The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy
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The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy. / Lindberg, Karin; Grozman, Vitali; Karlsson, Kristin; Lindberg, Sara; Lax, Ingmar; Wersäll, Peter; Persson, Gitte Fredberg; Josipovic, Mirjana; Khalil, Azza Ahmed; Moeller, Ditte Sloth; Nyman, Jan; Drugge, Ninni; Bergström, Per; Olofsson, Jörgen; Rogg, Lotte Victoria; Ramberg, Christina; Kristiansen, Charlotte; Jeppesen, Stefan Starup; Nielsen, Tine Bjørn; Lödén, Britta; Rosenbrand, Hans Olov; Engelholm, Silke; Haraldsson, André; Billiet, Charlotte; Lewensohn, Rolf.
In: Journal of Thoracic Oncology, Vol. 16, No. 7, 2021, p. 1200-1210.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy
AU - Lindberg, Karin
AU - Grozman, Vitali
AU - Karlsson, Kristin
AU - Lindberg, Sara
AU - Lax, Ingmar
AU - Wersäll, Peter
AU - Persson, Gitte Fredberg
AU - Josipovic, Mirjana
AU - Khalil, Azza Ahmed
AU - Moeller, Ditte Sloth
AU - Nyman, Jan
AU - Drugge, Ninni
AU - Bergström, Per
AU - Olofsson, Jörgen
AU - Rogg, Lotte Victoria
AU - Ramberg, Christina
AU - Kristiansen, Charlotte
AU - Jeppesen, Stefan Starup
AU - Nielsen, Tine Bjørn
AU - Lödén, Britta
AU - Rosenbrand, Hans Olov
AU - Engelholm, Silke
AU - Haraldsson, André
AU - Billiet, Charlotte
AU - Lewensohn, Rolf
PY - 2021
Y1 - 2021
N2 - Introduction: Stereotactic body radiation therapy of thoracic tumors close to the central airways implies risk of severe toxicity. We report a prospective multicenter phase 2 trial for tumors located less than or equal to 1 cm from the proximal bronchial tree with primary end point of local control and secondary end point of toxicity. Methods: Stereotactic body radiation therapy with 7 Gy × 8 was prescribed to the 67% isodose encompassing the planning target volume. The patients were stratified to group A (tumors ≤ 1 cm from the main bronchi and trachea) or group B (all other tumors). Risk factors for treatment-related death were tested in univariate analysis, and a logistic regression model was developed for fatal bronchopulmonary bleeding versus dose to the main bronchi and trachea. Results: A total of 65 patients (group A/group B, n = 39/26) were evaluated. The median distance between the tumor and the proximal bronchial tree was 0 mm (0–10 mm). The 2-year local control was 83%. Grade 3 to 5 toxicity was noted in 22 patients, including 10 cases of treatment-related death (bronchopulmonary hemorrhage, n = 8; pneumonitis, n = 1; fistula, n = 1). Dose to the combined structure main bronchi and trachea and tumor distance to the main bronchi were important risk factors. Dose modeling revealed minimum dose to the “hottest” 0.2 cc to the structure main bronchi and trachea as the strongest predictor for lethal bronchopulmonary hemorrhage. Conclusions: On the basis of the presented data, 7 Gy × 8, prescribed to the planning target volume-encompassing isodose, should not be used for tumors located within 1 cm from the main bronchi and trachea. Group B-type tumors may be considered for the treatment on the basis of an individual risk-benefit assessment and a maximum dose to the main bronchi and trachea in the order of 70 to 80 Gy (equivalent dose in 2 Gy fractions).
AB - Introduction: Stereotactic body radiation therapy of thoracic tumors close to the central airways implies risk of severe toxicity. We report a prospective multicenter phase 2 trial for tumors located less than or equal to 1 cm from the proximal bronchial tree with primary end point of local control and secondary end point of toxicity. Methods: Stereotactic body radiation therapy with 7 Gy × 8 was prescribed to the 67% isodose encompassing the planning target volume. The patients were stratified to group A (tumors ≤ 1 cm from the main bronchi and trachea) or group B (all other tumors). Risk factors for treatment-related death were tested in univariate analysis, and a logistic regression model was developed for fatal bronchopulmonary bleeding versus dose to the main bronchi and trachea. Results: A total of 65 patients (group A/group B, n = 39/26) were evaluated. The median distance between the tumor and the proximal bronchial tree was 0 mm (0–10 mm). The 2-year local control was 83%. Grade 3 to 5 toxicity was noted in 22 patients, including 10 cases of treatment-related death (bronchopulmonary hemorrhage, n = 8; pneumonitis, n = 1; fistula, n = 1). Dose to the combined structure main bronchi and trachea and tumor distance to the main bronchi were important risk factors. Dose modeling revealed minimum dose to the “hottest” 0.2 cc to the structure main bronchi and trachea as the strongest predictor for lethal bronchopulmonary hemorrhage. Conclusions: On the basis of the presented data, 7 Gy × 8, prescribed to the planning target volume-encompassing isodose, should not be used for tumors located within 1 cm from the main bronchi and trachea. Group B-type tumors may be considered for the treatment on the basis of an individual risk-benefit assessment and a maximum dose to the main bronchi and trachea in the order of 70 to 80 Gy (equivalent dose in 2 Gy fractions).
KW - Central
KW - Lung tumors
KW - SBRT
KW - Stereotactic
KW - Ultracentral
U2 - 10.1016/j.jtho.2021.03.019
DO - 10.1016/j.jtho.2021.03.019
M3 - Journal article
C2 - 33823286
AN - SCOPUS:85104983090
VL - 16
SP - 1200
EP - 1210
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
SN - 1556-0864
IS - 7
ER -
ID: 261445260