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Review
. 2024 Dec 11;16(24):4135.
doi: 10.3390/cancers16244135.

Recent Advances and Current Challenges in Stereotactic Body Radiotherapy for Ultra-Central Lung Tumors

Viola Salvestrini  1 , Andrea Lastrucci  1   2 , Marco Banini  3 , Mauro Loi  1 , Maria Grazia Carnevale  3 , Emanuela Olmetto  1 , Pietro Garlatti  1 , Gabriele Simontacchi  1 , Giulio Francolini  1 , Pierluigi Bonomo  1 , Yannick Wandael  2 , Isacco Desideri  3 , Renzo Ricci  2 , Daniele Giansanti  4 , Vieri Scotti  1 , Lorenzo Livi  1   3
Affiliations
Review

Recent Advances and Current Challenges in Stereotactic Body Radiotherapy for Ultra-Central Lung Tumors

Viola Salvestrini et al. Cancers (Basel). .

Abstract

Stereotactic body radiotherapy has been established as a viable treatment option for inoperable early-stage non-small cell lung cancer or secondary lesions mainly in oligoprogressive/oligometastatic scenarios. Treating lesions in the so-called "no flight zone" has always been challenging and conflicting data never cleared how to safely treat these lesions. This is truer considering ultra-central lesions, i.e., directly abutting or whose PTV is overlapping critical mediastinal organs. While historical retrospective data are abundant but mostly heterogenous in terms of the definition of ultra-central lesions, dosing regimens and outcomes, prospective data remain scarce, even though recently published studies have given new encouraging results for such delicate treatment scenarios. For this reason, we aimed to review and summarize current knowledge on stereotactic radiation treatment for ultra-central thoracic lesions, highlighting the most recent advances and the messages that can be taken from them. Lastly, we propose a workflow of the necessary steps to identify and treat such patients, therefore helping in elucidating the advantages and caveats of such treatment options.

Keywords: NSCLC; SBRT; oligometastasis; oligoprogression; ultra-central.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Treatment workflow of patients with ultra-central lung tumor.
Figure 2
Figure 2
The simulation phase for SBRT planning of Ultra-central Lung tumors.
See this image and copyright information in PMC

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