Is stereotactic body radiotherapy for ultra-central lung tumor a feasible option? A systemic review and meta-analysis

Chai Hong Rim, Young Kim, Chul Yong Kim, Won Sup Yoon, Dae-Sik Yang

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Introduction: Ultra-central (UC) tumors, which are generally defined as tumors directly abutting the proximal bronchial tree, are difficult to treat with stereotactic body radiotherapy (SBRT) owing to possible serious complications. This systemic review and meta-analysis analyzed the early experiences and evaluated the efficacy and feasibility of SBRT for UC tumors. Methods and materials: The present study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systemic searches of the EMBASE, PubMed, MEDLINE, and Cochrane library electronic databases were performed. The primary endpoints were two-year local control (LC), overall survival (OS), and grade ≥3 complication rates. A random-effects model was used to determine the pooled rates of the primary endpoints. Grade 5 complications were descriptively assessed. Results: Nine studies involving 291 patients with UC tumors who underwent SBRT were included. The pooled two-year LC, two-year OS, and grade ≥3 complication rates were 96.7% (95% confidence interval [CI]: 91.0–98.9), 57.7% (95% CI: 32.0–79.8), and 23.2% (95% CI: 11.8–40.5), respectively. The incidence of grade 5 complication was 0–22% and was 0% in three of eight available studies. Hemorrhage (68.2%) was the commonest fatal complication. The risk factors for fatal hemoptysis included anticoagulant use, excessive maximum irradiation dose, endobronchial involvement, squamous histology, and bevacizumab exposure. Conclusions: SBRT for UC tumors confers efficient LC, although the risk of complications was not negligible. Control of possible risk factors of hemorrhage and dose optimization through further studies are warranted.

Original languageEnglish
JournalInternational Journal of Radiation Biology
DOIs
Publication statusPublished - 2019 Jan 1

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Radiosurgery
Meta-Analysis
Lung
Confidence Intervals
Neoplasms
Hemorrhage
Survival
Hemoptysis
PubMed
MEDLINE
Anticoagulants
Libraries
Histology
Databases
Guidelines
Incidence

Keywords

  • central tumor
  • feasibility
  • lung cancer
  • Stereotactic body radiotherapy
  • ultra-central tumor

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging

Cite this

@article{571aa23ac8b2448b96ed8c4ee3df01c9,
title = "Is stereotactic body radiotherapy for ultra-central lung tumor a feasible option? A systemic review and meta-analysis",
abstract = "Introduction: Ultra-central (UC) tumors, which are generally defined as tumors directly abutting the proximal bronchial tree, are difficult to treat with stereotactic body radiotherapy (SBRT) owing to possible serious complications. This systemic review and meta-analysis analyzed the early experiences and evaluated the efficacy and feasibility of SBRT for UC tumors. Methods and materials: The present study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systemic searches of the EMBASE, PubMed, MEDLINE, and Cochrane library electronic databases were performed. The primary endpoints were two-year local control (LC), overall survival (OS), and grade ≥3 complication rates. A random-effects model was used to determine the pooled rates of the primary endpoints. Grade 5 complications were descriptively assessed. Results: Nine studies involving 291 patients with UC tumors who underwent SBRT were included. The pooled two-year LC, two-year OS, and grade ≥3 complication rates were 96.7{\%} (95{\%} confidence interval [CI]: 91.0–98.9), 57.7{\%} (95{\%} CI: 32.0–79.8), and 23.2{\%} (95{\%} CI: 11.8–40.5), respectively. The incidence of grade 5 complication was 0–22{\%} and was 0{\%} in three of eight available studies. Hemorrhage (68.2{\%}) was the commonest fatal complication. The risk factors for fatal hemoptysis included anticoagulant use, excessive maximum irradiation dose, endobronchial involvement, squamous histology, and bevacizumab exposure. Conclusions: SBRT for UC tumors confers efficient LC, although the risk of complications was not negligible. Control of possible risk factors of hemorrhage and dose optimization through further studies are warranted.",
keywords = "central tumor, feasibility, lung cancer, Stereotactic body radiotherapy, ultra-central tumor",
author = "Rim, {Chai Hong} and Young Kim and Kim, {Chul Yong} and Yoon, {Won Sup} and Dae-Sik Yang",
year = "2019",
month = "1",
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doi = "10.1080/09553002.2019.1552375",
language = "English",
journal = "International Journal of Radiation Biology",
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TY - JOUR

