AccScience Publishing / CP / Online First /
Submit to CP
Cite this article
40
Download
488
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
REVIEW

Stereotactic body radiotherapy in ultracentrally located lung tumors

Melek Yakar1*
Show Less
1 Department of Radiation Oncology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Eskişehir Province, Turkey
CP 2024, 6(3), 3683
Submitted: 16 May 2024 | Accepted: 25 June 2024 | Published: 30 August 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
Download PDF
Cite
XML
Abstract

Stereotactic body radiotherapy (SBRT) is a highly conformal radiotherapy technique that delivers high doses of radiation per fraction, typically in 1 – 5 fractions. It is a standard treatment option for patients with early-stage non-small cell lung cancer that is peripherally located, for those who are medically inoperable, or for patients who do not opt for surgery. Similarly, SBRT is considered an effective treatment option for oligometastatic lung tumors. However, in the case of ultracentrally located lung tumors—tumors situated close to the central airway and mediastinal region—there is an increased risk of severe toxicities (grade 4 – 5) due to the dose tolerances of the surrounding organs at risk. The definition of ultracentrally located lung tumors remains unclear. Some studies define an ultracentral lung tumor as one in which the gross tumor volume directly involves the proximal bronchial tree or trachea, while others define it as the planning target volume (PTV) that includes the trachea or main bronchial system. In addition, some studies consider tumors whose PTV touches or overlaps with the central bronchial tree, esophagus, pulmonary vein, or pulmonary artery as ultracentral. In addition, the optimal SBRT regime and organ-at-risk dose limitations for ultracentral tumors have yet to be clearly established. The aim of this review is to explore and discuss the role of SBRT in the treatment of ultracentrally located lung tumors.

Keywords
Ultracentral lung tumors
Stereotactic body radiotherapy
Oncological results
Toxicity
Funding
None.
Conflict of interest
The author declares no competing interests in this article.
References
  1. Videtic GM, Donington J, Giuliani M, et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive summary of an ASTRO evidence-based guideline. Pract Radiat Oncol. 2017;7(5):295-301. doi: 10.1016/j.prro.2017.04.014

 

  1. Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National lung screening trial. N Engl J Med. 2013;369(10):920-931. doi: 10.1056/NEJMoa1208962

 

  1. Abrams HL, Spiro R, Goldstein N. Metastases in carcinoma; analysis of 1000 autopsied cases. Cancer. 1950;3(1):74-85. doi: 10.1002/1097-0142(1950)3:1<74:aid-cncr2820030111> 3.0.co;2-7

 

  1. Onishi H, Araki T, Shirato H, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: Clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer. 2004;101(7):1623-1631. doi: 10.1002/cncr.20539

 

  1. Tekatli H, Haasbeek N, Dahele M, et al. Outcomes of hypofractionated high-dose radiotherapy in poor-risk patients with “Ultracentral” Non-small cell lung cancer. J Thorac Oncol. 2016;11(7):1081-1089. doi: 10.1016/j.jtho.2016.03.008

 

  1. Bezjak A, Paulus R, Gaspar LE, et al. Safety and efficacy of a five-fraction stereotactic body radiotherapy schedule for centrally located non-small-cell lung cancer: NRG oncology/ RTOG 0813 trial. J Clin Oncol. 2019;37(15):1316-1325. doi: 10.1200/JCO.18.00622

 

  1. Videtic GM, Hu C, Singh AK, et al. A randomized phase 2 study comparing 2 stereotactic body radiation therapy schedules for medically inoperable patients with stage I peripheral non-small cell lung cancer: NRG Oncology RTOG 0915 (NCCTG N0927). Int J Radiat Oncol Biol Phys. 2015;93(4):757-764. doi: 10.1016/j.ijrobp.2015.07.2260. Erratum in: Int J Radiat Oncol Biol Phys. 2016;94(3):638. doi: 10.1016/j.ijrobp.2015.11.031

 

  1. Haseltine JM, Rimner A, Gelblum DY, et al. Fatal complications after stereotactic body radiation therapy for central lung tumors abutting the proximal bronchial tree. Pract Radiat Oncol. 2016;6(2):e27-e33. doi: 10.1016/j.prro.2015.09.012

 

