<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_raon-2020-0022_s_006_w2aab3b7b7b1b6b1aab1c16b1Aa"><h3>Background</h3><p>Lung transplantation is a life-saving treatment for patients with end stage lung disease. There may be a higher incidence of lung cancer in lung transplant recipients, and these cancers tend to be diagnosed at a more advanced stage. There is very little data on the safety and efficacy of stereotactic body radiation therapy (SBRT) for lesions in the native lung in lung-transplant recipients.</p></sec><sec id="j_raon-2020-0022_s_007_w2aab3b7b7b1b6b1aab1c16b2Aa"><h3>Patients and methods</h3><p>A retrospective chart review of all patients who have undergone lung transplantation and were treated with SBRT for lung cancer in the native lung in the Davidoff Cancer Center was performed.</p></sec><sec id="j_raon-2020-0022_s_008_w2aab3b7b7b1b6b1aab1c16b3Aa"><h3>Results</h3><p>Four patients who were treated with SBRT to a total of 5 lesions were included. Two patients were treated without histological confirmation of malignancy. All cases were discussed in a multidisciplinary tumor board before being referred for radiotherapy. Standard SBRT dosing was used. Responses were assessed by imaging. Three lesions exhibited a complete response and two lesions had a partial response. The patients who had partial responses developed distant metastases and died shortly. No patient developed measurable toxicity.</p></sec><sec id="j_raon-2020-0022_s_009_w2aab3b7b7b1b6b1aab1c16b4Aa"><h3>Conclusions</h3><p>SBRT is effective and safe for the management of lung cancer in lung-transplant patients. Standard dose and fractionation can be used.</p></sec></abstract>

BackgroundLung transplantation is a life-saving treatment for patients with end stage lung disease. There may be a higher incidence of lung cancer in lung transplant recipients, and these cancers tend to be diagnosed at a more advanced stage. There is very little data on the safety and efficacy of stereotactic body radiation therapy (SBRT) for lesions in the native lung in lung-transplant recipients.Patients and methodsA retrospective chart review of all patients who have undergone lung transplantation and were treated with SBRT for lung cancer in the native lung in the Davidoff Cancer Center was performed.ResultsFour patients who were treated with SBRT to a total of 5 lesions were included. Two patients were treated without histological confirmation of malignancy. All cases were discussed in a multidisciplinary tumor board before being referred for radiotherapy. Standard SBRT dosing was used. Responses were assessed by imaging. Three lesions exhibited a complete response and two lesions had a partial response. The patients who had partial responses developed distant metastases and died shortly. No patient developed measurable toxicity.ConclusionsSBRT is effective and safe for the management of lung cancer in lung-transplant patients. Standard dose and fractionation can be used.

Stereotactic body radiation therapy (SBRT) for the treatment of primary lung cancer in recipients of lung transplant

Radiology and Oncology

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

BackgroundLung transplantation is a life-saving treatment for patients with end stage lung disease. There may be a higher incidence of lung cancer in lung...

	Case 1	Case 1	Case 2	Case 3	Case 4
	1^st course	2^nd course
Prescribed dose (Gy), number of fractions	54 Gy, 3	54 Gy, 3	60 Gy, 5	54 Gy, 3	60 Gy, 5
MLD – both lungs (Gy)	3.3	3.6	4.4	2.5	6
V5 – both lungs, (%)	15.6	21.5	18.9	10.2	27.1
V20 – both lungs, (%)	4.9	3.2	5.7	2.9	8
MLD – transplanted lung (Gy)	4.5	0.8	2.2	0.6	1.8
V5 – transplanted lung, (%)	20.4	1.4	9.6	0.1	6.1
V20 – transplanted lung, (%)	7	0	2.3	0	0

Organ	Constraints
Total Lung Dose (both lungs)	V20 < 10%
Spinal Cord	Max dose < 18 Gy
Esophagus	Dose to 1cc < 27 Gy
Heart	Dose to 1cc < 30 Gy

Stereotactic body radiation therapy (SBRT) for the treatment of primary lung cancer in recipients of lung transplant

Article Category: Research Article

Published Online: Apr 17, 2020

Page range: 227 - 232

Received: Dec 21, 2019

Accepted: Feb 29, 2020

DOI: https://doi.org/10.2478/raon-2020-0022

© 2020 Assaf Moore, Mordechai R. Kramer, Dror Rosengarten, Osnat Shtraichman, Alona Zer, Elizabeth Dudnik, Yasmin Korzets, Aaron M. Allen, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Figure 2

Figure 3

SBRT treatment parameters

Dose-volume histogram constraints for organs at risk