810 / 1161
German Cancer Consortium (DKTK)
Bronchial tree / trachea
(α/ß 3 Gy), potential side effects: fatal hemoptysis, fistula, stenosis, necrosis, atelectasis, pneumonia and abscess
Reference
Number of
reported patients
(treated tumours)
Number
of
centres
Pro (p)-/
retro(r)-
spective
Results (max. point dose or dose/fractionation and EqD2 in Gy provided if possible)
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)
#
Fakiris (59)
22
1
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
Li (60)
43
1
p
1 case of fatal hemoptysis, 70Gy, 10 fractions , hilar Dmax=83 Gy
(EqD2: 187.6 Gy)
Modh (57)
91
1
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.
Corradetti (52)
1
1
r
Central-airway necrosis, 5 x 10 Gy = 50 Gy (
EqD2: 130 Gy
)
#
Nishimura (61)
133
1
r
Fatal hemoptysis in 2 cases with Dmax >50 Gy (
EqD2: 130 Gy
) to the pulmonary artery /bronchus
(5 fractions regime)
Song (51)
9
1
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
)
#
Milano (62)
53
1
r
1x fatal hemoptysis (bronchus received a cumulative dose of 98 Gy,
EqD2 not applicable
)
Oshiro (63)
21
1
r
1x fatal hemoptysis (re-re treatment: 1x 25 Gy;
EqD2: 140 Gy
)
#
Bral (36)
17
1
p
1x bronchial stenosis and successively fatal hemoptysis after stent insert, 4x15Gy=60Gy (
EqD2:
216 Gy)
#
Unger (64)
17
1
r
1 x bronchial fistula, mainstem bronchus received a maximum point dose of 49 Gy (
EqD2 not
applicable
)
Canon (65)
75*
1
p
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
Recommendations/NT constraints
Timmerman
(66)
maximum point dose: 20.2 Gy (1 fraction regime –
EqD2: 93.7 Gy
)
DOSE CONSTRAINTS:
PROX BRONCHIAL TREE
Adebahr et al , BJR 2015