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Liu F, Ververs JD, Farris MK, Blackstock AW, Munley MT. Optimal Radiation Therapy Fractionation Regimens for Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2024; 118:829-838. [PMID: 37734445 DOI: 10.1016/j.ijrobp.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 08/04/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE A series of radiobiological models were developed to study tumor control probability (TCP) for stereotactic body radiation therapy (SBRT) of early-stage non-small cell lung cancer (NSCLC) per the Hypofractionated Treatment Effects in the Clinic (HyTEC) working group. This study was conducted to further validate 3 representative models with the recent clinical TCP data ranging from conventional radiation therapy to SBRT of early-stage NSCLC and to determine systematic optimal fractionation regimens in 1 to 30 fractions for radiation therapy of early-stage NSCLC that were found to be model-independent. METHODS AND MATERIALS Recent clinical 1-, 2-, 3-, and 5-year actuarial or Kaplan-Meier TCP data of 9808 patients from 56 published papers were collected for radiation therapy of 2 to 4 Gy per fraction and SBRT of early-stage NSCLC. This data set nearly triples the original HyTEC sample, which was used to further validate the HyTEC model parameters determined from a fit to the clinical TCP data. RESULTS TCP data from the expanded data set are well described by the HyTEC models with α/β ratios of about 20 Gy. TCP increases sharply with biologically effective dose and reaches an asymptotic maximal plateau, which allows us to determine optimal fractionation schemes for radiation therapy of early-stage NSCLC. CONCLUSIONS The HyTEC radiobiological models with α/β ratios of about 20 Gy determined from the fits to the clinical TCP data for SBRT of early-stage NSCLC describe the recent TCP data well for both radiation therapy of 2 to 4 Gy per fraction and SBRT dose and fractionation schemes of early-stage NSCLC. A steep dose response exists between TCP and biologically effective dose, and TCP reaches an asymptotic maximum. This feature results in model-independent optimal fractionation regimens determined whenever safe for SBRT and hypofractionated radiation therapy of early-stage NSCLC in 1 to 30 fractions to achieve asymptotic maximal tumor control, and T2 tumors require slightly higher optimal doses than T1 tumors. The proposed optimal fractionation schemes are consistent with clinical practice for SBRT of early-stage NSCLC.
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Affiliation(s)
- Feng Liu
- Department of Radiation Oncology, Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
| | - James D Ververs
- Department of Radiation Oncology, Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Michael K Farris
- Department of Radiation Oncology, Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - A William Blackstock
- Department of Radiation Oncology, Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Michael T Munley
- Department of Radiation Oncology, Wake Forest University School of Medicine and Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
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Shin J, Kober K, Yates P, Wong ML, Cooper BA, Paul SM, Hammer M, Conley Y, Levine JD, Wright F, Miaskowski C. Higher Lifetime Stress and Symptom Burden Contribute to the Occurrence of Shortness of Breath. Semin Oncol Nurs 2023; 39:151471. [PMID: 37500312 DOI: 10.1016/j.soncn.2023.151471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/10/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES Among four classes of patients with distinct shortness of breath profiles, evaluate for differences in levels of global, cancer-specific, and cumulative life stress, as well as resilience; evaluate for differences in the occurrence rates for various stressful life events, and evaluate for differences in the severity of common co-occurring symptoms. DATA SOURCES Outpatients (N = 1338) completed questionnaires six times over two cycles of chemotherapy. The occurrence of shortness of breath was assessed using the Memorial Symptom Assessment Scale. Latent class analysis was used to identify subgroups of patients with distinct shortness of breath profiles. Differences among the classes were evaluated using parametric and nonparametric tests. CONCLUSION Shortness of breath classes were labeled based on their distinct occurrence trajectories: None (70.5%), Decreasing (8.2%), Increasing (7.8%), and High (13.5%). Compared to None class, Decreasing and High classes had higher global and cancer-specific stress scores. The High class reported higher occurrence rates for several adverse childhood experiences. Compared to None class, Decreasing and High classes had higher depression, anxiety, and morning fatigue scores and lower morning energy and cognitive function scores. IMPLICATIONS FOR NURSING PRACTICE Given the additive or synergistic relationships between stress, co-occurring symptoms, and shortness of breath, multimodal interventions that include stress management, exercise training, and/or symptom management may decrease shortness of breath in oncology patients.
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Affiliation(s)
- Joosun Shin
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Kord Kober
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Melisa L Wong
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, San Francisco, California
| | - Marilyn Hammer
- The Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Yvette Conley
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jon D Levine
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Fay Wright
- Rory Meyers College of Nursing, New York University, New York, New York
| | - Christine Miaskowski
- Departments of Physiological Nursing and Anesthesia, School of Nursing and School of Medicine, University of California, San Francisco, California.
