Survival and Prognostic Factors of Ultra-Central Tumors Treated with Stereotactic Body Radiotherapy

SIMPLE SUMMARY: Stereotactic body radiotherapy for tumors directly touching or overlapping the trachea, proximal bronchial tree, or esophagus may be a high-risk clinical scenario. Some prognostic factors may be associated with better survival for ultra-central (UC) tumors. Indeed, the present study reports that patients with larger tumor sizes, who are elderly, and male, treated for ultra-central lung tumors, report a worse significant overall survival [OS: 33 vs. 15 months (p 0.028), 40 vs. 23 months (p 0.005), 40 vs. 24 months (p 0.027), respectively]. Tumor locations further away from the hilus of the lung is associated with a better prognosis. ABSTRACT: Introduction: Stereotactic body radiotherapy (SBRT) reported excellent outcomes and a good tolerability profile in case of central lung tumors, as long as risk-adapted schedules were adopted. High grade toxicity was more frequently observed for tumors directly touching or overlapping the trachea, proximal bronchial tree (PBT), and esophagus. We aim to identify prognostic factors associated with survival for Ultra-Central (UC) tumors. Methods: We retrospectively evaluated patients treated with SBRT for primary or metastatic UC lung tumors. SBRT schedules ranged from 45 to 60 Gy. Results: A total number of 126 ultra-central lung tumors were reviewed. The Median follow-up time was 23 months. Median Overall Survival (OS) and Progression Free Survival (PFS) was 29.3 months and 16 months, respectively. Local Control (LC) rates at 1 and 2 were 86% and 78%, respectively. Female gender, age < 70 years, and tumor size < 5 cm were significantly associated with better OS. The group of patients with tumors close to the trachea but further away from the PBT also correlated with better OS. The acute G2 dysphagia, cough, and dyspnea were 11%, 5%, and 3%, respectively. Acute G3 dyspnea was experienced by one patient. Late G3 toxicity was reported in 4% of patients. Conclusion: risk-adaptive SBRT for ultra-central tumors is safe and effective, even if it remains a high-risk clinical scenario.