  1. Giuliani M, Mathew AS, Bahig H, et al. SUNSET: Stereotactic radiation for ultracentral non-small-cell lung cancer-a safety and efficacy trial. Clin Lung Cancer. 2018;19(4):e529-e532. doi: 10.1016/j.cllc.2018.04.001

 

  1. Repka MC, Aghdam N, Kataria SK, et al. Five-fraction SBRT for ultra-central NSCLC in-field recurrences following high-dose conventional radiation. Radiat Oncol. 2017;12(1):162. doi: 10.1186/s13014-017-0897-6

 

  1. Cong Y, Sun B, Wang J, et al. Outcomes and toxicity of stereotactic body radiation therapy for advanced stage ultra-central non-small cell lung cancer. Thorac Cancer. 2019;10(7):1567-1575. doi: 10.1111/1759-7714.13105

 

  1. Cong Y, Xuan L, Sun B, et al. Retrospective comparison of stereotactic body radiotherapy versus intensity-modulated radiotherapy for stage III ultra-central squamous non-small-cell lung cancer. Future Oncol. 2019;15(16):1855-1862. doi: 10.2217/fon-2019-0061

 

  1. Park S, Kim Y, Yoon WS, Rim CH. A preliminary experience of moderate-intensity stereotactic body radiation therapy for ultra-central lung tumor. Int J Radiat Biol. 2019;95(9):1287-1294. doi: 10.1080/09553002.2019.1626026

 

  1. Loi M, Franceschini D, Dominici L, et al. Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy. Strahlenther Onkol. 2021;197(5):396-404. doi: 10.1007/s00066-020-01687-9

 

  1. Guillaume E, Tanguy R, Ayadi M, et al. Toxicity and efficacy of stereotactic body radiotherapy for ultra-central lung tumours: A single institution real life experience. Br J Radiol. 2022;95(1129):20210533. doi: 10.1259/bjr.20210533

 

  1. Lodeweges JE, Van Rossum PS, Bartels MM, et al. Ultra-central lung tumors: Safety and efficacy of protracted stereotactic body radiotherapy. Acta Oncol. 2021;60(8):1061-1068. doi: 10.1080/0284186X.2021.1942545

 

  1. Salvestrini V, Duijm M, Loi M, Nuyttens JJ. Survival and prognostic factors of ultra-central tumors treated with stereotactic body radiotherapy. Cancers (Basel). 2022;14(23):5908. doi: 10.3390/cancers14235908

 

  1. Wang B, Dong Y, Yu X, et al. Safety and efficacy of stereotactic ablative radiotherapy for ultra-central lung cancer. Front Oncol. 2022;12:868844. doi: 10.3389/fonc.2022.868844

 

  1. Wang C, Rimner A, Gelblum DY, et al. Analysis of pneumonitis and esophageal injury after stereotactic body radiation therapy for ultra-central lung tumors. Lung Cancer. 2020;147:45-48. doi: 10.1016/j.lungcan.2020.07.009

 

  1. Rim CH, Yoon WS, Park S. Safety and efficacy of moderate-intensity stereotactic body radiation therapy for ultra-central lung tumor. Medicina (Kaunas). 2024;60(4):538. doi: 10.3390/medicina60040538

 

  1. Li GJ, Tan H, Nusrat H, et al. Safety and efficacy of stereotactic body radiation therapy for ultra-central thoracic tumors: A single center retrospective review. Int J Radiat Oncol Biol Phys. 2024;1-11. doi: 10.1016/j.ijrobp.2024.04.009

 

  1. Giuliani ME, Filion E, Faria S, et al. Stereotactic radiation for ultra-central non-small cell lung cancer: A safety and efficacy trial (SUNSET). Int J Radiat Oncol Biol Phys. 2024;1-9. doi: 10.1016/j.ijrobp.2024.03.050

 

  1. Lindberg K, Grozman V, Karlsson K, et al. The HILUS-trial-a prospective nordic multicenter phase 2 study of ultracentral lung tumors treated with stereotactic body radiotherapy. J Thorac Oncol. 2021;16(7):1200-1210. doi: 10.1016/j.jtho.2021.03.019

 