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Fan S, Zhang Q, Chen J, Chen G, Zhu J, Li T, Xiao H, Du S, Zeng Z, He J. Comparison of long-term outcomes of stereotactic body radiotherapy (SBRT) via Helical tomotherapy for early-stage lung cancer with or without pathological proof. Radiat Oncol 2023; 18:49. [PMID: 36890550 PMCID: PMC9996902 DOI: 10.1186/s13014-023-02229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Stereotactic body radio therapy (SBRT) has emerged as a standard treatment option for nonsurgical candidates with early-stage non-small cell lung cancer (NSCLC). Pathological proof is sometimes difficult to obtain in patients with solitary pulmonary nodules (SPNs). We aimed to compare the clinical outcomes of stereotactic body radiotherapy via helical tomotherapy (HT-SBRT) for early-stage lung cancer patients with or without a pathological diagnosis. METHODS Between June 2011 and December 2016, we treated 119 lung cancer patients with HT-SBRT, including 55 with a clinical diagnosis and 64 with a pathological diagnosis. Survival outcomes, including local control (LC), progression-free survival (PFS), cancer-specific survival (CSS), and overall survival (OS), were compared between two cohorts with and without a pathological diagnosis. RESULTS The median follow-up for the whole group was 69 months. Patients with a clinical diagnosis were significantly older (p = 0.002). No significant differences were observed between the clinical and pathological diagnosis cohorts in terms of the long-term outcome, with 5-year LC, PFS, CSS, and OS of 87% versus 83% (p = 0.58), 48% versus 45% (p = 0.82), 87% versus 84% (p = 0.65), and 60% versus 63% (p = 0.79), respectively. Recurrence patterns and toxicity were also similar. CONCLUSIONS Empiric SBRT appears to be a safe and effective treatment option in a multidisciplinary setting when patients with SPNs highly suggestive of malignancy are unable/refuse to obtain a definitive pathological diagnosis.
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Affiliation(s)
- Shaonan Fan
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Qi Zhang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jingyao Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Gang Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jiangyi Zhu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Tingting Li
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Han Xiao
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Shisuo Du
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jian He
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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Shin J, Kober K, Wong ML, Yates P, Miaskowski C. Systematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients. Crit Rev Oncol Hematol 2023; 181:103870. [PMID: 36375635 DOI: 10.1016/j.critrevonc.2022.103870] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/31/2022] [Accepted: 11/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Dyspnea is a common and distressing symptom for oncology patients.However, dyspnea is not well-characterized and often underestimated by clinicians. This systematic review summarizes the prevalence, intensity, distress, and impact of dyspnea in oncology patients and identifies research gaps. METHODS A search of all of the relevant databases was done from 2009 to May 2022. A qualitative synthesis of the extant literature was performed using established guidelines. RESULTS One hundred-seventeen studies met inclusion criteria. Weighted grand mean prevalence of dyspnea in patients with advanced cancer was 58.0%. Intensity of dyspnea was most common dimension evaluated, followed by the impact and distress. Depression and anxiety were the most common symptoms that co-occurred with dyspnea. CONCLUSION Numerous methodologic challenges were evident across studies. Future studies need to use valid and reliable measures; evaluate the impact of dyspnea; and determine biomarkers for dyspnea.
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Affiliation(s)
- Joosun Shin
- School of Nursing, University of California, San Francisco, CA, USA.
| | - Kord Kober
- School of Nursing, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Melisa L Wong
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA; Division of Hematology/Oncology, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Patsy Yates
- Cancer & Palliative Outcomes Centre, Centre for Health Transformation, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia; School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Christine Miaskowski
- School of Nursing, University of California, San Francisco, CA, USA; School of Medicine, University of California, San Francisco, CA, USA; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
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Duan Y, Lin Y, Wang H, Kang B, Feng A, Ma K, Chen H, Huang Y, Gu H, Shao Y, Zhou T, Kong Q, Xu Z. How Does the Gradient Measure of the Lung SBRT Treatment Plan Depend on the Tumor Volume and Shape? Front Oncol 2021; 11:781302. [PMID: 34869034 PMCID: PMC8636139 DOI: 10.3389/fonc.2021.781302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose Gradient measure (GM) is a critical index related to normal tissue sparing in radiosurgery. This study aims to describe the dependence of GM on target volume and target shape for lung stereotactic body radiation therapy (SBRT) treatment plans. Methods A total of 307 peripheral and 119 central lung SBRT treatment plans were enrolled for this study. A least-squares regression was used for data analysis. First, the equations with different functional forms were established to determine the dependence of GM on a univariaty (VP or Sp) and bivariaty (VP and Sp), respectively. Then, the correlation coefficients and p-values of variables for all equations were compared and analyzed to determine the dependence of GM on PTV volume (VP) and sphericity (Sp). Results The power equations had the highest coefficient of determination (R2) in the dependence results of GM on univariate VP. The equations were GM = 0.674 V P 0.178 and GM = 0.660 V P 0.185 for peripheral and central lesions, respectively. On the other hand, the R2 of all functional forms were less than 0.25 when the relationship of GM versus univariate Sp was analyzed. Similarly, the power equation also obtained the highest R2 in bivariaty VP and Sp analysis, whether for central or peripheral. However, the R2 of the bivariate equations were not improved compared with those of univariate equations. Moreover, the p-values of the variable Sp were greater than 0.05. Conclusions The GM of the lung SBRT plan is shape-independent and volume-dependent. The dependence of GM on PTV volume for peripheral and central lung cancer can be described by two different power equations. The results of this study can be used as a potential tool to assist dosimetric quality control during the radiosurgery process.
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Affiliation(s)
- Yanhua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yang Lin
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Bodong Kang
- Pekoe Team, MIM Software Inc., Cleveland, OH, United States
| | - Aihui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Kui Ma
- Clinical Helpdesk, Varian Medical Systems, Beijing, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hengle Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Tao Zhou
- Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - Zhiyong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Yang Y, Li G, Li S, Wang Y, Zhao Y, Dong B, Wang J, Zhu R, Chen M. CT Appearance Pattern After Stereotactic Body Radiation Therapy Predicts Outcomes in Early-Stage Non-Small-Cell Lung Cancer. Front Oncol 2021; 11:746785. [PMID: 34707992 PMCID: PMC8542883 DOI: 10.3389/fonc.2021.746785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/27/2021] [Indexed: 12/25/2022] Open
Abstract
Backgrounds Computed tomography (CT) appearance pattern after lung tumor stereotactic body radiation therapy(SBRT) might predicts survival. This study aimed to investigate the correlation between CT appearance pattern after SBRT and outcomes in patients with early-stage non-small-cell lung cancer (NSCLC). Methods Clinical data of inoperable patients with early-stage NSCLC undergoing SBRT were retrospectively analyzed from 2012 to 2015 at the Zhejiang Cancer Hospital. The relationship between CT appearance pattern after SBRT and patient’s survival was analyzed. Results The data from 173 patients with early-stage lung cancer treated with SBRT were analyzed. One month after SBRT, diffuse consolidation was seen in 17 patients, patchy consolidation in 28 patients, diffuse ground-glass opacity (GGO) in 10 patients, and patchy GGO in 22 patients. The survival time was significantly longer in the “no evidence of increased density” group compared with the “consolidation or GGO” group [2-year overall survival (OS) rate, 96.1% vs 89.3%; hazard ratio (HR), 0.36; 95% confidence interval (CI), 0.16–0.85; P = 0.015]. A similar trend was found in the progression-free survival (PFS) analysis (2-year PFS rate, 91.3% vs 85.0%; HR, 0.35; 95% CI, 0.13–0.95; P = 0.015) and distant metastasis free survival(DMFS) (2-year DMFS rate, 93.3% vs 87.1%; HR, 0.41; 95% CI, 0.20–0.86; P = 0.031). However, no significant difference was found in recurrence-free survival between the two groups (P = 0.212). Conclusions One month after SBRT, the radiological change “no evidence of increased density” was prevalent. The OS, PFS, and DMFS were significantly longer in the “no evidence of increased density” group compared with the “consolidation or GGO” group. Further studies are needed to validate these findings.
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Affiliation(s)
- Yan Yang
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Gaohua Li
- Department of Neurology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Shuyuan Li
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Yuanhang Wang
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Yanbo Zhao
- Department of Radiation Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China.,Department of Medical Oncology, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Baiqiang Dong
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Jin Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Cancer and Basic Medicine (ICBM), Chinese Academy of Sciences, Hangzhou, China
| | - Ruiwu Zhu
- Department of Thoracic Surgery, General Hospital of Fushun Mining Bureau of Liaoning Health Industry Group, Fushun, China
| | - Ming Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, Guangzhou, China
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Duan Y, Zhou L, Wang H, Chen H, Gu H, Shao Y, Feng A, Huang Y, Fu X, Yue NJ, Ma K, Kong Q, Xu Z. A novel CRT-IMRT-combined (Co-CRIM) planning technique for peripheral lung stereotactic body radiotherapy in pinnacle treatment planning system. J Appl Clin Med Phys 2021; 22:97-107. [PMID: 34699670 PMCID: PMC8664147 DOI: 10.1002/acm2.13461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 09/27/2021] [Accepted: 10/10/2021] [Indexed: 12/31/2022] Open
Abstract
Objectives This study attempts to explore a novel peripheral lung stereotactic body radiotherapy (SBRT) planning technique that can balance the pros and cons of three‐dimensional conformal radiotherapy (CRT) and intensity‐modulated radiation therapy (IMRT) / volumetric modulated arc therapy (VMAT). Methods Treatment plans were retrospectively designed based on CRT, IMRT, VMAT, and the proposed CRT‐IMRT‐combined (Co‐CRIM) techniques using Pinnacle treatment planning system (TPS) for 20 peripheral lung cancer patients. Co‐CRIM used an inverse optimization algorithm available in Pinnacle TPS. To develop a Co‐CRIM plan, the number of segments in each field was limited to one, the minimum segment area was set to the internal target volume (ITV), and the minimum monitor units (MU) of the segment was the quotient of fractional dose divided by twice the number of total fields. The performance of Co‐CRIM was then compared with other techniques. Results For conformity index (CI), Co‐CRIM performed comparably to IMRT/VMAT but better than CRT. For gradient index (GI), Co‐CRIM was similar to IMRT/VMAT or CRT. For heterogeneity index (HI), Co‐CRIM was comparable to IMRT/VMAT, higher than CRT. The dosimetric results of spinal cord and lung with Co‐CRIM were better than CRT, comparable to IMRT, but inferior to VMAT. The MU resulted from Co‐CRIM was lower than IMRT/VMAT but higher than CRT. For plan verification γ passing rate, Co‐CRIM was higher than IMRT/VMAT, comparable to CRT. For planning time, Co‐CRIM was shorter than CRT or VMAT but similar to IMRT. Conclusions The proposed Co‐CRIM technique on Pinnacle TPS is an effective planning technique for peripheral lung SBRT.
