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The First Reported Case of Treating the Ultra-Central Thorax With Cone Beam Computed Tomography-Guided Stereotactic Adaptive Radiotherapy (CT-STAR).
Zhao, Stephanie; Beckert, Robbie; Zhao, Xiaodong; Laugeman, Eric; Robinson, Clifford G; Vlacich, Gregory; Samson, Pamela P; Schiff, Joshua P.
Afiliación
  • Zhao S; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Beckert R; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Zhao X; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Laugeman E; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Robinson CG; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Vlacich G; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Samson PP; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
  • Schiff JP; Department of Radiation Oncology, Washington University School of Medicine, St. Louis, USA.
Cureus ; 16(6): e62906, 2024 Jun.
Article en En | MEDLINE | ID: mdl-39040774
ABSTRACT
Stereotactic body radiotherapy (SBRT) to the central and ultra-central thorax is associated with infrequent but potentially serious adverse events. Adaptive SBRT, which provides more precise treatment planning and inter-fraction motion management, may allow the delivery of ablative doses to ultra-central tumors with effective local control and improved toxicity profiles. Herein, we describe the first reported case of cone beam computed tomography (CBCT)-guided stereotactic adaptive radiotherapy (CT-STAR) in the treatment of ultra-central non-small cell lung cancer (NSCLC) in a prospective clinical trial (NCT05785845). An 80-year-old man with radiographically diagnosed early-stage NSCLC presented for definitive management of an enlarging ultra-central lung nodule. He was prescribed 55 Gy in five fractions with CT-STAR. A simulation was performed using four-dimensional CT, and patients were planned for treatment at end-exhale breath-hold. Treatment plans were generated using a strict isotoxicity approach, which prioritized organ at risk (OAR) constraints over target coverage. During treatment, daily CBCTs were acquired and used to generate adapted contours and treatment plans based on the patient's anatomy-of-the-day, all while the patient was on the treatment table. The initial and adapted plans were compared using dose-volume histograms, and the superior plan was selected for treatment. The adapted plan was deemed superior and used for treatment in three out of five fractions. The adapted plan provided improved target coverage in two fractions and resolved an OAR hard constraint violation in one fraction. We report the successful treatment of a patient with ultra-central NSCLC utilizing CT-STAR. This case report builds on previously published in silico data to support the viability and dosimetric advantages of CT-STAR in the ablative treatment of this challenging tumor location. Further data are needed to confirm the toxicity and efficacy of this technique.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Cureus Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Cureus Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos