Outcome and safety of SBRT in centrally and ultra-centrally located lung tumours: A PRISMA-based systematic review and Meta-Analysis.

Abstract

<h4>Introduction</h4>Stereotactic Body Radiation Therapy (SBRT) offers a curative treatment option for patients with early-stage central and ultra-central lung tumours, however can be associated with severe side effects. This review provides a structured quantitative evaluation of outcomes and safety in these critical locations, therefore offering safety-oriented evidence to support individualised treatment planning.<h4>Methods</h4>Pubmed/MEDLINE was searched with the term ["Carcinoma, Non-Small-Cell Lung"[Mesh] AND ("Radiosurgery"[Mesh] OR "SABR" OR "stereotactic ablative radiotherapy" OR "SBRT" OR "stereotactic body radiotherapy")] according to PRISMA-guidelines. Trials reporting on SBRT in central and ultra-central lung tumours and on outcome parameters were included. A <i>meta</i>-analysis of proportions was performed using random-effect models.<h4>Results</h4>57 retrospective and 12 prospective trials were included, encompassing in total 3,672 and 1,509 patients with central and ultra-central lung tumours. The median follow-up was 22.7 (range: 10.6 - 93.6) months for centrally and 21.2 (8.6 - 93.6) months for ultra-centrally located tumours. For ultra-central lesions the median overall survival was 28.0 (12.0 - 64.5) months compared to 39.4 (19.0 - 57.0) months in central lesions with highest efficacy of SBRT with 60 Gy in 8 fractions. Overall, pooled grade 3-5 toxicity was low for both localizations. The most frequently reported fatal complication in ultra-centrally vs. centrally located tumours was haemorrhage with an estimated proportion of 0.48% [range: 0 - 14.89; CI 95% = 0.00 - 1.68] vs. 0.12% [range: 0 - 7.09; CI 95% = 0.00 - 0.46].<h4>Conclusion</h4>SBRT with 60 Gy in 8 fractions provides a feasible and safe curative treatment approach for patients with centrally and ultra-centrally located lung tumours.