Resumen
We studied clinical aspects in central vs. peripheral tumors (n = 78 patients) and applied the internal organ at risk volume (IRV) concept (n = 35 patients) in stereotactic body radiation therapy (SBRT) for centrally located non-small cell lung cancer (NSCLC). We found lower biologically effective doses, larger planning target volume sizes, higher lung doses, and worse locoregional control for central tumors when compared with peripheral tumors. We here provide evidence that organ motion/volume changes could be more pronounced in males and tall patients, and less pronounced in cases of higher body mass index. Applying the IRV concept (retrospectively, without new optimization), the normal tissue complication probabilities increased >10% for the bronchial tree in three patients. This study emphasizes the need to optimize methods to balance dose escalation with toxicities in central tumors. Since recent studies have made efforts to further subclassify central tumors to refine treatment, the IRV concept should be considered for optimal risk assessment.