Challenging Cases in Lung SBRT-Challenging Cases in SBRT

Video Transcription

Video Summary

In today's webinar, on Challenging Cases in Lung SBRT, there were discussions on the management of ultracentral lesions, multiple lesions, repeat SBRT, and SBRT in the context of interstitial lung disease. For ultracentral tumors, there is increased risk of toxicity, especially pulmonary hemorrhage. Studies have shown varying rates of grade 3+ toxicity, ranging from 10% to 30%, with the risk being higher for tumors located near the main bronchus or trachea. It is important to adhere to dose constraints for organs at risk, including the bronchi, trachea, great vessels, and the esophagus. There is ongoing research to determine the optimal dosing fractionation scheme and dose constraints for ultracentral lung tumors. For patients with multiple lung lesions, the optimal treatment strategy can depend on various factors, including surgical resection, thermal ablation, systemic therapy, or SABR. Each case should be evaluated on an individual basis, considering patient factors, tumor characteristics, and treatment goals. When considering repeat SBRT for lung cancer recurrences, there is always a risk of toxicity. Studies have reported grade 3+ toxicity rates of 10%, mainly pneumonitis, but there have been rare cases of fatal hemorrhage. It is important to balance the potential benefits of local control with the risk of toxicity, especially in patients with comorbidities like interstitial lung disease. Ongoing research is needed to determine optimal dosing and fractionation schemes, as well as the role of systemic therapies in the context of repeat SBRT. In cases of early stage non-small cell lung cancer in the setting of interstitial lung disease, treatment decisions can be challenging. Surgeon resection may not be feasible due to decreased pulmonary reserve, and systemic therapies may be limited. SABR can be an option, but there is a risk of pulmonary toxicity and exacerbation of the underlying interstitial lung disease. The ASPIRE-ILD trial is studying the outcomes of SABR in patients with fibrotic interstitial lung diseases and early stage lung cancer. Multidisciplinary input is crucial in these cases to weigh the benefits and risks of different treatment options and to provide individualized care. Overall, the management of challenging cases in lung SBRT requires careful consideration of patient factors, tumor characteristics, and treatment goals to minimize toxicity and maximize treatment outcomes.

Keywords

Challenging Cases in Lung SBRT

ultracentral lesions

multiple lesions

repeat SBRT

interstitial lung disease

toxicity

dose constraints

lung tumors

systemic therapy

ASPIRE-ILD trial

treatment outcomes