Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy
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ORIGINAL ARTICLE
Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy Mauro Loi1 · Davide Franceschini1 · Luca Dominici2 · Ilaria Chiola1 · Ciro Franzese1,4 · Giuseppe Roberto D’Agostino1 · Piera Navarria1 · Marco Marzo1 · Lucia Paganini1 · Tiziana Comito1 · Pietro Mancosu1 · Stefano Tomatis1 · Luca Cozzi1,4 · Marco Alifano3 · Marta Scorsetti1,4 Received: 29 April 2020 / Accepted: 24 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The use of Stereotactic Body Radiotherapy (SBRT) is controversial in Ultra-Central lung tumors, a subset of central lung tumors characterized by proximity to critical mediastinal structures. This is of interest in oligometastatic (≤3 metastases) patients, who can yield survival benefit from local treatments. The aim of our study is to assess the determinants of efficacy and toxicity in this setting. Materials and methods Clinical and dosimetric parameters were reviewed in a cohort of oligometastatic patients treated with SBRT for ultra-central tumors. Local control rate (LC) and toxicity were assessed. Statistical Analysis was carried out to assess the impact of those predictors on local recurrence and adverse events. Results One-hundred-nine consecutive patients were included. A median Biologic Effective Dose (BED) of 105 (75–132) Gy10 was prescribed. At a median follow-up of 17 (range 3–78) months, 2-year LC was 87%. Improved LC was correlated to Planning Treatment Volume (PTV) covered by 95% of the prescription dose (V95% PTV) > 85% (HR 0.15, 95%CI 0.05–0.49, p = 0.0017) and to Gross Tumor Volume (GTV) < 90 cm3 (HR 0.2, 95%CI 0.07–0.56, p = 0.0021). Overall and grade ≥ 3 toxicity incidence was 20% and 5%, respectively. Patients experiencing acute and late toxicities received significantly higher dose to 1 cm3 (D1cm3) of esophagus and lung volume receiving ≥5 Gy (V5Gy) (p = 0.016 and p = 0.013), and higher dose to 0.1 cm3 (D0.1cm3) of heart (p = 0.036), respectively. Conclusion V95% PTV > 85% and GTV < 90 cm3 are independent predictors of LC. Dose to esophagus, lung and heart should be carefully assessed to minimize treatment-related toxicities.
Keywords Oligometastases · Ultra-central tumors · Pulmonary metastases · Stereotactic Body Radiotherapy · Ablative Treatment
Introduction Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00066-020-01687-9) contains supplementary material, which is available to authorized users. Dr Mauro Loi
[email protected] 1
Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, 20089 Rozzano, Italy
2
Radiotherapy Department, University of Florence, Florence, Italy
3
Thoracic Surgery Department, Hopital Cochin, Université Paris Decartes, Paris, France
4
Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Area, Italy
Stereotactic body radiotherapy (SBRT) is an effective treatment option for early-stage non-small cell lung
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