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24.09.2020 | Original Article

Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy

verfasst von: Dr Mauro Loi, Davide Franceschini, Luca Dominici, Ilaria Chiola, Ciro Franzese, Giuseppe Roberto D’Agostino, Piera Navarria, Marco Marzo, Lucia Paganini, Tiziana Comito, Pietro Mancosu, Stefano Tomatis, Luca Cozzi, Marco Alifano, Marta Scorsetti

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 5/2021

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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.

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Titel: Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy
verfasst von: Dr Mauro Loi
Davide Franceschini
Luca Dominici
Ilaria Chiola
Ciro Franzese
Giuseppe Roberto D’Agostino
Piera Navarria
Marco Marzo
Lucia Paganini
Tiziana Comito
Pietro Mancosu
Stefano Tomatis
Luca Cozzi
Marco Alifano
Marta Scorsetti
Publikationsdatum: 24.09.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 5/2021
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-020-01687-9

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Dose coverage impacts local control in ultra-central lung oligometastases treated with stereotactic radiotherapy