From the Guidelines
Ultra central lung cancer is defined as a tumor with a planning target volume that overlaps the trachea or main bronchi, posing significant challenges for treatment due to the high risk of toxicity. This definition is based on the guidelines provided by the European Society for Medical Oncology (ESMO) in their 2017 clinical practice guidelines for the diagnosis, treatment, and follow-up of non-small-cell lung cancer (NSCLC) 1. The International Association for the Study of Lung Cancer (IASLC) has also defined central tumors as those located within 2 cm in all directions of any mediastinal critical structure, including the bronchial tree, esophagus, heart, and major vessels 1. However, ultra central tumors are a distinct subgroup that requires special consideration due to their proximity to critical structures.
Key characteristics of ultra central lung cancer include:
- Location in the central chest, with involvement or adjacency to critical structures such as the trachea, main bronchi, or proximal bronchial tree
- High risk of toxicity from traditional radiation therapy due to the tumor's proximity to vital structures
- Often requires a multidisciplinary treatment approach, including chemotherapy, targeted therapy, immunotherapy, and carefully planned radiation therapy
- Surgical resection is frequently difficult or impossible due to the tumor's location
Treatment options for ultra central lung cancer are limited, and stereotactic body radiation therapy (SBRT) may be used with modified dosing schedules to minimize damage to surrounding tissues 1. However, the prognosis for ultra central lung cancer is generally poorer than for peripheral lung cancers due to both the advanced stage at diagnosis and the treatment limitations imposed by the tumor's proximity to critical structures.
From the Research
Definition of Ultra Central Lung Cancer
- Ultra central lung cancer refers to lung tumors that are located in a central or ultra-central location, abutting or overlapping critical organs such as the main bronchi, trachea, esophagus, heart, spinal cord, and brachial plexus 2, 3, 4, 5, 6.
- The planning target volume (PTV) of ultra-central tumors often overlaps with these critical organs, making treatment challenging and increasing the risk of toxicity 2, 4, 6.
Characteristics of Ultra Central Lung Tumors
- Ultra-central lung tumors are typically defined as tumors that directly abut or invade the proximal bronchial tree 4, 5, 6.
- These tumors can be difficult to treat with stereotactic body radiotherapy (SBRT) due to the risk of serious complications, such as bronchopulmonary hemorrhage 2, 5, 6.
- The location of ultra-central tumors near critical organs requires careful consideration of treatment planning to minimize the risk of toxicity 3, 4, 6.
Treatment of Ultra Central Lung Cancer
- Stereotactic body radiotherapy (SBRT) is a commonly used treatment option for ultra-central lung cancer, although the optimal treatment regimen is still a topic of debate 2, 3, 4, 5, 6.
- Hypofractionated radiotherapy regimens, such as 50 Gy in 5 fractions or 60 Gy in 8-12 fractions, have been used to treat ultra-central lung tumors, with varying degrees of success 2, 3, 4, 5, 6.
- The risk of toxicity, particularly bronchopulmonary hemorrhage, must be carefully considered when treating ultra-central lung tumors with SBRT 2, 5, 6.