Course book Advanced Treatment Planning 2018

DOSE CONSTRAINTS: PROX BRONCHIAL TREE

Bronchial tree / trachea (α/ß 3 Gy), potential side effects: fatal hemoptysis, fistula, stenosis, necrosis, atelectasis, pneumonia and abscess Reference Number of

Number of centres

Pro (p)-/ retro(r)- spective

Results (max. point dose or dose/fractionation and EqD2 in Gy provided if possible)

reported patients (treated tumours)

Timmerman (50)

70

1

p Central lesions: 11 times more likely to experience grade 3-5 lung toxicity than those with peripheral tumours, 1x local recurrence next to carina with subsequent fatal hemoptysis (19.5 months after SBRT) 3 x 20 -22 Gy = 60 - 66 Gy (EqD2: 276-330 Gy) # P 4 year results of above study: lung toxicity rates of 10.4% (peripheral) and 27.3% (central lesions), 1 x fatal hemoptysis (same as above), 3 patients died of pneumonia p 1 case of fatal hemoptysis, 70Gy, 10 fractions , hilar Dmax=83 Gy (EqD2: 187.6 Gy) r 2 cases of fatal hemoptysis, 47 Gy ( EqD2: 116 Gy) and 48 Gy ( EqD2: 121 Gy ), 5 fractions. Tumours were involving the hilum and encasing the left superior segmental bronchus, respectively. r Fatal hemoptysis in 2 cases with Dmax >50 Gy ( EqD2: 130 Gy ) to the pulmonary artery /bronchus (5 fractions regime) r 8 x partial or complete bronchial strictures, 1 x complete bronchial stricture with fatal consequences (bleeding, aspiration and pneumonia), 4 x 12 Gy = 48Gy ( EqD2: 144 Gy ) # r 1x fatal hemoptysis (bronchus received a cumulative dose of 98 Gy, EqD2 not applicable ) p 1x bronchial stenosis and successively fatal hemoptysis after stent insert, 4x15Gy=60Gy ( EqD2: 216 Gy) # r 1 x bronchial fistula, mainstem bronchus received a maximum point dose of 49 Gy ( EqD2 not applicable ) CFRT: EqD2 of 75-83 Gy predicting a 5% complication rate, 3 x fatal hemoptysis, 85 and 75 Gy, 25 fractions ( EqD2 118 and 90, respectively ), tumors encasing or abutting a mainstem or proximal lobar bronchus and partially local invasion of adjacent normal structures p r Central-airway necrosis, 5 x 10 Gy = 50 Gy ( EqD2: 130 Gy ) # r 1x fatal hemoptysis (re-re treatment: 1x 25 Gy; EqD2: 140 Gy ) #

Fakiris (59)

22

1

Li (60)

43 91

1 1

Modh (57)

Corradetti (52) Nishimura (61)

1

1 1

133

Song (51)

9

1

Milano (62) Oshiro (63)

53 21 17

1 1 1

Bral (36)

Unger (64)

17

1

Canon (65)

75*

1

Adebahr et al , BJR 2015

Recommendations/NT constraints Timmerman (66)

maximum point dose: 20.2 Gy (1 fraction regime – EqD2: 93.7 Gy )

German Cancer Consortium (DKTK)