Dosimetric Analysis of Proximal Bronchial Tree Subsegments to Assess The Risk of Severe Toxicity After Stereotactic Body Radiation Therapy of Ultra-central Lung Tumors

Maiwand Ahmadsei; Vinojaa Jegarajah; Riccardo Dal Bello; Sebastian M Christ; Michael M Mayinger; Luisa Sabrina Stark; Jonas Willmann; Ivan R Vogelius; Panagiotis Balermpas; Nicolaus Andratschke; Stephanie Tanadini-Lang; Matthias Guckenberger

doi:10.1016/j.ctro.2023.100707

Dosimetric Analysis of Proximal Bronchial Tree Subsegments to Assess The Risk of Severe Toxicity After Stereotactic Body Radiation Therapy of Ultra-central Lung Tumors

Clin Transl Radiat Oncol. 2023 Dec 7:45:100707. doi: 10.1016/j.ctro.2023.100707. eCollection 2024 Mar.

Affiliations

¹ Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
² Center for Proton Therapy, Paul Scherrer Institute, ETH Domain, Villigen, Switzerland.
³ Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

Abstract

•Stereotactic body radiation therapy (SBRT) for ultra-central lung tumors is associated with high toxicity rates.•To evaluate differences in radiosensitivity within the proximal bronchial tree (PBT), the PBT was sub-segmented into seven anatomical sections.•A risk-adapted SBRT regimen of EQD2_10 = 54.4 Gy in 8 or 10 fractions results in excellent local control and low rates of severe toxicity.•Data from a recent meta-analysis, the NORDIC Hilus trial and dosimetric data from this study were combined to create a NTCP model.•A dose threshold of EQD2_3 = 100 Gy to the PBT or any of its subsegments is expected to result in low rates of severe bronchial toxicity.