Hilâl Tekatli1, Suresh Senan1, Max Dahele1, Ben J Slotman1, Wilko F A R Verbakel2. 1. Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. 2. Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: w.verbakel@vumc.nl.
Abstract
BACKGROUND AND PURPOSE: Central lung SABR is less established due to toxicity concerns. We describe plan quality and clinical outcomes for patients treated with VMAT SABR using 8×7.5Gy. MATERIALS AND METHODS: We studied 80 consecutive patients with primary NSCLC and PTV ⩽2cm from the proximal bronchial tree (PBT), treated between 2008 and 2013. Dosimetric data were compared with institutional guidelines and study protocols, and long-term clinical outcomes were analyzed. RESULTS: PTV V95% was 60Gy in 96% of patients. Dmax was ⩾60Gy in 40% of patients for PBT, 26.3% for aorta, 55% for heart, and 1.3% for trachea. Esophageal maximum Dmax was 58Gy. Mean lung V5Gy/V20Gy was 21/8%. 54 patients (68%) exceeded RTOG0813 Dmax for ⩾1 organ-at-risk (OAR), with 27 exceeding PBT Dmax. 5 of 78 patients (6.4%) with adequate follow-up information had grade 3 toxicity. Grade 4 toxicity was not observed. Treatment-related death was considered possible (n=3) or likely (n=3) in 6 patients (7.5%). With median follow-up of 47months, 3-year survival was 53%, compared with 57% for 252 peripheral tumors treated with 3/5-fractions SABR in the same period (p=0.369). CONCLUSIONS: Although a substantial proportion of central SABR patients received ⩾60Gy to OARs, the 3-year survival was no different from peripheral SABR.
BACKGROUND AND PURPOSE: Central lung SABR is less established due to toxicity concerns. We describe plan quality and clinical outcomes for patients treated with VMAT SABR using 8×7.5Gy. MATERIALS AND METHODS: We studied 80 consecutive patients with primary NSCLC and PTV ⩽2cm from the proximal bronchial tree (PBT), treated between 2008 and 2013. Dosimetric data were compared with institutional guidelines and study protocols, and long-term clinical outcomes were analyzed. RESULTS:PTV V95% was 60Gy in 96% of patients. Dmax was ⩾60Gy in 40% of patients for PBT, 26.3% for aorta, 55% for heart, and 1.3% for trachea. Esophageal maximum Dmax was 58Gy. Mean lung V5Gy/V20Gy was 21/8%. 54 patients (68%) exceeded RTOG0813 Dmax for ⩾1 organ-at-risk (OAR), with 27 exceeding PBT Dmax. 5 of 78 patients (6.4%) with adequate follow-up information had grade 3 toxicity. Grade 4 toxicity was not observed. Treatment-related death was considered possible (n=3) or likely (n=3) in 6 patients (7.5%). With median follow-up of 47months, 3-year survival was 53%, compared with 57% for 252 peripheral tumors treated with 3/5-fractions SABR in the same period (p=0.369). CONCLUSIONS: Although a substantial proportion of central SABRpatients received ⩾60Gy to OARs, the 3-year survival was no different from peripheral SABR.
Authors: Andrea Bezjak; Rebecca Paulus; Laurie E Gaspar; Robert D Timmerman; William L Straube; William F Ryan; Yolanda I Garces; Anthony T Pu; Anurag K Singh; Gregory M Videtic; Ronald C McGarry; Puneeth Iyengar; Jason R Pantarotto; James J Urbanic; Alexander Y Sun; Megan E Daly; Inga S Grills; Paul Sperduto; Daniel P Normolle; Jeffrey D Bradley; Hak Choy Journal: J Clin Oncol Date: 2019-04-03 Impact factor: 44.544
Authors: Andrea L H Arnett; Benjamin Mou; Dawn Owen; Sean S Park; Katy Nelson; Christopher L Hallemeier; Terence Sio; Yolanda I Garces; Kenneth R Olivier; Kenneth W Merrell Journal: Adv Radiat Oncol Date: 2019-01-24