  1. Yan M, Louie AV, Kotecha R, et al. Stereotactic body radiotherapy for Ultra-Central lung Tumors: A systematic review and meta-analysis and international stereotactic radiosurgery society practice guidelines. Lung Cancer. 2023;182:107281. doi: 10.1016/j.lungcan.2023.107281

 

  1. Von Reibnitz D, Shaikh F, Wu AJ, et al. Stereotactic body radiation therapy (SBRT) improves local control and overall survival compared to conventionally fractionated radiation for stage I non-small cell lung cancer (NSCLC). Acta Oncol. 2018;57(11):1567-1573. doi: 10.1080/0284186X.2018.1481292

 

  1. Jeppesen SS, Schytte T, Jensen HR, Brink C, Hansen O. Stereotactic body radiation therapy versus conventional radiation therapy in patients with early stage non-small cell lung cancer: An updated retrospective study on local failure and survival rates. Acta Oncol. 2013;52(7):1552-1558. doi: 10.3109/0284186X.2013.813635

 

  1. Chiang A, Thibault I, Warner A, et al. A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis. Radiother Oncol. 2016;118(3):478-484. doi: 10.1016/j.radonc.2015.12.026

 

  1. McMillan MT, Kang M, Shepherd AF, et al. Stereotactic body proton therapy for non-small cell lung cancer: Clinical indications and recommendations. J Radiosurg SBRT. 2023;9(1):17-32.

 

  1. McMillan MT, Shepherd AF, Kang M, et al. Safety and efficacy of stereotactic body proton therapy for high-risk lung tumors. J Radiosurg SBRT. 2023;9(1):63-74.

 

  1. Tong BC, Wallace S, Hartwig MG, D’Amico TA, Huber JC. Patient preferences in treatment choices for early-stage lung cancer. Ann Thorac Surg. 2016;102(6):1837-1844. doi: 10.1016/j.athoracsur.2016.06.031

 

  1. Donovan EK, Swaminath A. Stereotactic body radiation therapy (SBRT) in the management of non-small-cell lung cancer: Clinical impact and patient perspectives. Lung Cancer (Auckl). 2018;9:13-23. doi: 10.2147/LCTT.S129833

 

  1. Shaverdian N, Wang PC, Steinberg M, Lee P. The patient’s perspective on stereotactic body radiation therapy (SBRT) vs. surgery for treatment of early stage non-small cell lung cancer (NSCLC). Lung Cancer. 2015;90(2):230-233. doi: 10.1016/j.lungcan.2015.07.009

 

  1. Alberts L, Wolff HB, Kastelijn EA, et al. Patient-reported outcomes after the treatment of early stage non-small-cell lung cancer with stereotactic body radiotherapy compared with surgery. Clin Lung Cancer. 2019;20(5):370-377.e3. doi: 10.1016/j.cllc.2019.04.001

 

  1. Louie AV, Van Werkhoven E, Chen H, et al. Patient reported outcomes following stereotactic ablative radiotherapy or surgery for stage IA non-small-cell lung cancer: Results from the ROSEL multicenter randomized trial. Radiother Oncol. 2015;117(1):44-48. doi: 10.1016/j.radonc.2015.08.011

 

  1. Tekatli H, Duijm M, Oomen-de Hoop E, et al. Normal tissue complication probability modeling of pulmonary toxicity after stereotactic and hypofractionated radiation therapy for central Lung Tumors. Int J Radiat Oncol Biol Phys. 2018;100(3):738-747. doi: 10.1016/j.ijrobp.2017.11.022

 

  1. Duijm M, Schillemans W, Aerts JG, Heijmen B, Nuyttens JJ. Dose and volume of the irradiated main bronchi and related side effects in the treatment of central lung tumors with stereotactic radiotherapy. Semin Radiat Oncol. 2016;26(2):140-148. doi: 10.1016/j.semradonc.2015.11.002

 

  1. Ahmadsei M, Thaler K, Gasser E, et al. Dosimetric analysis of 17 cardiac Sub-structures, Toxicity, and survival in ultra central lung tumor patients treated with SBRT. Clin Transl Radiat Oncol. 2023;43:100675. doi: 10.1016/j.ctro.2023.100675
Share
Back to top
Cancer Plus, Electronic ISSN: 2661-3840 Print ISSN: 2661-3832, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept