... Stereotactic ablative radiotherapy (SABR) for treatment of central and ultra-central lung tumors. KW - lung cancer. Lung SBRT. Alex Louie, Ben Slotman. In this report, we present the technical details utilized by three academic institutions when treating a solitary … Sixty-eight patients, 34 with peripheral tumors and 34 with central tumors, including 7 which were ultra-central, were treated to a dose of 50 Gy in 4–5 fractions, with a median follow-up of 24.1 months. Stereotactic body radiotherapy (SBRT) is a well-established treatment option for patients presenting an early-stage non-small cell lung cancer (NSCLC). With increasing attention and research on SBRT for central lung cancer, a new subset, “ultra-central” (UC) lung cancer, has been defined and is associated with a higher risk of toxicity. Stereotactic body radiotherapy (SBRT) is commonly used to treat early-stage, node-negative primary lung cancer, but society guidelines provide limited information regarding several technical aspects of SBRT, leading to potential variation in practice. The aim of this single-center retrospective analysis was to evaluate the safety and efficacy of protracted SBRT with 60 Gy in 12 fractions (with a biological effective dose (BED 10) of … The main failure pattern after lung SBRT is represented by distant failure. Head and Neck SBRT FROM ELCC 2021. 50-56. SBRT allows the administration of a high antitumor biologically effective dose (BED).... info@biomedres.us +1 (720) 414-3554 One Westbrook Corporate Center, Suite 300, Westchester, IL 60154, USA As there is no consensus regarding the optimal radiotherapy treatment regimen for these tumors, we performed a … Disclaimer & Disclosure ... – Central / Ultra-central thoracic treatment – Thoracic re- irradiation. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Radiotherapy and Oncology publishes papers describing original research as well as review articles. Dr. Acibadem Bursa Hospital’s first-ever Elekta linear accelerator ramps up in four months to 70+ patients treated daily. SUNSET: SBRT for Ultra-central NSCLC- a Safety and Efficacy Trial The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A recent review analyzed data from 10 studies focusing on SBRT for ultra-central lung tumors, for a total number of 250 treated patients . In 2014, we published our experience treating 7 ultra-central lung tumors with SABR, 50 Gy in 4–5 fractions, Review Article Stereotactic ablative radiotherapy for central and ultra-central lung tumors A study from Stanford University described their experience treating peripheral, central and ultra-central tumors with SBRT. As @Maria Werner-Wasik notes, our experience at Memorial Sloan Kettering has indicated that giving SBRT for ultra-central lung tumors in a patient who has also been exposed to VEGF inhibitors may be an extremely dangerous combination associated with a high risk of fatal pulmonary hemorrhage. Introduction: Ultra-central (UC) tumors, which are generally defined as tumors directly abutting the proximal bronchial tree, are difficult to treat with stereotactic body radiotherapy (SBRT) owing to possible serious complications. Methods: We conducted a retrospective and monocentric … Local treatment options for patients with in-field non-small cell lung cancer (NSCLC) recurrence following conventionally fractionated external beam radiation therapy (CF-EBRT) are limited. Lung Cancer, 89 (2015), pp. For patients with early stage or medically inoperable lung cancer, stereotactic body radiotherapy (SBRT) is a general accepted and effective treatment option. However, the rate of grade 3+ toxicity for UC tumors remained relatively low at 14% in this challenging patient population. Our study indicates that SBRT for UC lung tumors results in similar tumor control and OS compared with more peripheral lesions. Local recurrence in a previously irradiated lung volume is observed in 5 to 15% of cases and treatment remains a challenge due to co … Does Not Capture Real-time Maximal Tumor Deviations All patients … textabstractBackground: Stereotactic body radiotherapy (SBRT) in ultra-central (UC) lung tumors, defined in the presence of planning target volume (PTV) overlap or direct tumor abutment to the central bronchial tree or esophagus, may be correlated to a higher incidence of severe adverse events. The role of SBRT in ultra-central tumors remains controversial. Even so, SBRT is still controversial in the rescue treatment of recurrent lung cancer after radiotherapy, especially for "ultral-central" lesions close to mediastinal structures (such as bronchus, esophagus and large blood vessels), which have a high probability of fatal side effects. Outcome and toxicity in oligometastatic (≤3 metastases) non-small-cell lung … KW - ultra-central tumor that have “ultra-central” location (7,14), defined as tumor abutting the trachea or proximal bronchial tree. We report our experience treating ultracentral, central, and paramediastinal tumors with SBRT and compare toxicity, disease … Increased rates of toxicity have been described after stereotactic body radiation therapy (SBRT) for central lung tumors within 2 cm of the proximal bronchial tree (PBT). The median interval between the end of CF-EBRT and SBRT was 23.3 months (range: 2.6 – 93.6 months). the cardiac toxicity associated with SBRT treatment in patients with central lung lesions treated in our centre. For the EORTC 22113-8113 Lungtech-trial on SBRT of central lung tumours, safety-related issues contributed to early closure of the trial.In the HILUS-trial, delivering SBRT to central and ultra-central tumours, 15% of the patients died from causes possibly being treatment related, hereof eight from pulmonal haemorrhage. This systemic review and meta-analysis analyzed the early experiences and evaluated the efficacy and feasibility of SBRT for UC tumors. Controversy remains however as to its efficacy and safety for central or ultra-central lung tumors. Lung Oligometastasis; Ciro Franzese, Maria Scorsetti. Abstract: Background: Stereotactic body radiotherapy (SBRT) in ultra-central (UC) lung tumors, defined in the presence of planning target volume (PTV) overlap or direct tumor abutment to the central bronchial tree or esophagus, may be correlated to a … Purpose: Stereotactic body radiation therapy (SBRT) is a widely-accepted treatment for early-stage lung cancer, however, safety concerns in the treatment of central (C) lung tumors have been raised. In our study, patients treated with SBRT for ultra-central lung tumours experienced few Grade three toxicities (2.7%) and no Grade four or five toxicities, … I have always thought that risk of pneumothorax or other complications in someone with unhealthy lungs is higher than risk of lung SBRT (assuming small target, not ultra-central, good technique, etc). While most successful data come from peripherally located tumours, the role … Publish date: March 29, 2021 . Delivery of SBRT to central thoracic tumours within 2 cm of the proximal bronchial tree (PBT), and especially ultra-central tumours which directly abut the PBT, has been controversial due to concerns about high risk of toxicity and treatment-related death when delivering high doses close to critical mediastinal structures. In addition, a new concept, called “ultra-central” (UC) tumor, has emerged. following SBRT to tumors in this location have reported mixed results. Hepatocellular Carcinoma; Timothy Nguyen, Allison Tree. fied SBRT regimen with a 5 fraction schedule of 50 –60 Gy, which showed good efficacy and safety despite the occurrence of grade 3 or higher toxicity.8 With increasing attention and research on SBRT for central lung cancer, a new subset, “ultra-central” (UC) lung cancer, has been defined and is associated with a higher risk of toxicity. KW - Stereotactic body radiotherapy. 2019) • Phase III RCT • Randomized N = 101 to SABR (54 Gy/3Fr or 48 Gy/4Fr) vs. conventional RT (66 Gy/33Fr or 50 Gy/20Fr) • Excluded central tumors • SABR: improved freedom from local failure (HR 0.32; 95% CI Recent studies have defined a new class of ultracentral tumors. We report our experience treating ultracentral, central, and paramediastinal tumors with SBRT and compare toxicity, disease control, and survival rates. We reviewed the records of patients with central lung tumors treated with SBRT between September 2009 and July 2017. The author found no difference in LC, OS, and grade ≥3 toxicity comparing patients with central and ultra-central tumors . Fifty percent of recurrences were adenocarcinoma, while 35% of tumors were classified as squamous cell carcinoma. Sixty-eight patients, 34 with peripheral tumors and 34 with central tumors, including 7 which were ultra-central, were treated to a dose of 50 Gy in 4–5 The aim of this single-center retrospective analysis was to evaluate the safety and efficacy of protracted SBRT with 60 Gy in 12 fractions (with a … Due to compelling evidence, SBRT is now the treatment of choice for medically inoperable patients with peripherally located stage I non-small cell lung cancer (NSCLC). KW - feasibility. Recent studies have defined a new class of ultracentral tumors. et al. Pediatric SBRT; Irene Karam, Arjun Sahgal. Lung stereotactic ablative radiotherapy (SABR) is associated with low morbidity, however there is an increased risk of treatment-related toxicity in tumors directly abutting or invading the proximal bronchial tree, termed ‘ultra-central’ tumors. Radiat Oncol, 12 (2017), p. 162. It covers areas of interest relating to radiation oncology. Despite obvious limitations linked to the retrospective nature of the study and the heterogeneity of delivered doses (BED ranging from 48 to 138 Gy), safety was confirmed. Proton SBRT may also be particularly useful for ultra-central lung cancers and for patients with oligometastatic or oligoprogressive disease who are on systemic therapy, where the side effects of conventional photon SBRT are higher. Increased rates of toxicity have been described after stereotactic body radiation therapy (SBRT) for central lung tumors within 2 cm of the proximal bronchial tree (PBT). Recent studies have defined a new class of ultracentral tumors. Of the 72 patients studied, 15 (21%) experienced grade 3 or higher toxicity and 10 (14%) died of bronchopulmonary hemorrhage. Control of possible risk factors of hemorrhage and dose optimization through further studies are warranted. A study from Stanford University described their experience treating peripheral, central and ultra-central tumors with SBRT. KW - central tumor. Can benefits of SBRT outweigh risks in ultra-central lung tumors? Tumors were classified as central if within 2 cm of the PBT, ultracentral if the planning target volume touched the PBT or esophagus, and paramediastinal if touching mediastinal pleura. Findings in context. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, … SBRT for the ultra-central lung tumor, 5 patients (7%) received radiotherapy for the same ( n ¼ 1) or for a new lesion ( n ¼ 4) in the same lung with a median time interval Background: For patients with early stage or medically inoperable lung cancer, stereotactic body radiotherapy (SBRT) is a general accepted and effective treatment option. Motion as Assessed by 4D-CT Lischalk et al., PRO, 2016 v:6 i:3; p:176-182. Materials and Methods From 1 April 2018 to 31 December 2020, 28 patients with 30 central lesions were treated with the SBRT technique with radical intent. observed that this group of central tumors (including primary NSCLC and lung metastases) exhibited excellent tumor control and a similar toxicity rate to its less central counterpart, suggesting that even ultra-central tumors can be treated with 50 Gy in four or five fractions if not in contact with the esophagus . Central and ultra-central lesions were defined according to RTOG 0813 criteria. A recent review analyzed data from 10 studies focusing on SBRT for ultra-central lung tumors, for a total number of 250 treated patients . 4D-CT . Objectives: The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. The HILUS‐trial –a prospective Nordic multi‐center phase II study of ultra‐central lung tumors treated with stereotactic body radiotherapy, Journal of Thoracic Oncology (2021) Retrospective Ultracentral Lung Tumor Outcomes Yau VK … Stereotactic body radiation therapy (SBRT) is an effective and well tolerated treatment for early stage non-small cell lung cancer (NSCLC). How do the results of the current study sit with other studies of SBRT in non–small cell lung cancer? Non-spine bone metastases; Matthias Guckenberger. Lung stereotactic body radiotherapy (SBRT) is considered a standard curative treatment for medically inoperable early stage non-small-cell lung cancer (NSCLC). SBRT has been associated with serious toxicity in ultra-central lung tumors, but little is known about the incidence and dosimetric correlates of pulmonary and esophageal complications in this setting.We retrospectively reviewed SBRT patients whose lung tumor abutted proximal airways, or whose planning target volume overlapped esophagus. Chaudhuri et al. Twenty patients were treated with five-fraction robotic SBRT for ultra-central in-field recurrence following CF-EBRT. Patients previously treated with … Stereotactic body radiation therapy (SBRT) is a promising modality to achieve reasonable local control, although toxicity remains a concern. Lindberg K et al. Liver Metastasis; Erin Murphy, Rupesh Kotecha. Background: Stereotactic body radiotherapy (SBRT) in ultra-central (UC) lung tumors, defined in the presence of planning target volume (PTV) overlap or direct tumor abutment to the central bronchial tree or esophagus, may be correlated to a higher incidence of severe adverse events. Our objective was to assess toxicities, local control (LC) rate and survival data in patients with ultra-central lung tumours treated with SBRT. Stereotactic body radiotherapy (SBRT) produced high disease control rates but serious toxicity in a retrospective study of patients with ultra-central lung tumors. Six months after the Elekta Harmony radiation therapy system earned CE mark, the first clinical system found a home at Acibadem Bursa Hospital (Bursa, Turkey), part of the Acibadem Healthcare Group, the country’s largest private hospital … Axis of . CHISEL (Ball . All the employed positions I … Five-fraction SBRT for ultra-central NSCLC in-field recurrences following high-dose conventional radiation. Ultra-central lung SBRT; WON-IL Jang, Mi-Sook Kim. The role of SBRT in ultra-central tumors remains controversial. SBRT and conventional RT • Potential better disease control rate in SBRT with better QoL and less toxicity. 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