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Late Toxicity and Long-Term Local Control in Patients With Ultra-Central Lung Tumours Treated by Intensity-Modulated
A M Mihai1, P J Armstrong2, D Hickey1
1Department of Radiotherapy, Beacon Hospital, Dublin, Ireland.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|June 7, 2021
Summary
Intensity-modulated radiotherapy (IMRT)-based stereotactic ablative body radiotherapy (SABR) offers high local control for ultra-central lung tumors. While fatal hemoptysis occurred in 8.7% of patients, SABR was directly linked in only 3%.
Area of Science:
- Radiation Oncology
- Thoracic Oncology
- Medical Physics
Background:
- Ultra-central lung tumors pose unique treatment challenges due to proximity to critical structures.
- Stereotactic ablative body radiotherapy (SABR) has shown efficacy for peripheral lung tumors, but data for ultra-central locations are limited.
- Intensity-modulated radiotherapy (IMRT) techniques are crucial for dose escalation while sparing organs at risk.
Purpose of the Study:
- To evaluate the late toxicity and long-term outcomes of IMRT-based SABR for ultra-central lung tumors.
- To assess local control rates and overall survival in this high-risk patient cohort.
- To identify potential factors influencing treatment-related toxicity, particularly fatal hemoptysis.
Main Methods:
- Retrospective analysis of patients treated with SABR for ultra-central lung tumors (abutting or involving major airways) between 2008 and 2016.
- Utilized IMRT with respiratory motion management and homogeneous dose prescription (maximum <120%).
- Outcomes assessed using descriptive statistics, Kaplan-Meier survival analysis, log-rank tests, and Cox regression.
Main Results:
- High local control rates were achieved, with 87.7% of patients free from local recurrence at last follow-up.
- Freedom from local progression at 2 and 4 years was 92% and 79.8%, respectively.
- Fatal hemoptysis occurred in 8.7% of patients, with 3% directly attributed to SABR. Higher airway radiation dose (BED3) was associated with increased hemoptysis risk (P=0.005).
Conclusions:
- IMRT-based SABR with homogeneous dose prescription provides effective local control for high-risk ultra-central lung tumors, comparable to peripheral sites.
- While fatal hemoptysis is a concern, the incidence directly attributable to SABR is low.
- Further research is needed to identify predictive factors for toxicity and optimize treatment selection for these challenging tumors.
