Bronchial Stenosis in Central Pulmonary Tumors Treated With Stereotactic Body Radiation Therapy |
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| Affiliation: | 1. Department of Radiation Oncology;2. Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands;1. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri;2. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas;3. The Royal Marsden NHS Foundation Trust, The Institute of Cancer Research, London, United Kingdom;4. Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, Floridas;5. Department of Radiation Oncology, University of California Los Angeles, Los Angeles, California;6. Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida;7. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin;8. Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea;9. Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, United States.;1. Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea;2. Department of Radiation Oncology, Gangnam Severance Hospital, Seoul, South Korea;1. Departments of Radiation Oncology, University of Michigan, Ann Arbor, Michigan;2. Departments of Biostatistics, University of Michigan, Ann Arbor, Michigan;3. Department of Radiation Oncology, Karmanos Cancer Institute, Detroit, Michigan;4. Department of Radiation Oncology, Henry Ford Health System, Detroit, Michigan;5. MHP Radiation Oncology Institute/GenesisCare USA, Farmington Hills, Michigan;6. St. Mary''s Hospital, Lacks Cancer Center, Grand Rapids, Michigan;7. Department of Radiation Oncology, Brighton Center for Specialty Care, Brighton, Michigan;8. Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan;9. Department of Radiation Oncology, Spectrum Health Lakeland, St. Joseph, Michigan;1. University of Miami, Department of Radiation Oncology, Miami, Florida;2. Fox Chase Cancer Center, Temple University Health System, Philadelphia, Pennsylvania;3. Depts of Radiation Oncology and Otolaryngology, NYU Langone Medical Center, New York, New York;4. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan;1. Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan;1. Department of Radiation Oncology, National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;2. Department of Radiation Oncology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China;3. Department of Radiation Oncology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China;4. Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors, Hubei Cancer Clinical Study Center, Wuhan, China;5. Department of Radiation Oncology, The First Hospital of Jilin University, Changchun, China;6. Department of Radiation Oncology, Cancer Hospital of Jilin Province, Changchun, China;7. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, China;8. Department of Radiation Oncology, Beijing Hospital, Ministry of Health, Beijing, China;9. Department of Radiation Oncology, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China;10. Department of Radiochemotherapy, Tangshan People''s Hospital, Tangshan, China;11. Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China;12. Department of Radiation Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China;13. Department of Radiation Oncology, Xijing Hospital, The First Affiliated Hospital of Fourth Military Medical University, Xi''an, China;14. Department of Radiation Oncology, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China |
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| Abstract: | PurposeStereotactic body radiation therapy (SBRT) in lung tumors has an excellent local control due to the high delivered dose. Proximity of the proximal bronchial tree (PBT) to the high dose area may result in pulmonary toxicity. Bronchial stenosis is an adverse event that can occur after high dose to the PBT. Literature on the risk of developing bronchial stenosis is limited. We therefore evaluated the risk of bronchial stenosis for tumors central to the PBT and correlated the dose to the bronchi.Methods and MaterialsPatients with a planning tumor volume (PTV) ≤2 cm from PBT receiving SBRT (8 × 7.5 Gy) between 2015 to 2019 were retrospectively reviewed. Main bronchi and lobar bronchi were manually delineated. Follow-up computed tomography scans were analyzed for bronchial stenosis and atelectasis. Bronchial stenosis was assessed using Common Terminology Criteria for Adverse Events Version 4.0 (CTCAEv4). Patient, tumor, dosimetric factors and survival were evaluated between patients with and without stenosis using uni- and multivariate and Kaplan-Meier analysis.ResultsFifty-one patients were analyzed with a median age of 70 years and World Health Organization (WHO) performance status ≤1 in 92.2%. Median follow-up was 36 months (interquartile range [IQR], 19.6-45.4) and median overall survival 48 months (IQR 21.5-59.3). In 15 patients (29.4%) bronchial stenosis was observed on follow-up computed tomography scan. Grade 1 stenosis was seen in 21.6% (n = 11), grade 2 in 7.8% (n = 4). No grade ≥3 stenosis was observed. Median time to stenosis was 9.6 months (IQR 4.4-19.2). Patients who developed stenosis had significantly larger gross tumor volume with a median of 19 cm3(IQR 7.7-63.2) versus 5.2 cm3 (IQR 1.7-11.3, P <.01). Prognostic factors in multivariate analysis for stenosis were age (P = .03; odds ratio [OR] 1.1), baseline dyspnea (P = .02 OR 7.7), and the mean lobar bronchus dose (P = .01; OR 1.1).ConclusionsLow-grade (≤2) lobar bronchial stenosis is a complication in approximately one-third of patients after SBRT for lung tumors with a PTV ≤2 cm from PBT. Prognostic risk factors were age, baseline dyspnea and mean dose on a lobar bronchus. |
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