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Affiliation(s)
- YanHua Duan
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - LiJun Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hao Wang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Hua Chen
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - HengLe Gu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Shao
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - AiHui Feng
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Huang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - XiaoLong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ning Jeff Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Jersey, USA
| | - Kui Ma
- Clinical helpdesk, Varian Medical Systems, Beijing, China
| | - Qing Kong
- Institute of Modern Physics, Fudan University, Shanghai, China
| | - ZhiYong Xu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Concurrent versus sequential chemoradiotherapy for unresectable locally advanced stage III non-small cell lung cancer: Retrospective analysis in a single United Kingdom cancer centre. Cancer Treat Res Commun 2021; 29:100460. [PMID: 34598059 DOI: 10.1016/j.ctarc.2021.100460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stage III unresectable locally advanced non-small cell lung cancer (NSCLC) is a complex disease group with poor long-term survival. Clinical data suggests curative intent concurrent chemoradiotherapy (CCRT) is superior to a sequential (SCRT) approach but comes with additional toxicities. We report real world data regarding overall survival and toxicity to aid clinical decision making in balancing optimal management and treatment tolerability. METHODS Retrospective analysis of survival data, treatment toxicities, and rates of treatment completion were performed for 241 patients who underwent chemoradiotherapy for unresectable stage III NSCLC within Leeds Cancer Centre from January 2011 to December 2014. RESULTS Median survival was 18.8 months following SCRT compared to 22.7 months following CCRT HR 0.90 (95% CI 0.67-1.20, P = 0.46). Median follow up was 21 months. The clinical benefit rate for CCRT compared to SCRT was 22.7% versus 24%. In the CCRT group 63.8% patients completed treatment compared to 46% in the SCRT arm (P < 0.01). 90-day mortality rates were low in CCRT and SCRT cohorts at 4.3% and 1% respectively. There was greater pulmonary toxicity following CCRT versus SCRT (13.5% versus 1.0%, P < 0.01). CONCLUSION This study provides real world data regarding the radical treatment of unresectable stage III NSCLC. Increased hospital admissions and pneumonitis toxicities did not adversely affect treatment completion for those undergoing CCRT; this was likely due to careful patient selection based on performance status. SCRT still remains an important treatment modality for patients who cannot tolerate the upfront CCRT approach but could still be treated with curative intent.
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Koh TL, Ong WL, Farrugia B, Leong T, Lapuz C, Lim A. To biopsy or not to biopsy? Outcomes following stereotactic body radiotherapy (SBRT) for biopsy-confirmed versus radiologically-diagnosed primary lung cancer in a single Australian institution. Asia Pac J Clin Oncol 2021; 18:319-325. [PMID: 34187094 DOI: 10.1111/ajco.13614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Obtaining tissue diagnosis for lung cancer can sometimes be difficult and unsafe. We evaluated outcomes of biopsy-confirmed versus radiologically-diagnosed lung cancer treated with stereotactic body radiotherapy (SBRT). METHODS A single-institutional retrospective cohort of lung cancer patients treated with SBRT between February 2014 and October 2018. Outcomes of interest were: local failure (LF), distant failure (DF), and overall survival (OS). Probability of LF, DF, and OS were estimated using the Kaplan-Meier method. Differences in outcomes between biopsy-confirmed versus radiologically-diagnosed lung cancer were evaluated using the log-rank test. RESULTS Sixty-five lung lesions in 61 patients were treated with SBRT. Mean age was 75.6 years. Twenty-seven patients (44.3%) were ECOG 2-3. Thirty-nine patients (64%) were radiologically-diagnosed. There were five cases of LF observed at median of 12.8 months post-SBRT and 12-month LF-free survival was 96% (95% CI, 86-99%), with no differences between groups (p = 0.1). Sixteen patients developed DF, with 12-month DF-free survival of 84% (95% CI, 71-91%), and no difference between groups (p = 0.06). Sixteen deaths were reported at a median of 12.5 months post-SBRT, with 12-month OS of 85% (95% CI, 73-92%), and no differences between study groups (p = 0.5). No grade 3 toxicities were reported. CONCLUSION The oncological outcomes were similar in patients with early lung cancer treated with SBRT with or without biopsy-confirmation. In situations where tissue diagnosis is not feasible or unsafe, it is not unreasonable to offer SBRT based on clinical and radiological suspicion following multidisciplinary discussions.
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Affiliation(s)
- Tze Lui Koh
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Wee Loon Ong
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Center for Digital Transformation of Health, The University of Melbourne, Melbourne, VIC, Australia.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Briana Farrugia
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Tracy Leong
- Department of Respiratory Medicine, Austin Health, Heidelberg, VIC, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Carminia Lapuz
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
| | - Adeline Lim
- Department of Radiation Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia
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Saha A, Beasley M, Hatton N, Dickinson P, Franks K, Clarke K, Jain P, Teo M, Murray P, Lilley J. Can dosimetry affect local control and survival in patients with early-stage lung cancer treated with Stereotactic Ablative Radiotherapy (SABR)? An analysis of the UK's largest cohort of lung SABR patients. Acta Oncol 2021; 60:505-512. [PMID: 33491521 DOI: 10.1080/0284186x.2021.1874617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/06/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE/OBJECTIVES A recent study has shown that tight conformity of lung Stereotactic Ablative Radiotherapy (SABR) plans might worsen loco-regional control and can predict distant metastases. The study aims to report overall survival (OS), progression-free survival (PFS), local recurrence free survival (LRFS), and dosimetry of early-stage lung cancer patients treated with SABR and to try to explore any dosimetric predictor of outcomes. MATERIAL AND METHODS Patients treated in our institute (May 2009-August 2018) were included. Electronic medical records were reviewed for baseline characteristics, treatment details, and outcomes. Dosimetric data were extracted from Xio and Monaco software. Patients were treated according to the United Kingdom (UK) SABR consortium guidelines. Kaplan-Meier's analysis with log-rank test was used for survival analysis. The univariate and multivariable Cox regression model was used for correlating dosimetric variables and outcomes. RESULTS We treated 1266 patients with median age of 75 years and 47.4% were male. Median follow up was 56 months. Median OS was 36 months with 1, 2, and 5 years OS of 84.2%, 64.5%, and 31.5%, respectively. Median for PFS and LRFS was not reached. One, 2, and 5 years PFS were 87.4%, 78.4%, and 72.5%, respectively. One, 2, and 5 years LRFS were 98.2%, 95.1%, and 92.5%, respectively. Planning target volume (PTV), dose to 99% volume of PTV (D99), and R50 (volume receiving the 50% dose/volume (PTV)) were significantly associated with OS. PTV, mean lung dose (MLD), V20 (volume of lung minus gross tumour volume (GTV) receiving 20 Gy), V12.5 (volume of lung minus GTV receiving 12.5 Gy), and dose fractionation were significantly associated with PFS. Nothing was associated with LRFS on univariate analysis. R100 of >1.1 was associated with better OS, PFS, and LRFS compared to R100 ≤ 1.1. CONCLUSION SABR achieves good clinical outcomes in patients with early-stage lung cancer; even in elderly patients with multiple comorbidities. In the largest UK early lung cancer cohort treated with SABR, we found that dosimetry correlates with clinical outcomes. Further validation of these results is needed to guide future optimisation of SABR delivery.
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Affiliation(s)
- Animesh Saha
- Department of Oncology, Apollo Gleneagles Cancer Hospital, Kolkata, India
| | - Matthew Beasley
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Nathaniel Hatton
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Peter Dickinson
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Kevin Franks
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Katy Clarke
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Pooja Jain
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Mark Teo
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - Patrick Murray
- Department of Oncology, Leeds Teaching Hospitals, NHS trust, Leeds, UK
| | - John Lilley
- Department of Medical Physics, Leeds Teaching Hospitals, NHS trust, Leeds, UK
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11
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Yuan XS, Chen WC, Lin QR, Liu YJ, Zhu YY, Sun XJ, Wu QY, Liu JS, Xu YP. A propensity-matched analysis of stereotactic body radiotherapy and sublobar resection for stage I non-small cell lung cancer in patients at high risk for lobectomy: the results in a Chinese population. J Thorac Dis 2021; 13:1822-1832. [PMID: 33841971 PMCID: PMC8024811 DOI: 10.21037/jtd-21-339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background To investigate the comparative effectiveness of stereotactic body radiotherapy (SBRT) and sublobar resection (SLR) in patients with stage I non-small cell lung cancer (NSCLC) considered to be high-risk lobectomy patients. Methods From January 2012 to December 2015, patients who underwent SBRT or SLR for clinical stage I NSCLC were examined retrospectively. Propensity score matching (PSM) was performed to reduce selection bias in SBRT and SLR patients. Results Data from 86 SBRT and 79 SLR patients was collected. Median follow-up periods of the SBRT and SLR groups were 32 and 37 months, respectively. Patients treated with SBRT exhibited significantly higher age, higher likelihood of being male, larger tumor diameter, lower forced expiratory volume in 1 second (FEV1), and poorer performance status compared with SLR patients. There were no significant differences between SBRT and SLR patients for 3-year overall survival (OS) (80.3% and 82.3%, P=0.405), cause-specific survival (CSS) (81.3% and 83.4%, P=0.383), and local control (LC) (89.7% and 86.0%, P=0.501). Forty-nine patients were identified from each group after performing PSM. After patients were matched for age, gender, performance status, tumor characteristics and pulmonary function, no significant differences were observed in 3-year OS (85.4% and 73.3%, P=0.649), CSS (87.2% and 74.9%, P=0.637) and LC (95.6% and 82.1%, P=0.055). Prevalence of significant adverse events (grade 3 or worse) was 0% and 10.2% in the matched SBRT and SLR groups (P=0.056), respectively. Conclusions Disease control and survival in the SBRT patients was equivalent to that seen in SLR patients with stage I NSCLC considered high-risk lobectomy candidates. SBRT could therefore be an alternative option to SLR in treating patients with a high operative risk.
