% IMPORTANT: The following is UTF-8 encoded.  This means that in the presence
% of non-ASCII characters, it will not work with BibTeX 0.99 or older.
% Instead, you should use an up-to-date BibTeX implementation like “bibtex8” or
% “biber”.

@ARTICLE{Eichkorn:212542,
      author       = {T. Eichkorn and J. W. Lischalk and C. Stüwe and E.
                      Tonndorf-Martini and K. Schubert and L.-A. Dinges and S.
                      Regnery and F. Bozorgmehr and L. König and P. Christopoulos
                      and J. Hörner-Rieber and S. Adeberg and K. Herfarth and H.
                      Winter and M. Thomas and S. Rieken and J. Debus$^*$ and R.
                      A. El Shafie},
      title        = {{H}igh-risk patients with locally advanced non-small cell
                      lung cancer treated with stereotactic body radiation therapy
                      to the peripheral primary combined with conventionally
                      fractionated volumetric arc therapy to the mediastinal lymph
                      nodes.},
      journal      = {Frontiers in oncology},
      volume       = {12},
      issn         = {2234-943X},
      address      = {Lausanne},
      publisher    = {Frontiers Media},
      reportid     = {DKFZ-2023-00227},
      pages        = {1035370},
      year         = {2023},
      abstract     = {A very narrow therapeutic window exists when delivering
                      curative chemoradiotherapy for inoperable locally advanced
                      non-small cell lung cancer (NSCLC), particularly when large
                      distances exist between areas of gross disease in the
                      thorax. In the present study, we hypothesize that a novel
                      technique of stereotactic body radiation therapy (SBRT) to
                      the primary tumor in combination with volumetric arc therapy
                      (VMAT) to the mediastinal lymph nodes (MLN) is a suitable
                      approach for high-risk patients with large volume
                      geographically distant locally advanced NSCLC.In this single
                      institutional review, we identified high-risk patients
                      treated between 2014 and 2017 with SBRT to the parenchymal
                      lung primary as well as VMAT to the involved MLN using
                      conventional fractionation. Dosimetrically, comparative
                      plans utilizing VMAT conventionally fractionated delivered
                      to both the primary and MLN were analyzed. Clinically,
                      toxicity (CTCAE version 5.0) and oncologic outcomes were
                      analyzed in detail.A total of 21 patients were identified,
                      $86\%$ (n=18) of which received chemotherapy as a portion of
                      their treatment. As treatment phase was between 2014 and
                      2017, none of the patients received consolidation
                      immunotherapy. Target volume (PTV) dose coverage (99 vs.
                      $87\%)$ and CTV volume (307 vs. 441 ml) were significantly
                      improved with SBRT+MLN vs. for VMAT alone (p<0.0001).
                      Moreover, low-dose lung (median V5Gy $[\%]:$ 71 vs. 77,
                      p<0.0001), heart (median V5Gy $[\%]:$ 41 vs. 49, p<0.0001)
                      and esophagus (median V30Gy $[\%]:$ 54 vs. 55, p=0.03) dose
                      exposure were all significantly reduced with SBRT+MLN. In
                      contrast, there was no difference observed in high-dose
                      exposure of lungs, heart, and spinal cord. Following
                      SBRT+MLN treatment, we identified only one case of
                      high-grade pneumonitis. As expected, we observed a higher
                      rate of esophagitis with a total of seven patients
                      experience grade 2+ toxicity. Overall, there were no grade
                      4+ toxicities identified. After a median 3 years follow up,
                      disease progression was observed in $70\%$ of patients
                      irradiated using SBRT+MLN, but never in the spared
                      'bridging' tissue between pulmonary SBRT and mediastinal
                      VMAT.For high risk patients, SBRT+MLN is dosimetrically
                      feasible and can provide an alternative to dose reductions
                      necessitated by otherwise very large target volumes.},
      keywords     = {dosimetric comparison (Other) / high-risk patients (Other)
                      / locally advanced non-small cell lung cancer (NSCLC)
                      (Other) / peripherally located NSCLC (Other) / pulmonary
                      toxicity (Other) / radiation therapy (Other)},
      cin          = {E050 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)E050-20160331 / I:(DE-He78)HD01-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36713565},
      pmc          = {pmc:PMC9880536},
      doi          = {10.3389/fonc.2022.1035370},
      url          = {https://inrepo02.dkfz.de/record/212542},
}