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

Autor: Loi M; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy. mauro.loi82@gmail.com., Franceschini D; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Dominici L; Radiotherapy Department, University of Florence, Florence, Italy., Chiola I; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Franzese C; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy.; Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Area, Italy., D'Agostino GR; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Navarria P; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Marzo M; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Paganini L; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Comito T; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Mancosu P; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Tomatis S; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy., Cozzi L; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy.; Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Area, Italy., Alifano M; Thoracic Surgery Department, Hopital Cochin, Université Paris Decartes, Paris, France., Scorsetti M; Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center, IRCSS, Via Manzoni 56, Rozzano, 20089, Italy.; Dept. of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan Area, Italy.
Jazyk: angličtina
Zdroj: Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] [Strahlenther Onkol] 2021 May; Vol. 197 (5), pp. 396-404. Date of Electronic Publication: 2020 Sep 24.
DOI: 10.1007/s00066-020-01687-9
Abstrakt: 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 cm 3 (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 cm 3 (D1cm 3 ) of esophagus and lung volume receiving ≥5 Gy (V5Gy) (p = 0.016 and p = 0.013), and higher dose to 0.1 cm 3 (D0.1cm 3 ) of heart (p = 0.036), respectively.
Conclusion: V95% PTV > 85% and GTV < 90 cm 3 are independent predictors of LC. Dose to esophagus, lung and heart should be carefully assessed to minimize treatment-related toxicities.
Databáze: MEDLINE
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