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Affiliation(s)
- Xiao-Shuai Yuan
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Wu-Cheng Chen
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Qing-Ren Lin
- Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yuan-Jun Liu
- Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Yao-Yao Zhu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Xiao-Jiang Sun
- First Clinical Medical School, Wenzhou Medical University, Wenzhou, China
| | - Qiong-Ya Wu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China
| | - Jin-Shi Liu
- Department of Thoracic Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
| | - Ya-Ping Xu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital Tongji University, Shanghai, China.,First Clinical Medical School, Wenzhou Medical University, Wenzhou, China.,Department of Radiation Oncology, Cancer Hospital, University of Chinese Academy of Sciences, Hangzhou, China
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12
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Saha A, Beasley M, Hatton N, Dickinson P, Franks K, Clarke K, Jain P, Teo M, Murray P, Lilley J. Clinical and dosimetric predictors of radiation pneumonitis in early-stage lung cancer treated with Stereotactic Ablative radiotherapy (SABR) - An analysis of UK's largest cohort of lung SABR patients. Radiother Oncol 2021; 156:153-159. [PMID: 33333139 DOI: 10.1016/j.radonc.2020.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stereotactic Ablative Radiotherapy (SABR) is the standard treatment for early-stage medically inoperable lung cancer. Predictors of radiation pneumonitis (RP) in patients treated with SABR are poorly defined. In this study, we investigate clinical and dosimetric parameters, which can predict symptomatic RP in early-stage lung cancer patients treated with SABR. MATERIALS AND METHODS Patients treated with lung SABR between May 2009 and August 2018, in a single United Kingdom (UK) radiotherapy center were included. The patient's baseline characteristics, treatment details, and toxicity were retrieved from the electronic medical record. Dosimetric data was extracted from Xio and Monaco treatment planning systems. Patients were treated according to the UK SABR consortium guidelines. RP was graded retrospectively using Common Terminology Criteria for Adverse Events (CTCAE) version 4.0, based on available clinical and imaging information. Univariate and multivariate binary logistic regression was performed to determine predictive factors for grade ≥ 2 radiation pneumonitis, using Statistical Package for the Social Sciences (SPSS) statistics version 21 software. The goodness of fit was assessed using the Hosmer and Lemeshow test. The optimal diagnostic threshold was tested using the Receiver operating characteristics (ROC) curve. The chi-square test was carried out to test the different risk factors against the likelihood of developing grade ≥ 2 pneumonitis. RESULTS A total of 1266 patients included in the analysis. The median age of patients was 75 years. Six hundred sixty-six patients (52.6%) were female. Median follow up was 56 months. Sixty-five percent of patients received 55 Gy in 5 fractions. Forty-three percent of patients had Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 2 and 16.2% had PS of 3. The Median Charlson comorbidity index was 6 (range 2-11). Median Standardized Uptake Value (SUV) max of the tumor was 6.5. Four hundred two patients (31.8%) had confirmed histological diagnosis; other patients were treated based on a radiological diagnosis. The median tumor size was 20 mm (range 4 mm-63 mm). Median Planning Target Volume (PTV) was 30.3 cc. Median values of R100, R50, and D2cm were 1.1, 5.6, 32.8 Gy. The median value of mean lung dose, V20, and V12.5 were 3.9 Gy, 5 %and 9.3% respectively. Eighty-five (6.7%) patients developed symptomatic RP (grade ≥ 2) with only 5(0.4%) developing grade 3 RP. Five percent of patients developed rib fractures but only 28% of these were symptomatic. On univariate analysis lower lobe tumor location, larger tumor size, PTV, mean lung dose, lung V20Gy, and V12.5 Gy were significantly associated with grade ≥ 2 RP. On multivariate analysis, only mean lung dose was associated with grade ≥ 2 pneumonitis. ROC curve analysis showed optimal diagnostic threshold for tumour size, PTV, mean lung dose, V20 and V12.5; are 22.5 mm ((Area Under Curve (AUC)-0.565)), 27.15 cc (AUC-0.58), 3.7 Gy (AUC-0.633), 4.6% (AUC-0.597), 9.5% (AUC-0.616). The incidence of ≥grade 2 RP was significantly high for values higher than the ROC threshold. CONCLUSION SABR treatment resulted in a very low rate of grade 3 pneumonitis. Lower lobe tumor location, larger tumor size, PTV, mean lung dose, V20, and V12.5 were found to be significant predictors of symptomatic radiation pneumonitis.
