Toxicity in patients receiving radiotherapy for ultracentral stage I non-small cell lung cancer: A secondary analysis of the LUSTRE randomized trial.

Lung cancer Randomized trial Stereotactic Radiotherapy Toxicity Ultracentral

Journal

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
ISSN: 1879-0887
Titre abrégé: Radiother Oncol
Pays: Ireland
ID NLM: 8407192

Informations de publication

Date de publication:
29 Oct 2024
Historique:
received: 25 04 2024
revised: 22 10 2024
accepted: 28 10 2024
medline: 1 11 2024
pubmed: 1 11 2024
entrez: 31 10 2024
Statut: aheadofprint

Résumé

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. Patients (n = 233) with medically inoperable stage I NSCLC were recruited from 2014 to 2020. Patients with UC targets directly overlapping the proximal bronchial tree (PBT) were identified. The primary objective was the occurrence of related grade 3-5 toxicity > 3 months following radiation. Secondary endpoints included local control, survival, and evaluation of PBT dose and its association with late toxicity. Thirty UC tumors were identified (23 - SBRT 60 Gy/8 fractions, 7 - CRT 60 Gy/15 fractions). Median age was 72 years, and median tumor size was 2.8 cm. Most patients (67 %) had histologically confirmed NSCLC. At a median follow-up of 2.9 years, 3 and 1 patients developed grade 3 and 5 toxicity respectively (all SBRT). 3-year local control was 85 %. Mean PBT dose (converted to 2 Gy dose equivalents) was higher in patients with grade ≥ 3 toxicity, particularly for 4 cc (105.5 vs 51.8 Gy, p = 0.0004), 5 cc (84 vs 46.1 Gy, p = 0.003), and volumetric doses (V65 - V100Gy). The patient with grade 5 toxicity had the highest 5 cc dose (117 Gy), V90Gy (8.2 cc), and V100Gy (7 cc). SBRT for UC NSCLC provides good local control but carries a high rate of late grade 3-5 toxicity. An apparent association between toxicity and PBT volumetric dose was observed, which should be considered if SBRT is offered.

Sections du résumé

BACKGROUND AND PURPOSE OBJECTIVE
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 METHODS
Patients (n = 233) with medically inoperable stage I NSCLC were recruited from 2014 to 2020. Patients with UC targets directly overlapping the proximal bronchial tree (PBT) were identified. The primary objective was the occurrence of related grade 3-5 toxicity > 3 months following radiation. Secondary endpoints included local control, survival, and evaluation of PBT dose and its association with late toxicity.
RESULTS RESULTS
Thirty UC tumors were identified (23 - SBRT 60 Gy/8 fractions, 7 - CRT 60 Gy/15 fractions). Median age was 72 years, and median tumor size was 2.8 cm. Most patients (67 %) had histologically confirmed NSCLC. At a median follow-up of 2.9 years, 3 and 1 patients developed grade 3 and 5 toxicity respectively (all SBRT). 3-year local control was 85 %. Mean PBT dose (converted to 2 Gy dose equivalents) was higher in patients with grade ≥ 3 toxicity, particularly for 4 cc (105.5 vs 51.8 Gy, p = 0.0004), 5 cc (84 vs 46.1 Gy, p = 0.003), and volumetric doses (V65 - V100Gy). The patient with grade 5 toxicity had the highest 5 cc dose (117 Gy), V90Gy (8.2 cc), and V100Gy (7 cc).
CONCLUSIONS CONCLUSIONS
SBRT for UC NSCLC provides good local control but carries a high rate of late grade 3-5 toxicity. An apparent association between toxicity and PBT volumetric dose was observed, which should be considered if SBRT is offered.

Identifiants

DOI: 10.1016/j.radonc.2024.110605 PMID: 39481606
pubmed: 39481606
pii: S0167-8140(24)04267-1
doi: 10.1016/j.radonc.2024.110605
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

110605

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

Che Hsuan David Wu (CHD)

Department of Radiation Oncology, BC Cancer Agency - Victoria, 2410 Lee Avenue, Victoria, British Columbia V8R 6V5, Canada.

Marcin Wierzbicki (M)

Juravinski Cancer Centre, McMaster University, Department of Medical Physics, 699 Concession Street, Hamilton, Ontario L8V 5C2, Canada.

Sameer Parpia (S)

Department of Oncology, McMaster University, Hamilton, Ontario L8V 5C2, Canada.

Vijayananda Kundapur (V)

Saskatchewan Cancer Agency, University of Saskatchewan, Department of Radiation Oncology, 20 Campus Drive, Saskatoon, Saskatchewan, Canada.

Alexis Bujold (A)

Département de Radio-oncologie Clinique-Enseignement-Recherche, Centre Intégré Universitaire de Soins et Services Sociaux de l'Est-de-l'Île-de-Montréal - Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada.

Edith Filion (E)

Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.

Harold Lau (H)

Department of Oncology, University of Calgary, Calgary, Alberta, Canada.

Sergio Faria (S)

Department of Radiation Oncology, McGill University Health Centre, Montreal, Quebec, Canada.

Naseer Ahmed (N)

Department of Radiology, Section of Radiation Oncology, Rady Faculty of Health Sciences, University of Manitoba and CancerCare Manitoba Research Institute, Winnipeg, Manitoba, Canada.

Nelson Leong (N)

Allan Blair Cancer Centre, Department of Radiation Oncology, University of Saskatchewan, Regina, Saskatchewan, Canada.

Gordon Okawara (G)

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.

Khalid Hirmiz (K)

Department of Radiation Oncology, Windsor Regional Cancer Centre, Windsor, Ontario, Canada.

Timothy Owen (T)

Department of Oncology, Queen's University, Cancer Centre of Southeast Ontario at Kingston Health Sciences Centre Kingston, Ontario, Canada.

Alexander V Louie (AV)

Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.

James R Wright (JR)

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.

Timothy J Whelan (TJ)

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.

Anand Swaminath (A)

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: swaminath@hhsc.ca.

Classifications MeSH