Single-fraction stereotactic ablative body radiation therapy for primary and metastasic lung tumor: A new paradigm?

Table 2 Single fraction stereotactic ablative body radiotherapy for pulmonary metastases

Ref.	Study design	Total lesions (n)/LM (n)	Mean, Dose Gy (range)/Location	SABR technique/prescription	Mean GTV (cc) (range) failing this, cm	FU (mo), median	LC	Toxicity ≥ GIII	Comments
Nakagawa et al[11]	P	22/12	22.8 (18-25)1/NR	Rotational or StaticTherapy 3D-CRT. Abdominal compression/PTV enclosing isodose.	4.8 (0.8-13)	10	100%1	0	Non actuarial LC
Hara et al[26]	P	59/48	30(20-34)/Periph	Static 3D-CRT. Gating/Minimal dose to GTV	5 (1-19)	12(mean)	1-yr 93%	1 GIII	LC 52% < 30 Gy
									LC 83% ≥ 30 Gy
									P = 0.068
							2-yr 78%
Wulf et al[54]	R	92/31	26/Central	Static 3D-CRT. Abdominal compression/65-80%-isodose enclosing PTV	NR	14	100%	NR	SF data are shown
Fritz et al[53]	P	64/31	30/Periph	Static 3D-CRT. Abdominal compression/Isocenter, 90% isodose enclosing GTV, 80% isodose enclosing PTV	Median: 6 (2.8-55.8)1	221	5-yr 80%1	0	No difference LC and OS LM vs primary lung cancer
Le et al [29]	Phase I	32/11	22.34 (15-30)/Periph	Cyberknife. Gold fiducials.Breathold or Synchrony (Accuray) respiratory tracking system / Isodose coverage: 95% of PTV	Median: 17.1 (2-103)	18	1-yr 91% (≥ 20 Gy)	1 GIII (pn)	LC primary vs LM: 78% vs 58%
									And OS (85% vs 56%)
							1-yr 54% (< 20 Gy)	3 GV (central)
									Higher toxicity in central tumors
Hof et al [63]	P	0/71	24.35 (12-30)/NR	Static 3D-CRT. Abdominal compression/Isocenter: 80% isodose enclosing PTV	10 (1-53)	14	1-yr 88.6%	3 GIII (pn)	LC 3 yr 78% 26-30 Gy
							2-yr 73.7%
							3-yr 63.1%
Gandhidasan et al [56]	R	186/95	18/Central26 or 28/Periph	Static 3D-CRT or IMRT/80% isodose enclosing PTV	NR	22	2yr 84%	0
Osti et al [57]	P	0/103	23Gy/Central30 Gy/Periph	Static 3D-CRT. 4DCT. 80% isodose enclosing PTV	NR	15	Central vs peripheral:1-yr 79.4% vs 94.7%	2 GIII (pn)	Prognostic factors for LC: sex and histology
							Global: 1-yr 89.1%, 2-yr 82.1%
Filippi et al[58]	R	0/90	26Gy/Periph	Static 3D-CRT or IMRT or VMAT. Abdominal compression/80% isodose enclosing PTV	< 5 cm	24	1-yr 93.4%	8 GII-IIIlate radiological toxicity	They suggest not to use a SF in lesions close to the chest wall
							2-yr 88.1%
								6 GII-IIIchest wall toxicity
Siva et al [44]	R	0/41	18/Central26/Periph	Static 3D-CRT or IMRT or VMAT. /70-80% isodose enclosing PTV	< 5 cm	25	2-yr 93%	0	LC, OS and toxicity rates between SF and multi-fraction SABR
Osti et al [59]	R	0/166	30/Periph	Static 3D-CRT. 4DCT/95% isodose enclosing PTV	3.46 (0.03-47.48)	38	3-yr 80.1%	6 GIII (pn)	Lesions ≤ 15 mm from mediastinum were not included in the study
								11 GIIIlung fibrosis
							5-yr 79.2%
								1 GV at 15 mm PBT
Sharma et al [61]	R	32	30/Periph	Cyberknife. Radiopaque markers Tumor traking.70-90% isodose enclosing PTV	< 3 cm	22	2-yr 68%	No details for SF	BED10 < 100, delivery of pre-SBRT chemo. and synchronous metastasis: independently < LC
							3-yr 63%
							4-yr 59%
Sogono et al [60]	R	167 (95% peripher)	16-18/Central26-28/Periph	Static 3D-CRT or IMRT or VMAT. 4DCT/99% isodose enclosing PTV	NR	37	1-yr 96%	NR	Several locations
							2-yr 92%
							5-yr 92%
Siva et al[55]	Phase II	133	28/NR	Static 3D-CRT or IMRT or VMAT. Abdominalo compression/70-80% isodose enclosing PTV	2.2 cm (mean)	12	1-yr 93%	2 GIII	Preliminary results (TROG 13.01 SAFRON II)
									1-3 metastases non-central targets < 5 cm

¹Data refer to subgroup pulmonary metastases; when not specified otherwise, data refer to the whole series.

FU: Follow up; LC: Local control; OS: Overall survival; G: Grade; LM: Lung metastases; P: Prospective; R: Retrospective; NR: No reported; pn: Pneumonitis; periph: Peripheral; 3D-CRT: Tridimensional conformal radiotherapy. 4DCT: Four-dimensional CT; IMRT: Intensity-modulated radiotherapy; VMAT: Volumetric-modulated arc therapy.