학술논문
Stereotactic body radiation therapy for mediastinal lymph node metastases: how do we fly in a 'no-fly zone'?
Document Type
Article
Author
Jereczek-Fossa, Barbara Alicja; Muto, Matteo; Durante, Stefano; Ferrari, Annamaria; Piperno, Gaia; Fodor, Cristiana; Comi, Stefania; Ricotti, Rosalinda; Garibaldi, Cristina; Dicuonzo, Samantha; Mazza, Stefano; Golino, Federica; Spaggiari, Lorenzo; De Marinis, Filippo; Orecchia, Roberto; Ciardo, Delia; Fossati, Piero
Source
Subject
*LUNG diseases
*ESOPHAGUS diseases
*CANCER relapse
*CHI-squared test
*FISHER exact test
*HISTOLOGICAL techniques
*LYMPH nodes
*METASTASIS
*PROBABILITY theory
*RADIATION doses
*RADIOSURGERY
*SURVIVAL
*LOGISTIC regression analysis
*TREATMENT effectiveness
*PROPORTIONAL hazards models
*RETROSPECTIVE studies
*DISEASE progression
*DISEASE risk factors
*PROGNOSIS
MEDIASTINAL tumors
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
Language
ISSN
0284-186X
Abstract
Purpose: To evaluate the treatment-induced toxicity (as primary endpoint) and the efficacy (as secondary endpoint) of stereotactic body radiation therapy (SBRT) in the treatment of mediastinal lymph nodes (LNs) in the so-called no-fly zone (NFZ) in cancers with various histology. Material and methods: Forty-two patients were retrospectively analyzed. Institutional dose/volume constraints for organs at risk (OARs) derived by published data were strictly respected. The correlation between treatment-related variables and toxicity was investigated by logistic regression, Chi-squared test or Fisher's exact test. Overall survival (OS), cause-specific survival (CSS), progression-free survival (PFS) and local control (LC) were collected from the follow-up reports. The impact of potential predictive factors on LC, PFS and OS were estimated by Cox proportional-hazard regression. Results: Median follow-up time was 16 months (range 1-41). Four patients had esophageal G1 toxicity. Ten and six patients had G1 and G2 pulmonary toxicity, respectively. Treatment site and irradiation technique were significantly correlated with G≥2 and G≥1 toxicity, respectively. OS probability at 19 months was 88.3% and corresponded to CSS. LC probability at 16 months was 66.3% (median LC duration: 22 months, range 1-41). Fifteen patients (35.7%) were disease-free at 25 months (median time, range 1-41). The biologically effective dose (BED) and the target dose coverage indexes were significantly correlated with LC. Conclusions: SBRT can be considered as a safe treatment option for selected patients with oligo-metastases/ recurrences in the NFZ, if strict dose/volume constraints are applied. [ABSTRACT FROM AUTHOR]