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@ARTICLE{Regnery:274461,
      author       = {S. Regnery and E. Katsigiannopulos and P. Hoegen and F.
                      Weykamp and E. Sandrini and T. Held and M. Deng and T.
                      Eichkorn and C. Buchele and C. Rippke and C. K. Renkamp and
                      L. König and K. Lang and M. Thomas and H. Winter and S.
                      Adeberg and S. Klüter and J. Debus$^*$ and J.
                      Hörner-Rieber$^*$},
      title        = {{T}o fly or not to fly: {S}tereotactic {MR}-guided adaptive
                      radiotherapy effectively treats ultracentral lung tumors
                      with favorable long-term outcomes.},
      journal      = {Lung cancer},
      volume       = {179},
      issn         = {0169-5002},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier},
      reportid     = {DKFZ-2023-00606},
      pages        = {107175},
      year         = {2023},
      note         = {#LA:E050#},
      abstract     = {Stereotactic radiotherapy of ultracentral lung tumors (ULT)
                      is challenging as it may cause overdoses to sensitive
                      mediastinal organs with severe complications. We aimed to
                      describe long-term outcomes after stereotactic magnetic
                      resonance (MR)-guided online adaptive radiotherapy (SMART)
                      as an innovative treatment of ULT.We analyzed 36 patients
                      that received SMART to 40 tumors between 02/2020 - 08/2021
                      inside prospective databases. ULT were defined by planning
                      target volume (PTV) overlap with the proximal bronchial tree
                      or esophagus. We calculated Kaplan Meier estimates for
                      overall survival (OS) and progression-free survival (PFS),
                      and competing risk estimates for the incidence of tumor
                      progression and treatment-related toxicities. ULT patients
                      (N = 16) were compared to non-ULT patients (N = 20).Baseline
                      characteristics were similar between ULT and non-ULT, but
                      ULT were larger (median PTV: ULT 54.7 cm3, non-ULT 19.2
                      cm3). Median follow-up was 23.6 months. ULT and non-ULT
                      showed a similar OS (2-years: ULT $67\%,$ non-ULT $60\%,$ p
                      = 0.7) and PFS (2-years: ULT $37\%,$ non-ULT $34\%,$ p =
                      0.73). Progressions occurred mainly at distant sites (2-year
                      incidence of distant progression: ULT $63\%,$ non-ULT
                      $61\%,$ p = 0.77), while local tumor control was favorable
                      (2-year incidence of local progression: ULT $7\%,$ non-ULT
                      $0\%,$ p = 0.22). Treatment of ULT led to significantly more
                      toxicities ≥ grade (G) 2 (ULT: 9 $(56\%),$ non-ULT: 1
                      $(5\%),$ p = 0.002). Most toxicities were moderate (G2). Two
                      ULT patients developed high-grade toxicities: 1) esophagitis
                      G3 and bronchial bleeding G4 after VEGF treatment, 2)
                      bronchial bleeding G3. Estimated incidence of high-grade
                      toxicities was $19\%$ $(3-48\%)$ in ULT, and no
                      treatment-related death occurred.Our small series supports
                      SMART as potentially effective treatment of ULT. SMART with
                      careful fractionation could reduce severe complications, but
                      treatment of ULT remains a high-risk procedure and needs
                      careful benefit-risk-assessment.},
      keywords     = {Image-guided radiotherapy (IGRT) (Other) / MR-guided
                      adaptive radiotherapy (Other) / Magnetic resonance imaging
                      (MRI) (Other) / Pulmonary cancer (Other) / Stereotactic body
                      radiotherapy (SABR) (Other)},
      cin          = {E050},
      ddc          = {610},
      cid          = {I:(DE-He78)E050-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36965207},
      doi          = {10.1016/j.lungcan.2023.03.011},
      url          = {https://inrepo02.dkfz.de/record/274461},
}