Purpose: To assess local control, overall survival, and toxicity of four-dimensional, risk-adapted stereotactic body radiotherapy (SBRT) delivered while tracking respiratory motion in patients with primary and metastatic lung cancer located in the central chest. Methods: Fifty-eight central lesions of 56 patients (39 with primary, 17 with metastatic tumors) were treated. Fifteen tumors located near the esophagus were treated with 6 fractions of 8 Gy. Other tumors were treated according to the following dose escalation scheme: 5 fractions of 9 Gy (n = 6), then 5 fractions of 10 Gy (n = 15), and finally 5 fractions of 12 Gy (n = 22). Results: Dose constraints for critical structures were generally achieved; in 21 patients the coverage of the PTV was reduced below 95% to protect adjacent organs at risk. At a median follow-up of 23 months, the actuarial 2-years local tumor control was 85% for tumors treated with a BED >100 Gy compared to 60% for tumors treated with a BED ≤100 Gy. No grade 4 or 5 toxicity was observed. Acute grade 1-2 esophagitis was observed in 11% of patients. Conclusion: SBRT of central lung lesions can be safely delivered, with promising early tumor control in patients many of whom have severe comorbid conditions.

Central tumors, Lung cancer, Real-time tumor tracking, Stereotactic radiotherapy
dx.doi.org/10.1016/j.radonc.2011.12.023, hdl.handle.net/1765/62642
Radiotherapy & Oncology
Department of Surgery

Nuyttens, J.J.M.E, van der Voort van Zyp, N.C.M-G, Praag, J, Aluwini, S, van Klaveren, R.J, Verhoef, C, … Hoogeman, M.S. (2012). Outcome of four-dimensional stereotactic radiotherapy for centrally located lung tumors. Radiotherapy & Oncology, 102(3), 383–387. doi:10.1016/j.radonc.2011.12.023