Low-dose Hilar and Mediastinal Stereotactic Body Radiation Therapy for Non-small Cell Lung Cancer: Analysis of Outcomes in Patients Receiving One or Multiple Courses of Treatment

Overview

Journal Thorac Cancer

Specialties Oncology
Pulmonary Medicine

Date 2020 May 30

PMID 32469465

Citations 3

Authors

Roman O Kowalchuk

Michael R Waters

Martin Richardson

Kelly Spencer

James M Larner

Charles R Kersh

Affiliations

Soon will be listed here.

Abstract

Background: This study reports the outcomes of a single institutional experience treating non-small cell lung cancer (NSCLC) involving the pulmonary hilum with low-dose stereotactic body radiation therapy (SBRT). The authors also present a series of repeat hilar SBRT.

Methods: Inclusion criteria required treatment with SBRT for NSCLC involving regional lymph nodes of the: (i) hilum, (ii) mediastinum, (iii) aortopulmonary window (station 5), or (iv) mainstem bronchus. At least one clinical follow-up with imaging was required, unless the patient had a prior documented death from cancer.

Results: A total of 32 patients with 44 treatments were included, and 37 treatments targeted the hilum directly, with seven concerning the mediastinum, AP window, or mainstem bronchus. Median dose was 28 Gy in four fractions with once-weekly fractionation. At a median clinical follow-up of 23 months, local control was 64%. Median overall survival was 24 months, and median progression-free survival was 15 months. A total of 48% of treatments resulted in complete radiographic response on last imaging follow-up, and no cases of grade ≥ 3 toxicity were reported. For repeat SBRT (after prior hilar SBRT), local control was 92%. Median overall survival was 20 months, and median progression-free survival was 19 months. Complete radiographic response was noted after 58% of treatments, with 0 instances of progressive response and no reported side effects.

Conclusions: Low-dose hilar SBRT was efficacious and well-tolerated, with impressive overall survival and no grade ≥ 3 toxicity. Repeat treatments with SBRT were feasible and effective, demonstrating overall survival, local control, and toxicity comparable to primary treatments.

Key Points: Significant findings of the study Low-dose hilar SBRT was efficacious and well-tolerated Repeated treatments with SBRT demonstrated encouraging results, comparable to primary treatments What this study adds This study contributes to the small body of literature concerning hilar SBRT Repeat hilar SBRT was safe and feasible Toxicity was minimal with low-dose SBRT Once-weekly fractionation may have contributed to low rate of side effects.

Citing Articles

Risk-adapted stereotactic body radiation therapy delivered in four fractions in patients with non-small cell lung cancer.

Masuoka Y, Tada T, Matsuda S, Hasegawa Y, Ishii K, Inokuchi H Nagoya J Med Sci. 2025; 86(4):588-595.

PMID: 39780923 PMC: 11704765. DOI: 10.18999/nagjms.86.4.588.

Multi-institutional study using sbrt to treat mediastinal and hilar lymphadenopathy.

Caivano D, Pezzulla D, Bonome P, Ricciardi C, Zuccoli P, Rotondi M Clin Exp Metastasis. 2024; 42(1):4.

PMID: 39680157 DOI: 10.1007/s10585-024-10324-z.

Effect of histology on stereotactic body radiotherapy for non-small cell lung cancer oligometastatic pulmonary lesions.

Allen A, Labella D, Kowalchuk R, Waters M, Kersh C Transl Lung Cancer Res. 2023; 12(1):66-78.

PMID: 36762063 PMC: 9903091. DOI: 10.21037/tlcr-22-538.

Stereotactic Body Radiation Therapy (SBRT) for Oligorecurrent/Oligoprogressive Mediastinal and Hilar Lymph Node Metastasis: A Systematic Review.

Cozzi S, Ali E, Bardoscia L, Najafi M, Botti A, Blandino G Cancers (Basel). 2022; 14(11).

PMID: 35681659 PMC: 9179886. DOI: 10.3390/cancers14112680.

References

Brown J, Carlson D, Brenner D . The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved?. Int J Radiat Oncol Biol Phys. 2014; 88(2):254-62. PMC: 3893711. DOI: 10.1016/j.ijrobp.2013.07.022. View

Videtic G, Donington J, Giuliani M, Heinzerling J, Karas T, Kelsey C . Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017; 7(5):295-301. DOI: 10.1016/j.prro.2017.04.014. View

Senthi S, Haasbeek C, Slotman B, Senan S . Outcomes of stereotactic ablative radiotherapy for central lung tumours: a systematic review. Radiother Oncol. 2013; 106(3):276-82. DOI: 10.1016/j.radonc.2013.01.004. View

Okunieff P, Petersen A, Philip A, Milano M, Katz A, Boros L . Stereotactic Body Radiation Therapy (SBRT) for lung metastases. Acta Oncol. 2006; 45(7):808-17. DOI: 10.1080/02841860600908954. View

