Cooke, R;
Camilleri, P;
Chu, K-Y;
O'Cathail, SM;
Robinson, M;
Van Den Heuvel, F;
Hawkins, MA;
(2020)
Stereotactic body radiotherapy for moderately central and ultra-central oligometastatic disease: Initial outcomes.
Technical Innovations & Patient Support in Radiation Oncology
, 13
pp. 24-30.
10.1016/j.tipsro.2020.01.002.
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Abstract
BACKGROUND 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. We present dosimetric and clinical outcomes from a group of oligometastatic patients treated with a risk-adapted SBRT approach. METHODS Between September 2015 and October 2018, 27 patients with 28 central thoracic oligometastases (6 moderately central, 22 ultra-central) were treated with 60 Gy in 8 fractions under online CBCT guidance. PTV dose was compromised where necessary to meet mandatory OAR constraints. Patients were followed up for toxicity and disease status. RESULTS Mandatory OAR constraints were met in all cases; this required PTV coverage compromise in 23 cases, with V100% reduced to <70% in 11 cases. No acute or late toxicities of Grade ≥ 3 were reported. One and 2 year in-field control rates were 95.2% and 85.7% respectively, progression-free survival rates were 42.8% and 23.4% respectively, and overall survival rates were 82.7% and 69.5% respectively. No significant differences were seen in control or survival rates by extent of PTV underdosage or between moderately and ultra-central cases. CONCLUSION It appears that compromising PTV coverage to meet OAR constraints allows safe and effective delivery of SBRT to moderately and ultra-central tumours, with low toxicity rates and high in-field control rates. This treatment can be delivered on standard linear accelerators with widely available imaging technology.
| Type: | Article |
|---|---|
| Title: | Stereotactic body radiotherapy for moderately central and ultra-central oligometastatic disease: Initial outcomes |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.tipsro.2020.01.002 |
| Publisher version: | https://doi.org/10.1016/j.tipsro.2020.01.002 |
| Language: | English |
| Additional information: | This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
| Keywords: | SBRT, No fly zone, Central, Ultra-central, Oligometastases |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > UCL BEAMS UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Med Phys and Biomedical Eng |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10092262 |
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