Abstract
Background and Purpose:
High-dose irradiation to the pulmonary hilar region is generally considered to be of high risk in causing bronchial injury. The aim of this retrospective study is to investigate the safety and efficacy of stereotactic body radiotherapy (SBRT) for patients with lung tumors in the pulmonary hilum.
Patients and Methods:
21 patients who underwent SBRT for lung tumors within 2 cm from a major bronchus were retrospectively analyzed. The total biologically effective doses ranging from 50.7 to 157.5 Gy (median, 100 Gy) were given to the tumors by SBRT.
Results:
The overall survival rates at 1 and 2 years after SBRT were 90.0% and 62.2%, respectively. Nine patients were alive and 15 irradiated tumors were controlled during the follow-up period of 10–54 months (median, 20 months). Nine patients died of tumor progression and one patient each died of hemoptysis, infectious pneumonia, and epidural hemorrhage. Severe late toxicity (≥ grade 3) was seen in three patients of whom two had previously received repeated radiotherapy.
Conclusion:
SBRT for lung tumors located in the pulmonary hilar region may be tolerable and acceptable, if multiple treatments to the same major bronchus are avoided, and irradiated volumes are carefully taken into consideration.
Zusammenfassung
Hintergrund und Ziel:
Die hochdosierte Bestrahlung der Lungenhilusregion gilt im Allgemeinen als großes Risiko in Bezug auf die Verursachung von Bronchialverletzungen. Ziel dieser retrospektiven Studie ist die Untersuchung der Sicherheit und Wirksamkeit der stereotaktischen Strahlentherapie bei Patienten mit Lungentumoren im Hilum pulmonis.
Patienten und Methodik:
21 Patienten, die sich einer stereotaktischen Bestrahlung von Lungentumoren im Abstand von bis zu 2 cm zu einem Hauptbronchus unterzogen, wurden retrospektiv analysiert. Die Tumoren wurden mit biologisch wirksamen Gesamtdosen im Bereich von 50,7 bis 157,5 Gy (Median: 100 Gy) bestrahlt.
Ergebnisse:
Die Gesamtüberlebensraten 1 und 2 Jahre nach der stereotaktischen Strahlentherapie lagen bei 90,0% bzw. 62,2%. Während des Nachuntersuchungszeitraums von 10–54 Monaten (Median: 20 Monate) waren neun Patienten am Leben, und 15 bestrahlte Tumoren wurden kontrolliert. Neun Patienten starben aufgrund von Tumorprogression und je ein Patient starb infolge von Hämoptysis, infektiöser Pneumonie und epiduraler Blutung. Schwere Spättoxizität (≥ Grad 3) wurde bei drei Patienten beobachtet, von denen sich zwei in der Vergangenheit mehreren Strahlentherapien unterzogen hatten.
Schlussfolgerung:
Eine stereotaktische Strahlentherapie bei Lungentumoren in der Gegend des Lungenhilus ist möglicherweise verträglich und vertretbar, wenn mehrere Behandlungen des gleichen Hauptbronchus vermieden und bestrahlte Volumen sorgfältig berücksichtigt werden.
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Oshiro, Y., Aruga, T., Tsuboi, K. et al. Stereotactic Body Radiotherapy for Lung Tumors at the Pulmonary Hilum. Strahlenther Onkol 186, 274–279 (2010). https://doi.org/10.1007/s00066-010-2072-y
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DOI: https://doi.org/10.1007/s00066-010-2072-y