Stereotactic Radiation for Ultra-Central Lung Tumors: Good Idea, or Ultra-Risky?

The dangers of treating patients with stereotactic ablative radiation therapy (SABR) for tumors in the "No Fly Zone" have been recognized for more than a decade.1 In 2006, a paradigm-changing phase 2 trial reported excessive toxicity with SABR doses of 60 to 66 Gy in 3 fractions for tumors within 2 cm of the proximal bronchial tree (PBT). The 2-year freedom from severe toxicity was only 54% for patients with central tumors, compared with 83% for those with peripheral tumors.1

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