Stereotactic Body Radiotherapy and Radiofrequency Ablation for Lung Tumors Near Central Airways

Inclusion criteria

• Histologically confirmed primary lung cancer, lung metastasis from another primary, or recurrent tumors in the setting of prior RFA or cryotherapy
• Tumors < 2 cm from trachea or zone of proximal bronchial tree (central tumors)
• Each tumor < 5 cm in size prior to treatment
• Medically inoperable patients as determined at the multidisciplinary thoracic tumor board, or medically operable patients who refuse surgery
• Criterion for medical inoperability include:

• Overall clinical assessment at the UCLA thoracic tumor board
• Reduced Pulmonary Function (FEV1, DLCO, etc) based on one major or two minor criterion as described below:
• Modified ACOSOG Criteria for medical inoperability:

• Major Criteria: FEV1% < 50% or < 1L and DLCO < 50%
• Minor Criteria: Age > 75, FEV1 51-60% predicted, or FEV1 1-1.2L, DLCO 51%-60% predicted, pulmonary hypertension, poor left ventricular function (EF < 40% or less), resting or exercise arterial pO2 < 55 mmHg, and pCO2 > 45 mmHg
• Age > 18 years old
• KPS > 70
• If a woman is of childbearing potential, a negative urine or serum pregnancy test must be documented.
• Ability to understand and the willingness to sign a written informed consent

Exclusion criteria

• Prior thoracic radiation near the targets of interest
• More than 2 central tumor targets per patient
• Active infections requiring systemic antibiotics