Top Line: Can SBRT be used to treat mediastinal nodes?
The Study: As much as we fret over using SBRT for ultracentral lung tumors overlapping with mediastinal structures, you would think SBRT for mediastinal nodes would be out of the question. This single-arm phase 2 trial from Italy evaluated the safety of using SBRT to treat oligometastatic mediastinal nodes. It included 32 patients with 41 mediastinal lymph nodes metastases. Eligible patients could have up to 3 mediastinal nodal oligomets and any primary histology, but most (40%) had NSCLC followed by breast (16%). The most common involved nodal stations were the hilum (39%) and paratracheal (29.4%). The targets consisted of the iGTV plus a 5mm margin, however targets were cropped out of adjacent organs at risk when necessary. OAR objectives were generally prioritized over PTV coverage, and 65.6% had compromised coverage to respect OAR objectives. Three different prescription doses could be used in a risk-adapted fashion including 50 Gy in 5 fractions (56.2%), 60 Gy in 8 fractions (31.3%), and 70 Gy in 10 fractions (12.5%). Toxicity was favorable with no acute or late grade 3+ toxicity. At 36 months, the rate of local progression was 18.7%.
TBL: In this phase 2 study, risk-adaptive SBRT for mediastinal lymph node metastases resulted in good disease control with mild toxicity. | Franceschini, Radiother Oncol 2024
The Study: As much as we fret over using SBRT for ultracentral lung tumors overlapping with mediastinal structures, you would think SBRT for mediastinal nodes would be out of the question. This single-arm phase 2 trial from Italy evaluated the safety of using SBRT to treat oligometastatic mediastinal nodes. It included 32 patients with 41 mediastinal lymph nodes metastases. Eligible patients could have up to 3 mediastinal nodal oligomets and any primary histology, but most (40%) had NSCLC followed by breast (16%). The most common involved nodal stations were the hilum (39%) and paratracheal (29.4%). The targets consisted of the iGTV plus a 5mm margin, however targets were cropped out of adjacent organs at risk when necessary. OAR objectives were generally prioritized over PTV coverage, and 65.6% had compromised coverage to respect OAR objectives. Three different prescription doses could be used in a risk-adapted fashion including 50 Gy in 5 fractions (56.2%), 60 Gy in 8 fractions (31.3%), and 70 Gy in 10 fractions (12.5%). Toxicity was favorable with no acute or late grade 3+ toxicity. At 36 months, the rate of local progression was 18.7%.
TBL: In this phase 2 study, risk-adaptive SBRT for mediastinal lymph node metastases resulted in good disease control with mild toxicity. | Franceschini, Radiother Oncol 2024