Long-Term Toxicity and Survival Outcomes After Stereotactic Ablative Radiotherapy for Patients With Centrally Located Thoracic Tumors

SABR for Central Thoracic Tumors

  • Terence Sio Mayo Clinic
  • Banu Atalar Acibadem MAA University, Istanbul, Turkey; Department of Radiation Oncology; Acibadem Maslak Hospital, Istanbul, Turkey
  • Teuta Zoto Mustafayev Acibadem Maslak Hospital, Istanbul, Turkey
  • Bilgehan Sahin Acibadem MAA University, Istanbul, Turkey
  • Gorkem Gungor Acibadem MAA University, Istanbul, Turkey
  • Gokhan Aydın gokhan.aydin@acibadem.com
  • Bulent Yapici Acibadem MAA University, Istanbul, Turkey
  • Enis Ozyar Acibadem MAA University, Istanbul, Turkey

Abstract

Purpose: Stereotactic ablative radiotherapy (SABR) is effective for thoracic cancer and metastases; however, adverse effects are greater for central tumors. We evaluated factors affecting outcomes and toxicities after SABR for patients with primary lung (PL) and oligometastatic (OM) tumors.

Methods and Materials: We retrospectively identified consecutive patients with centrally located lung tumors that were treated at our hospital from 2009-2016. The effects of patient, disease, and treatment-related parameters on local control (LC), overall survival (OS), and toxicity-free survival (TFS) were evaluated with multivariate analyses.

Results: Among 65 consecutive patients identified with 70 centrally located tumors, 20 tumors (28%) were reirradiated. Median (range) total dose for all tumors was 55 (30-60) Gy in 5 (3-10) fractions. Radiographic complete response was obtained in 43 lesions (61%). None of the analyzed factors were correlated with complete response. After a median follow-up of 57 (95% CI, 48-65) months, 10 tumors (14%) relapsed and 37 patients (57%) died; the actuarial 2- and 5-year OS rates were 52% and 28%, respectively. Median OS was significantly lower in patients with grade 3 or higher toxicity vs lower toxicity (5 vs 39 months; P<.001). Among 17 severe toxicities, 5 were grade 5. Grade 3 to 5 TFS was lower with vs without reirradiation (2-year TFS, 63% vs 96%; P=.02).

Conclusions: Our study showed that modern SABR is effective for central lung tumors, and toxicities are acceptable. SABR for reirradiated central lung lesions and possibly for lesions abutting the tracheobronchial tree may result in higher risk of serious toxicities.

Published
2020-11-13
How to Cite
Sio, T., Atalar, B., Mustafayev, T. Z., Sahin, B., Gungor, G., Aydın, G., Yapici, B., & Ozyar, E. (2020). Long-Term Toxicity and Survival Outcomes After Stereotactic Ablative Radiotherapy for Patients With Centrally Located Thoracic Tumors. Radiology and Oncology, 54(4), 480-487. Retrieved from https://radioloncol.com/index.php/ro/article/view/3439
Section
Clinical oncology