Stereotactic body radiation therapy (SBRT) for centrally located
primary and recurrent non-small cell lung cancer (NSCLC):
analysis of toxicity and local control
Nathan R. Bennion
Received: 12 September 2016 /Accepted: 2 November 2016 /Published online: 26 November 2016
Springer-Verlag Berlin Heidelberg 2016
Purpose/objectives Stereotactic body radiation therapy for
centrally located lung tumors has been associated with in-
creased risk of toxicity. A current study aims to evaluate tumor
control and toxicity in large cohort of centrally located lesions.
Methods Central location was defined as tumors within 2 cm
of the bronchial tree, trachea, major vessels, esophagus, heart,
pericardium, brachial plexus, or vertebral body. Tumors were
biopsy proven or PET positive and included recurrent or pri-
mary non-small cell lung cancer (NSCLC). A dose was pre-
scribed to a non-uniform planning target volume based on the
internal tumor volume constructed from a 4D CT scan
allowing for tumor motion. The treatment plans consisted of
non-coplanar static aperture arcs and non-coplanar static
fields. Treatments were delivered using 6MV X-rays with
Results At a median follow-up of 12.3 months, 107 total
NSCLC tumors were retrospectively reviewed. A cohort
consisted of primary (n = 57) and recurrent (n = 50) NSCLC
tumors with subset of recurrent lesions including 27 hilar or
mediastinal lymph nodes. Median and most frequent dose
were 45 Gy in four fractions treated once weekly. Estimated
2-year Kaplan-Meier survival was 81.7%, with a significant
survival advantage between primary and recurrent (p =0.003).
Eleven patients failed locally giving a 2-year actuarial local
control rate of 80.7%, with control rates of 82.5 and 79.2% for
primary and recurrent tumors, respectively (p =0.828).
Regional control at 2 years was not significantly different for
primary (72.6%) and recurrent (62.7%). Analysis of toxicity
revealed no grade 4 or 5 events. One grade 3 event was re-
ported as pneumonitis. Grade 2 toxicity occurred in 10 pa-
tients, including dyspnea (1), chest wall pain (2), pneumonitis
(4), rib fracture (1), and cough (2).
Conclusions Moderate prescription dosing, treated once
weekly, offers acceptable local control rates for centrally lo-
cated tumors including recurrent mediastinal and hilar lymph
nodes. Toxicity was minimal with the majority of patients
experiencing no treatment-related adverse events.
Keywords Stereotactic body radiation therapy (SBRT)
Surgical resection has long been the standard treatment for
early-stage non-small cell lung cancer (NSCLC) of the lung.
For inoperable patients, stereotactic body radiation therapy
(SBRT) has become a well-established definitive treatment
with a 3-year local control reported from 88 to 98% [1, 2].
One propensity-matched comparison between SBRT, lobecto-
my, and sublobar resection failed to show a statistically sig-
nificant difference in overall or lung cancer specific survival
. Interestingly, a pooled analysis from two prospective stud-
ies showed a statistically significant improvement in overall
survival with SBRT when compared to lobectomy as well as a
decrease in grade 3 or greater toxicity .
Early reports of SBRT, however, raised concerns about
treating centrally located tumors—classically defined as being
* John Bowers
Department of Radiosurgery, Riverside Regional Hospital, Newport
News, VA, USA
Department of Radiation Oncology, Baylor College of Medicine,
One Baylor Plaza, MS BCM 711, Houston, TX 77030, USA
Department of Radiation Oncology, University of Virginia Cancer
Center, Charlottesville, VA, USA
J Radiat Oncol (2017) 6:247–253