Roesch J, Panje C, Sterzing F, Mantel F, Nestle U, Andratschke N . SBRT for centrally localized NSCLC - What is too central?. Radiat Oncol. 2016; 11(1):157. PMC: 5135810. DOI: 10.1186/s13014-016-0732-5. View

Barriger R, Forquer J, Brabham J, Andolino D, Shapiro R, Henderson M . A dose-volume analysis of radiation pneumonitis in non-small cell lung cancer patients treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2010; 82(1):457-62. DOI: 10.1016/j.ijrobp.2010.08.056. View

Nakayama J, Miyasaka K, Omatsu T, Onodera Y, Terae S, Matsuno Y . Metastases in mediastinal and hilar lymph nodes in patients with non-small cell lung cancer: quantitative assessment with diffusion-weighted magnetic resonance imaging and apparent diffusion coefficient. J Comput Assist Tomogr. 2010; 34(1):1-8. DOI: 10.1097/RCT.0b013e3181a9cc07. View

Mazzola R, Ruggieri R, Figlia V, Rigo M, Giaj Levra N, Ricchetti F . Stereotactic body radiotherapy of central lung malignancies using a simultaneous integrated protection approach : A prospective observational study. Strahlenther Onkol. 2019; 195(8):719-724. DOI: 10.1007/s00066-018-01419-0. View

Bott M, Patel A, Verma V, Crabtree T, Morgensztern D, Robinson C . Patterns of care in hilar node-positive (N1) non-small cell lung cancer: A missed treatment opportunity?. J Thorac Cardiovasc Surg. 2016; 151(6):1549-1558.e2. PMC: 4876013. DOI: 10.1016/j.jtcvs.2016.01.058. View

10.

Modh A, Rimner A, Williams E, Foster A, Shah M, Shi W . Local control and toxicity in a large cohort of central lung tumors treated with stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys. 2014; 90(5):1168-76. PMC: 4276458. DOI: 10.1016/j.ijrobp.2014.08.008. View

11.

Timmerman R, Paulus R, Pass H, Gore E, Edelman M, Galvin J . Stereotactic Body Radiation Therapy for Operable Early-Stage Lung Cancer: Findings From the NRG Oncology RTOG 0618 Trial. JAMA Oncol. 2018; 4(9):1263-1266. PMC: 6117102. DOI: 10.1001/jamaoncol.2018.1251. View

12.

Kang K, Okoye C, Patel R, Siva S, Biswas T, Ellis R . Complications from Stereotactic Body Radiotherapy for Lung Cancer. Cancers (Basel). 2015; 7(2):981-1004. PMC: 4491695. DOI: 10.3390/cancers7020820. View

13.

Onishi H, Araki T, Shirato H, Nagata Y, Hiraoka M, Gomi K . Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer. 2004; 101(7):1623-31. DOI: 10.1002/cncr.20539. View

14.

Lemjabbar-Alaoui H, Hassan O, Yang Y, Buchanan P . Lung cancer: Biology and treatment options. Biochim Biophys Acta. 2015; 1856(2):189-210. PMC: 4663145. DOI: 10.1016/j.bbcan.2015.08.002. View

15.

Bezjak A, Paulus R, Gaspar L, Timmerman R, Straube W, Ryan W . Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/RTOG 0813 Trial. J Clin Oncol. 2019; 37(15):1316-1325. PMC: 6524984. DOI: 10.1200/JCO.18.00622. View

16.

Brunner T, Nestle U, Adebahr S, Gkika E, Wiehle R, Baltas D . Simultaneous integrated protection : A new concept for high-precision radiation therapy. Strahlenther Onkol. 2016; 192(12):886-894. PMC: 5122615. DOI: 10.1007/s00066-016-1057-x. View

17.

Tekatli H, Haasbeek N, Dahele M, De Haan P, Verbakel W, Bongers E . Outcomes of Hypofractionated High-Dose Radiotherapy in Poor-Risk Patients with "Ultracentral" Non-Small Cell Lung Cancer. J Thorac Oncol. 2016; 11(7):1081-9. DOI: 10.1016/j.jtho.2016.03.008. View

18.

Davis J, Medbery C, Sharma S, Pablo J, Kimsey F, Perry D . Stereotactic body radiotherapy for centrally located early-stage non-small cell lung cancer or lung metastases from the RSSearch(®) patient registry. Radiat Oncol. 2015; 10:113. PMC: 4443630. DOI: 10.1186/s13014-015-0417-5. View

19.

Timmerman R, McGarry R, Yiannoutsos C, Papiez L, Tudor K, Deluca J . Excessive toxicity when treating central tumors in a phase II study of stereotactic body radiation therapy for medically inoperable early-stage lung cancer. J Clin Oncol. 2006; 24(30):4833-9. DOI: 10.1200/JCO.2006.07.5937. View

20.

Hasegawa I, Eguchi K, Kohda E, Tanami Y, Mori T, Hatabu H . Pulmonary hilar lymph nodes in lung cancer: assessment with 3D-dynamic contrast-enhanced MR imaging. Eur J Radiol. 2003; 45(2):129-34. DOI: 10.1016/s0720-048x(02)00056-6. View