Toxicities of Organs at Risk in the Mediastinal and Hilar Regions Following Stereotactic Body Radiotherapy for Centrally Located Lung Tumors Shuichi.

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Toxicities of Organs at Risk in the Mediastinal and Hilar Regions Following Stereotactic Body Radiotherapy for Centrally Located Lung Tumors Shuichi Nishimura, MD, Atsuya Takeda, MD, PhD, Naoko Sanuki, MD, Satoshi Ishikura, MD, PhD, Yohei Oku, PhD, Yousuke Aoki, BMSc, Etsuo Kunieda, MD, PhD, Naoyuki Shigematsu, MD, PhD Journal of Thoracic Oncology Volume 9, Issue 9, Pages 1370-1376 (September 2014) DOI: 10.1097/JTO.0000000000000260 Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 1 Flow chart of the patients in this study. SBRT, stereotactic body radiotherapy; OARs, organs at risk. Journal of Thoracic Oncology 2014 9, 1370-1376DOI: (10.1097/JTO.0000000000000260) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 2 Typical computed tomography images of tumors adjacent to or invading the organs at risk in the central region. A, Aorta, (B) vena cava, (C) pulmonary artery (without bronchus), (D) pulmonary vein, (E) heart, (F) trachea and esophagus. Journal of Thoracic Oncology 2014 9, 1370-1376DOI: (10.1097/JTO.0000000000000260) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 3 Dose–volume histograms of the organs at risk in the central region. A, aorta, (B) bronchus, (C) esophagus, (D) heart, (E) pulmonary artery, (F) pulmonary vein, (G) trachea, (H) vena cava. The bold black lines represent three cases with hemoptysis, the dotted-lines represent two cases with obstructive pneumonia. Journal of Thoracic Oncology 2014 9, 1370-1376DOI: (10.1097/JTO.0000000000000260) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions

FIGURE 4 A patient with grade 5 hemoptysis after SBRT. A, Enhanced CT and (B) 18F-FDG PET/CT before SBRT suggest tumor invasion to the right pulmonary artery and right main bronchus. C, D, Planning CT with dose distribution curves of SBRT (axial and coronal images). A prescribed dose of 50 Gy was delivered in five fractions, with isodose lines from the outer to the inner representing 12.5, 25, 37.5, 50, and 56.3 Gy, respectively. E, Plain CT 16 months after SBRT and (F) 18F-FDG PET/CT 13 months after SBRT shows a complete response for the primary tumor. SBRT, stereotactic body radiation therapy; CT, computed tomography; 18F-FDG PET, [18F]-fluorodeoxyglucose positron emission. Journal of Thoracic Oncology 2014 9, 1370-1376DOI: (10.1097/JTO.0000000000000260) Copyright © 2014 International Association for the Study of Lung Cancer Terms and Conditions