title: Volumetric modulated arc therapy for thoracic node metastases: a safe and effective treatment for a neglected disease.
abstract: OBJECTIVE
  To evaluate the outcome of Stereotactic Body Radiation Therapy (SBRT) with Volumetric Modulated Arc Therapy (VMAT) for thoracic node metastases.
  
  
  RESULTS
  18 out of 29 patients presented with isolated thoracic node metastases with no other sites of disease. Median prescribed dose was 45Gy (range 30-60Gy).Acute toxicity was recorded as G0 in 28 patients, while one patient was scored as G1. Late toxicity was G0 in 26 patients, one patient was scored G1, one as G2, and one as G4 presented acute myocardial infarction.During follow up, the best local response was complete remission in 14 patients and partial remission in 11 patients. With a median follow up of 12 months (range 2-35) 9 patients died from disease progression, 10 were still alive with distant metastases, 5 had a locally controlled disease and 5 patients were disease free.The median OS estimated was 18 months (76%, 49% at one, two years). The median PFS was 9 months (28%, 17% at one, two years).
  
  
  METHODS
  Twenty-nine patients with 32 thoracic nodes metastases were treated with SBRT in our institution. Toxicities and response were assessed. Overall Survival (OS) and Progression Free Survival (PFS) were evaluated.
  
  
  CONCLUSIONS
  SBRT is an efficient treatment for thoracic node metastases.
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Franceschini
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Fiorenza
authors.initials: F
authors.lastname: De Rose
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Fogliata
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Piera
authors.initials: P
authors.lastname: Navarria
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ascolese
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Ciro
authors.initials: C
authors.lastname: Franzese
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Comito
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Tozzi
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Iftode
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Di Brina
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: D'Agostino
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Clerici
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.|Department of Biomedical Sciences, Humanitas University, 20089 Milan-Rozzano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cozzi
authors.affiliation: Humanitas Cancer Center and Research Hospital, Radiosurgery and Radiotherapy Department, 20089 Milan-Rozzano, Italy.|Department of Biomedical Sciences, Humanitas University, 20089 Milan-Rozzano, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Scorsetti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008198:Lymph Nodes / Q000473:pathology / Q000528:radiation effects*; D008207:Lymphatic Metastasis / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D058069:Neglected Diseases / Q000532:radiotherapy*; D011014:Pneumonia / Q000209:etiology; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013909:Thorax / Q000473:pathology / Q000528:radiation effects*; D055815:Young Adult
keywords: SBRT; mediastinal nodes; oligometastases