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Affiliation(s)
- Animesh Saha
- Department of Oncology, Apollo Gleneagles Cancer Hospital, Kolkata, India.
| | - Matthew Beasley
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Nathaniel Hatton
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Peter Dickinson
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Kevin Franks
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Katy Clarke
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Pooja Jain
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Mark Teo
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Patrick Murray
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - John Lilley
- Department of Medical Physics, St James's University Hospital, Leeds, UK
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13
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Sahin B, Atalar B, Kaytan Saglam E, Akgun Z, Abacioglu U, Arifoglu A, Ozyar E, Yaprak G, Ozseker Isik N, Guney Y, Caglar HB, Karaman S, Igdem S, Selek U, Berber T, Oner Dincbas F, Sengoz M, Yucel S, Demiral AN, Akyurek S. Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study. CLINICAL RESPIRATORY JOURNAL 2020; 14:1050-1059. [PMID: 32749053 DOI: 10.1111/crj.13240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/30/2020] [Accepted: 07/27/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey. MATERIALS AND METHODS We retrospectively analyzed 431 patients with stage I-II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an α/β ratio of 10 (BED10 ); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity. RESULTS Median follow-up time was 27 months (range 1-115); median SABR dose was 54 Gy (range 30-70) given in a median three fractions (range 1-10); median BED10 was 151 Gy (range 48-180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and <1 cm from mediastinal structures in 77 (17.9%). Response was evaluated with PET/CT in most cases at a median 3 months after SABR. Response rates were: 48% complete, 36.7% partial, 7.9% stable and 7.4% progression. LC rates were 97.1% at 1 year, 92.6% at 2 years and 91.2% at 3 years; corresponding OS rates were 92.6%, 80.6% and 72.7%. On multivariate analysis, BED10 > 100 Gy (P = .011), adenocarcinoma (P = .025) and complete response on first evaluation (P = .007) predicted favorable LC. BED10 > 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1-3.2, P = .019) and tumor size (<2 cm HR 1.9, 95% CI 1.3-3, P = .003) predicted favorable OS. No grade 4-5 acute side effects were observed; late effects were grade ≤3 pneumonitis (18 [4.2%]), chest wall pain (11 [2.5%]) and rib fracture (1 [0.2%]). CONCLUSION SABR produced encouraging results, with satisfactory LC and OS and minimal toxicity. BED10 > 120 Gy was needed for better LC and OS for large, non-adenocarcinoma tumors.
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Affiliation(s)
- Bilgehan Sahin
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Banu Atalar
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Esra Kaytan Saglam
- Radiation Oncology Department, Istanbul University Institute of Oncology, Istanbul, Turkey.,Radiation Oncology Department, Memorial Şişli Hospital, Istanbul, Turkey
| | - Zuleyha Akgun
- Radiation Oncology Department, Memorial Şişli Hospital, Istanbul, Turkey
| | - Ufuk Abacioglu
- Radiation Oncology Department, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Alptekin Arifoglu
- Radiation Oncology Department, Acıbadem Altunizade Hospital, Istanbul, Turkey
| | - Enis Ozyar
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Gokhan Yaprak
- Radiation Oncology Department, University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Naciye Ozseker Isik
- Radiation Oncology Department, University of Health Sciences Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Yıldız Guney
- Radiation Oncology Department, Memorial Ankara Hospital, Ankara, Turkey
| | - Hale Basak Caglar
- Radiation Oncology Department, Anadolu Medical Center John Hopkins International, Istanbul, Turkey
| | - Sule Karaman
- Radiation Oncology Department, Istanbul University Institute of Oncology, Istanbul, Turkey
| | - Sefik Igdem
- Faculty of Medicine, Radiation Oncology Department, Bilim University, Istanbul, Turkey
| | - Ugur Selek
- Radiation Oncology Department, School of Medicine, Koc University, Istanbul, Turkey.,MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Tanju Berber
- Radiation Oncology Department, University of Health Sciences, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Fazilet Oner Dincbas
- Faculty of Medicine, Radiation Oncology Department, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Meric Sengoz
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Serap Yucel
- Faculty of Medicine, Radiation Oncology Department, Acıbadem MAA University, Istanbul, Turkey
| | - Ayşe Nur Demiral
- Faculty of Medicine, Radiation Oncology Department, Dokuz Eylül University, Izmir, Turkey
| | - Serap Akyurek
- Faculty of Medicine, Radiation Oncology Department, Ankara University, Ankara, Turkey
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14
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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15
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Varela G, Novoa NM. Definitive radiation for early stage lung cancer: who is medically inoperable? ANNALS OF TRANSLATIONAL MEDICINE 2020; 7:S361. [PMID: 32016079 DOI: 10.21037/atm.2019.09.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gonzalo Varela
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Nuria M Novoa
- Thoracic Surgery Service, Salamanca University Hospital and School of Medicine, Salamanca, Spain
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16
