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Research Article|Articles in Press, 100488

MR-Guided SBRT/Hypofractionated RT for Metastatic and Primary Central and Ultracentral Lung Lesions

Open AccessPublished:February 24, 2023DOI:https://doi.org/10.1016/j.jtocrr.2023.100488
MR-Guided SBRT/Hypofractionated RT for Metastatic and Primary Central and Ultracentral Lung Lesions
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      Abstract

      Objectives

      The recent results from Nordic-HILUS study indicate SBRT is associated with high-grade toxicity for ultracentral (UC) tumors. We hypothesized that Magnetic Resonance-guided Stereotactic body radiation (MRgSBRT) or hypofractionated RT (MRgHRT) enables safe delivery of high dose radiation to central and UC lung lesions.

      Methods

      Patients with UC or central lesions were treated with MRgSBRT/MRgHRT with real-time gating or adaptation. Central lesions were defined as per the RTOG and UC as per the HILUS definitions: Group A tumors < 1 cm from the trachea and/or mainstem bronchi or Group B < 1 cm from lobar bronchi. Kaplan-Meier estimate and log rank test were used to estimate survival. Associations between toxicities and other patient factors were tested using Mann Whitney U test and Fisher’s exact test.

      Results

      47 patients were included with median follow-up of 22.9 months (95% CI 16.4 – 29.4). A majority (53%) had metastatic disease. All patients had central lesions and 55.3% (n=26) had UC Group A. Median distance from the proximal bronchial tree was 6.0 mm (range 0.0 – 19.0 mm). Median biologically equivalent dose (α/β=10) was 105 Gy (range 75 - 151.2). The most common radiation schedule was 60 Gy in 8 fractions (40.4%). A majority (55%) had prior systemic therapy, 32% had immunotherapy and 23.4% had previous thoracic RT. Sixteen patients underwent daily adaptation. One-year overall survival was 82% (median not reached), local control 87% (median not reached) and progression free survival 54% (median 15.1 months, 95% CI 5.1 – 25.1). Acute toxicity included Grade 1 (26%) and Grade 2 (21%) with only 2 patients experiencing Grade 3 (4.3%) in the long term. No Grade 4 or 5 toxicities were seen.

      Conclusion

      Prior studies noted high rates of toxicity after SBRT to central and UC lung lesions, with reports of Grade 5 toxicities. In our cohort, the use of MRgSBRT/MRgHRT with high BEDs was well tolerated with two Grade 3 toxicities with no Grade 4/5.

      Article info

      Publication history

      Accepted: February 21, 2023
      Received in revised form: January 31, 2023
      Received: December 16, 2022

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Conflict of Interest Disclosure:

      Dr. Sim, Dr. Wuthrick, Dr. Rosenberg and Dr. Latifi receive consulting fees from ViewRay Inc. Dr. Sim and Dr. Rosenberg have grant funding from ViewRay Inc. Dr. Rosenberg has research funding from ViewRay to support the present manuscript and receives honoraria for lectures/presentations from ViewRay Inc and Novocure as well as having a leadership role in ViewRay Lung Research Consortium. Dr. Dilling has consulting fees from AstraZeneca and received honoraria for lectures/presentations from NCCN, additionally he has stock at Moderna. The other authors have no disclosures or conflicts of interest.

      Credit Statement

      Maria Sandoval: Conceptualization, Data Collection, Data Analysis, Writing – Original draft preparation

      Austin Sim: Conceptualization, Data Collection, Data Analysis, Writing – Original draft preparation

      John Bryant: Data Collection, Data Curation, Writing – Review/ Editing

      Menal Bhandari: Data Collection, Data Curation

      Thomas Dilling: Conceptualization, Methodology, Writing – Review/Editing

      Bradford Perez: Methodology, E Writing – Review/Editing

      Evan Wuthrick: Methodology, Writing – Review/Editing

      Gage Redler: Supervision, Writing – Review/Editing

      Jacqueline Andreozzi: Supervision, Writing – Review/Editing

      Louis Nardella: Supervision, Writing – Review/Editing

      Vladimir Feygelman: Supervision, Writing – Review/Editing

      Kujtim Latifi: Supervision, Writing – Review/Editing

      Stephen Rosenberg: Conceptualization, Administration, Supervision, Writing – Review/Editing

      Identification

      DOI: https://doi.org/10.1016/j.jtocrr.2023.100488

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer.

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