Ultracentral (UC) lung lesions are generally defined by the presence of the tumour or the Planning Target Volume (PTV) abutting proximal bronchial tree (PBT) or the esophagus. Initial reports rose awareness regarding the potential toxicity of stereotactic body radiotherapy (SBRT) when delivered to UC lesions. Major concerns include necrosis, stenosis, and bleeding of the PBT. Technological improvements now enable the delivery of more accurate treatments, possibly redefining the historical "no-fly zone". In this review, studies focusing on the treatment of UC lesions with SBRT are presented. The narrow therapeutic window requires a multidisciplinary approach.
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http://dx.doi.org/10.1016/j.canrad.2023.06.021 | DOI Listing |
Pract Radiat Oncol
January 2024
Department of Radiation Oncology, Anderson Regional Health System, Meridian, Mississippi. Electronic address:
Radiother Oncol
January 2025
Department of Oncology, McMaster University, and the Division of Radiation Oncology Juravinski Cancer Centre at Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada. Electronic address:
Background And Purpose: Stereotactic body radiotherapy (SBRT) carries potentially higher risks for ultracentral (UC) NSCLC with limited prospective data to guide decision making. We conducted a secondary analysis from a randomized trial of SBRT and conventionally hypofractionated radiation (CRT) to assess these risks.
Materials And Methods: Patients (n = 233) with medically inoperable stage I NSCLC were recruited from 2014 to 2020.
Pract Radiat Oncol
October 2024
Department of Radiation Oncology, City of Hope National Medical Center, Duarte, California; Department of Radiation Oncology, City of Hope Orange County Lennar Foundation Cancer Center, Irvine, California. Electronic address:
Purpose: Data informing the safety, efficacy, treatment logistics, and dosimetry of stereotactic body radiation therapy (SBRT) for lung tumors has primarily been derived from patients with favorably located solitary tumors. SBRT is now considered a standard-of-care treatment for inoperable early-stage non-small cell lung cancer and lung metastases, and therefore extrapolation beyond this limited foundational patient population remains an active source of interest.
Methods And Materials: This case-based discussion provides a practical framework for delivering SBRT to challenging, yet frequently encountered, cases in radiation oncology.
Radiother Oncol
December 2024
Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Australia; School of Medicine, University of Western Australia, Perth, Australia; Institute for Respiratory Health, Perth, Australia.
Background & Purpose: Local treatment of oligometastases has been found to improve survival and prognosis. Stereotactic body radiotherapy (SBRT) has emerged as a treatment option for oligometastases but its use in ultra-central (UC) areas can cause significant toxicity and mortality. Fiducial markers (FM) can be used to improve SBRT accuracy, and can be inserted in the central thorax using linear endobronchial ultrasound (EBUS) bronchoscopy.
View Article and Find Full Text PDFInt J Radiat Oncol Biol Phys
November 2024
Department of Radiation Oncology, University of California Irvine, Orange, California.
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