablative radiotherapy for central versus peripheral lung tumors. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 864. doi:10.1158/1538-7445.AM2014-864

Simple Clinical Factors Associated With Radiation-Induced Lung Toxicity After Stereotactic Body Radiation Therapy in Lung Cancer: A Pooled Analysis of 70 Studies

radiation therapy (SABR) from a toxicity standpoint, with RTOG 0813 designed to help address this issue. Here we report our institution’s experience in treating central lung tumor patients with SABR, compared to similarly treated peripheral lung tumors. Materials/Methods: We retrospectively reviewed outcomes in 82 patients with 96 primary or metastatic lung tumors treated by SABR. The cohort included 47 central and 49 peripheral tumors; all were treated with 50 Gy in 4 to 5 fractions. Outcomes, toxicities, and dosimetric parameters were compared between the 2 groups, not including patients in whom central and peripheral tumors were concurrently treated (8 such patients). Results: Median follow-up time was 15 months (range 1 to 59 months). Median overall survival was 34 and 40 months (PZ.75) for patients with central and peripheral tumors, respectively. We observed no hemoptysis, and no grade 5 toxicities. Rates of symptomatic (grade 2+) toxicity were higher in patients with central tumors by both univariate analysis (38% vs 11%, PZ.0056, HRZ3.7) and multivariate analysis (PZ.02, HRZ3.9), but were equivalent for severe (grade 3+) toxicity (5.4% vs 5.4%, PZ.93, HRZ1.1). The vast majority of observed toxicities were due to symptomatic pneumonitis, incidence of which was significantly greater in patients with central tumors by both univariate analysis (30% vs 2.7%, PZ.0021, HRZ6.5) and multivariate analysis (PZ.02, HRZ11.1). These patients also had higher rates of severe pneumonitis that trended towards significance (5.4% vs 0, PZ.15, HRZ7.6). Dosimetric analysis revealed that the central tumor patients in our study experienced significantly greater ipsilateral mean lung doses than their peripheral tumor counterparts (7.33 vs 5.15 Gy, PZ.0058). Total mean lung dose and total lung V20 were not significantly different between the 2 populations. Further analysis of the 35 available central tumor treatment plans revealed that 23 (66%) exceeded at least 1 of the dose constraints used in RTOG 0813, most commonly for central airway. Rates of symptomatic pneumonitis were not significantly different between patients exceeding RTOG 0813 central airway dosing constraints versus those meeting them (25% vs 20%, PZ.64), but trended towards significance for severe pneumonitis, with patients exceeding RTOG 0813 central airway dose constraints experiencing higher rates (0 vs 13%, PZ.10). Conclusions: Central lung tumor patients treated with SABR appear to experience higher rates of symptomatic pneumonitis compared to patients with peripherally located lung tumors, which grossly correlates with increased ipsilateral mean lung dose. Exceeding RTOG 0813 dosimetric constraints for central airway may predispose to higher risk for severe radiation pneumonitis. Author Disclosure: A. Chaudhuri: None. C. Tang: None. N. Trakul: None. J. Wynne: None. B.W. Loo: E. Research Grant; Varian, RaySearch Laboratories. F. Honoraria; Varian. M. Diehn: E. Research Grant; Varian, RaySearch Laboratories. F. Honoraria; Varian. G. Consultant; Varian.

Endobronchial Fiducial to Guide Stereotactic Body Radiotherapy

Optimal treatment for unresectable central airway tumors is not well established. Stereotactic body radiation therapy has shown efficacy for both peripheral and central lung lesions. However, the treatment of central tumors has been limited because of associated radiation toxicity. We report the use of an endobronchial fiducial to localize hypofractionated stereotactic body radiation therapy treatment of a limited central airways disease in a patient with recurrent metastatic squamous cell lung cancer. The fiducial was instrumental in designing the treatment field and minimizing related treatment toxicity. Future studies may take advantage of this technique in patients with unresectable central airways non-small cell lung cancers.

Cold saline irrigation of the renal pelvis during Radiofrequency Ablation of a central renal neoplasm: a case report

IntroductionThermal destruction mediated by radiofrequency ablation (RFA) is gaining attention as an alternative treatment for patients with renal cell carcinoma (RCC), particularly in those who are not candidates for open surgery. Treatment of central tumours is occasionally associated with complications such as ureteric stricture, injury to the psoas muscle, haematuria and vascular laceration.Case presentationWe have used infusion of cold saline during RFA, through a retrograde ureteric catheter with its tip in the renal pelvis, in a patient with a central renal tumour.ConclusionWe believe this process to have successfully avoided the risk of thermal injury.

Sleeve lobectomy an affidable lung sparing procedure

17159 Background: Sleeve Lobectomy (Sl) is generally considered a surgical alternative of choice to Pneumonectomy (Pn) for the treatment of central NSCLC. The aim of this study is to value if the Sl could be really a Lung saving procedure that warrants right survivals, according to stage of disease, with acceptable perioperative risks. Methods: In 165 patients (67 Sl and 98 Pn) operated from 1995 to 2003 for NSCLC of main bronchus we have analyzed the hospital stay, morbidity and mortality within 30 days, long term survival. In 39 Sl and 46 Pn we compared spyrometric volume’s changes at a distance of 6–24 months from operation. Sl was performed where it was technically possible. Long term survivals had been separated and comparated according to pathologic stadium (TNM 1997) and lymphonodal involvement: all these data were estimated by Kaplan-Meier method and log rank test. All statistical data underwent SPSS elaboration and significant assumption for p < 0.05. Results: In our population of study we didn’t check any statistically significant’s differences comparing age, sex or preoperative Fev1. Complications occurred in 28% of cases where Sl was performed and in 36.7% after Pn with a mortality rate of 2.9% vs 5.1%. Average hospital staying was longer in patients underwent to Pneumonectomy. Long term survival (5 years) in Sl group is 36% and 24% in Pn group with a statistically significant difference P = 0.016, but this difference is not evident from the comparison between the two group’s survivals based on pathological stadium or lymphonodal involvement. Spyrometric values showed a global Fev1 reduction of 245 ml (−10%) after Sl procedure and 884ml (36.3%) after Pn with a significant difference of p = 0.0042. Conclusions: In this study Sl got similar survival results if not better, with those obtained after Pn. Moreover, Sl showed to be a lung sparing procedure with an acceptable operative risk. These data confirmed that SL is the gold standard surgical procedure in the treatment of central tumors where if technically possible. [Table: see text] No significant financial relationships to disclose.

Contribution to the surgical treatment of central tumors of the mandible

Contribution to the surgical treatment of central tumors of the mandible