Toxicity and Efficacy of Stereotactic Body Radiotherapy for Ultra-central Lung Tumours: a Single Institution Real Life Experience

OBJECTIVES The use of stereotactic body radiotherapy (SBRT) to treat ultra-central lung tumours remains more controversial than for peripheral and central tumours. Our objective was to assess toxicities, local control (LC) rate and survival data in patients with ultra-central lung tumours treated with SBRT. METHODS We conducted a retrospective and monocentric study about 74 patients with an ultra-central lung tumour, consecutively treated between 2012 and 2018. Ultra-central tumours were defined as tumours whose PTV (planning target volume) overlapped one of the following organs at risk (OAR): the trachea, right and left main bronchi, intermediate bronchus, lobe bronchi, oesophagus, heart. RESULTS Median follow-up was 25 months. Two patients (2.7%) showed Grade three toxicity. No Grade four or five toxicity was observed. 11% of patients experienced primary local relapse. Local control rate was 96.7% at 1 year and 87.6% at 2 years. Median progression free survival (PFS) was 12 months. Median overall survival (OS) was 31 months. CONCLUSIONS SBRT for ultra-central tumours remains safe and effective as long as protecting organs at risk is treatment-planning priority. ADVANCES IN KNOWLEDGE The present study is one of the rare to describe exclusively ultra-central tumours through real-life observational case reports. Globally, literature analysis reveals a large heterogeneity in ultra-central lung tumours definition, prescribed dose, number of fractions. In our study, patients treated with SBRT for ultra-central lung tumours experienced few Grade three toxicities (2.7%) and no Grade four or five toxicities, due to the highest compliance with dose constraints to OARs. LC remained efficient.