Justin M Haseltine1, Andreas Rimner2, Daphna Y Gelblum2, Ankit Modh3, Kenneth E Rosenzweig4, Andrew Jackson2, Ellen D Yorke2, Abraham J Wu5. 1. Weill Cornell Medical College, New York, New York; Memorial Sloan Kettering Cancer Center, New York, New York. 2. Memorial Sloan Kettering Cancer Center, New York, New York. 3. Henry Ford Hospital, Detroit, Michigan. 4. Mount Sinai Hospital, New York, New York. 5. Memorial Sloan Kettering Cancer Center, New York, New York. Electronic address: wua@mskcc.org.
Abstract
PURPOSE: Stereotactic body radiation therapy (SBRT) is associated with excess toxicity following treatment of central lung tumors. Risk-adapted fractionation appears to have mitigated this risk, but it remains unclear whether SBRT is safe for all tumors within the central lung zone, especially those abutting the proximal bronchial tree (PBT). We investigated the dependence of toxicity on tumor proximity to PBT and whether tumors abutting the PBT had greater toxicity than other central lung tumors after SBRT. MATERIALS AND METHODS: A total of 108 patients receiving SBRT for central lung tumors were reviewed. Patients were classified based on closest distance from tumor to PBT. Primary endpoint was SBRT-related death. Secondary endpoints were overall survival, local control, and grade 3+ pulmonary adverse events. We compared tumors abutting the PBT to nonabutting and those ≤1 cm and >1 cm from PBT. RESULTS: Median follow-up was 22.7 months. Median distance from tumor to PBT was 1.78 cm. Eighty-eight tumors were primary lung and 20 were recurrent or metastatic; 23% of tumors were adenocarcinoma and 71% squamous cell. Median age was 77.5 years. Median dose was 4500 cGy in 5 fractions prescribed to the 100% isodose line. Eighteen patients had tumors abutting the PBT, 4 of whom experienced SBRT-related death. No other patients experienced death attributed to SBRT. Risk of SBRT-related death was significantly higher for tumors abutting the PBT compared with nonabutting tumors (P < .001). Two patients with SBRT-related death received anti-vascular endothelial growth factor therapy and experienced pulmonary hemorrhage. Patients with tumors ≤1 cm from PBT had significantly more grade 3+ events than those with tumors >1cm from PBT (P = .014). CONCLUSIONS: Even with risk-adapted fractionation, tumors abutting PBT are associated with a significant and differential risk of SBRT-related toxicity and death. SBRT should be used with particular caution in central-abutting tumors, especially in the context of anti-vascular endothelial growth factor therapy.
PURPOSE: Stereotactic body radiation therapy (SBRT) is associated with excess toxicity following treatment of central lung tumors. Risk-adapted fractionation appears to have mitigated this risk, but it remains unclear whether SBRT is safe for all tumors within the central lung zone, especially those abutting the proximal bronchial tree (PBT). We investigated the dependence of toxicity on tumor proximity to PBT and whether tumors abutting the PBT had greater toxicity than other central lung tumors after SBRT. MATERIALS AND METHODS: A total of 108 patients receiving SBRT for central lung tumors were reviewed. Patients were classified based on closest distance from tumor to PBT. Primary endpoint was SBRT-related death. Secondary endpoints were overall survival, local control, and grade 3+ pulmonary adverse events. We compared tumors abutting the PBT to nonabutting and those ≤1 cm and >1 cm from PBT. RESULTS: Median follow-up was 22.7 months. Median distance from tumor to PBT was 1.78 cm. Eighty-eight tumors were primary lung and 20 were recurrent or metastatic; 23% of tumors were adenocarcinoma and 71% squamous cell. Median age was 77.5 years. Median dose was 4500 cGy in 5 fractions prescribed to the 100% isodose line. Eighteen patients had tumors abutting the PBT, 4 of whom experienced SBRT-related death. No other patients experienced death attributed to SBRT. Risk of SBRT-related death was significantly higher for tumors abutting the PBT compared with nonabutting tumors (P < .001). Two patients with SBRT-related death received anti-vascular endothelial growth factor therapy and experienced pulmonary hemorrhage. Patients with tumors ≤1 cm from PBT had significantly more grade 3+ events than those with tumors >1cm from PBT (P = .014). CONCLUSIONS: Even with risk-adapted fractionation, tumors abutting PBT are associated with a significant and differential risk of SBRT-related toxicity and death. SBRT should be used with particular caution in central-abutting tumors, especially in the context of anti-vascular endothelial growth factor therapy.
Authors: Robert Timmerman; Rebecca Paulus; James Galvin; Jeffrey Michalski; William Straube; Jeffrey Bradley; Achilles Fakiris; Andrea Bezjak; Gregory Videtic; David Johnstone; Jack Fowler; Elizabeth Gore; Hak Choy Journal: JAMA Date: 2010-03-17 Impact factor: 56.272
Authors: Zafer Kocak; Elizabeth S Evans; Su-Min Zhou; Keith L Miller; Rodney J Folz; Timothy D Shafman; Lawrence B Marks Journal: Int J Radiat Oncol Biol Phys Date: 2005-07-01 Impact factor: 7.038
Authors: Eda Yirmibesoglu; Daniel S Higginson; Merdan Fayda; M Patricia Rivera; Jan Halle; Julian Rosenman; Liyi Xie; Lawrence B Marks Journal: Lung Cancer Date: 2012-01-09 Impact factor: 5.705
Authors: Bryan P Rowe; Daniel J Boffa; Lynn D Wilson; Anthony W Kim; Frank C Detterbeck; Roy H Decker Journal: J Thorac Oncol Date: 2012-09 Impact factor: 15.609
Authors: Michael T Milano; Yuhchyau Chen; Alan W Katz; Abraham Philip; Michael C Schell; Paul Okunieff Journal: Radiother Oncol Date: 2009-03-28 Impact factor: 6.280
Authors: Kyle E Rusthoven; Brian D Kavanagh; Stuart H Burri; Changhu Chen; Higinia Cardenes; Mark A Chidel; Thomas J Pugh; Madeleine Kane; Laurie E Gaspar; Tracey E Schefter Journal: J Clin Oncol Date: 2009-03-02 Impact factor: 44.544
Authors: David H Johnson; Louis Fehrenbacher; William F Novotny; Roy S Herbst; John J Nemunaitis; David M Jablons; Corey J Langer; Russell F DeVore; Jacques Gaudreault; Lisa A Damico; Eric Holmgren; Fairooz Kabbinavar Journal: J Clin Oncol Date: 2004-06-01 Impact factor: 44.544
Authors: Chunyu Wang; Andreas Rimner; Daphna Y Gelblum; Jessica Flynn; Andrew Jackson; Ellen Yorke; Abraham J Wu Journal: JAMA Oncol Date: 2019-05-01 Impact factor: 31.777
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: Chunyu Wang; Andreas Rimner; Daphna Y Gelblum; Rosalind Dick-Godfrey; Dominique McKnight; Danielle Torres; Jessica Flynn; Zhigang Zhang; Baho Sidiqi; Andrew Jackson; Ellen Yorke; Abraham J Wu Journal: Lung Cancer Date: 2020-07-08 Impact factor: 5.705