T1 - Is stereotactic body radiotherapy for ultra-central lung tumor a feasible option? A systemic review and meta-analysis

AU - Rim, Chai Hong

AU - Kim, Young

AU - Kim, Chul Yong

AU - Yoon, Won Sup

AU - Yang, Dae-Sik

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Ultra-central (UC) tumors, which are generally defined as tumors directly abutting the proximal bronchial tree, are difficult to treat with stereotactic body radiotherapy (SBRT) owing to possible serious complications. This systemic review and meta-analysis analyzed the early experiences and evaluated the efficacy and feasibility of SBRT for UC tumors. Methods and materials: The present study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systemic searches of the EMBASE, PubMed, MEDLINE, and Cochrane library electronic databases were performed. The primary endpoints were two-year local control (LC), overall survival (OS), and grade ≥3 complication rates. A random-effects model was used to determine the pooled rates of the primary endpoints. Grade 5 complications were descriptively assessed. Results: Nine studies involving 291 patients with UC tumors who underwent SBRT were included. The pooled two-year LC, two-year OS, and grade ≥3 complication rates were 96.7% (95% confidence interval [CI]: 91.0–98.9), 57.7% (95% CI: 32.0–79.8), and 23.2% (95% CI: 11.8–40.5), respectively. The incidence of grade 5 complication was 0–22% and was 0% in three of eight available studies. Hemorrhage (68.2%) was the commonest fatal complication. The risk factors for fatal hemoptysis included anticoagulant use, excessive maximum irradiation dose, endobronchial involvement, squamous histology, and bevacizumab exposure. Conclusions: SBRT for UC tumors confers efficient LC, although the risk of complications was not negligible. Control of possible risk factors of hemorrhage and dose optimization through further studies are warranted.

AB - Introduction: Ultra-central (UC) tumors, which are generally defined as tumors directly abutting the proximal bronchial tree, are difficult to treat with stereotactic body radiotherapy (SBRT) owing to possible serious complications. This systemic review and meta-analysis analyzed the early experiences and evaluated the efficacy and feasibility of SBRT for UC tumors. Methods and materials: The present study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Systemic searches of the EMBASE, PubMed, MEDLINE, and Cochrane library electronic databases were performed. The primary endpoints were two-year local control (LC), overall survival (OS), and grade ≥3 complication rates. A random-effects model was used to determine the pooled rates of the primary endpoints. Grade 5 complications were descriptively assessed. Results: Nine studies involving 291 patients with UC tumors who underwent SBRT were included. The pooled two-year LC, two-year OS, and grade ≥3 complication rates were 96.7% (95% confidence interval [CI]: 91.0–98.9), 57.7% (95% CI: 32.0–79.8), and 23.2% (95% CI: 11.8–40.5), respectively. The incidence of grade 5 complication was 0–22% and was 0% in three of eight available studies. Hemorrhage (68.2%) was the commonest fatal complication. The risk factors for fatal hemoptysis included anticoagulant use, excessive maximum irradiation dose, endobronchial involvement, squamous histology, and bevacizumab exposure. Conclusions: SBRT for UC tumors confers efficient LC, although the risk of complications was not negligible. Control of possible risk factors of hemorrhage and dose optimization through further studies are warranted.

KW - central tumor

KW - feasibility

KW - lung cancer

KW - Stereotactic body radiotherapy

KW - ultra-central tumor

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JO - International Journal of Radiation Biology

JF - International Journal of Radiation Biology

SN - 0955-3002

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