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Dautruche A, Filion E, Mathieu D, Bahig H, Roberge D, Lambert L, Vu T, Campeau MP. To Biopsy or Not to Biopsy?: A Matched Cohort Analysis of Early-Stage Lung Cancer Treated with Stereotactic Radiation with or Without Histologic Confirmation. Int J Radiat Oncol Biol Phys 2020; 107:88-97. [PMID: 32004581 DOI: 10.1016/j.ijrobp.2020.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 01/11/2020] [Accepted: 01/21/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE For nonoperable stage I non-small cell lung cancer, stereotactic body radiation therapy (SBRT) has emerged as a standard treatment option. We aimed to compare the clinical outcomes of lung SBRT between patients with versus without pathologic cancer diagnosis. METHODS AND MATERIALS We included patients treated by SBRT for a single pulmonary lesion between July 2009 and July 2017. Patients in the clinical diagnosis group had a positron emission tomography/computed tomography scan showing hypermetabolism, growth of the mass on sequential computed tomography, and were not eligible for biopsy, refused biopsy, or had an inconclusive biopsy. For each of those patients, a matched pair in the pathologic diagnosis group was identified by matching for patient, treatment, and tumoral characteristics. We performed a power calculation to estimate the sample size required to detect a difference arising from a 5% or 15% rate of benign processes in the group without pathology. RESULTS A total of 924 lung SBRT treatments were performed among 878 patients from 2009 to 2017. Within this population, 131 patients were treated based on clinical findings. They were matched with 131 patients with a pathologic diagnosis who received treatment. At 3 years, no significant differences were observed in overall survival (hazard ratio [HR], 1.2; 95% confidence interval [CI], 0.7-2.1), local control (HR, 0.9; 95% CI, 0.4-2), or regional (HR, 0.5; 95% CI, 0.2-1.4) or distant recurrence (HR, 0.6; 95% CI, 0.3-1.1). CONCLUSIONS In our population, we found no clinically significant difference in patterns of recurrence or survival after lung SBRT for patients who had received clinical versus pathological diagnoses. There was, however, a trend toward more distant recurrences in the pathologic diagnosis group. Our power calculation suggests that data from multiple institutions would be required to rule out a difference in outcomes due to 5% to 15% of clinically diagnosed cases being treated for benign processes.
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Affiliation(s)
| | - Edith Filion
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | | | - Houda Bahig
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - David Roberge
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Louise Lambert
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
| | - Toni Vu
- Centre hospitalier de l'Université de Montréal, Quebec, Canada
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17
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Radiation-induced lung injury patterns and the misdiagnosis after SBRT of lung cancer. Eur J Radiol 2019; 121:108708. [DOI: 10.1016/j.ejrad.2019.108708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/29/2019] [Accepted: 10/08/2019] [Indexed: 12/25/2022]
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18
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Dissaux G, Visvikis D, Da-Ano R, Pradier O, Chajon E, Barillot I, Duvergé L, Masson I, Abgral R, Santiago Ribeiro MJ, Devillers A, Pallardy A, Fleury V, Mahé MA, De Crevoisier R, Hatt M, Schick U. Pretreatment 18F-FDG PET/CT Radiomics Predict Local Recurrence in Patients Treated with Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer: A Multicentric Study. J Nucl Med 2019; 61:814-820. [PMID: 31732678 DOI: 10.2967/jnumed.119.228106] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
The aim of this retrospective multicentric study was to develop and evaluate a prognostic 18F-FDG PET/CT radiomic signature in early-stage non-small cell lung cancer patients treated with stereotactic body radiotherapy (SBRT). Methods: Patients from 3 different centers (n = 27, 29, and 8) were pooled to constitute the training set, whereas the patients from a fourth center (n = 23) were used as the testing set. The primary endpoint was local control. The primary tumor was semiautomatically delineated in the PET images using the fuzzy locally adaptive Bayesian algorithm, and manually in the low-dose CT images. In total, 184 Image Biomarkers Standardization Initiative-compliant radiomic features were extracted. Seven clinical and treatment parameters were included. We used ComBat to harmonize radiomic features extracted from the 4 institutions relying on different PET/CT scanners. In the training set, variables found significant in the univariate analysis were fed into a multivariate regression model, and models were built by combining independent prognostic factors. Results: Median follow-up was 21.1 mo (range, 1.7-63.4 mo) and 25.5 mo (range, 7.7-57.8 mo) in training and testing sets, respectively. In univariate analysis, none of the clinical variables, 2 PET features, and 2 CT features were significantly predictive of local control. The best predictive models in the training set were obtained by combining one feature from PET (Information Correlation 2) and one feature from CT (flatness), reaching a sensitivity of 100% and a specificity of 96%. Another model combining 2 PET features (Information Correlation 2 and strength) reached sensitivity of 100% and specificity of 88%, both with an undefined hazard ratio (P < 0.001). The latter model obtained an accuracy of 0.91 (sensitivity, 100%; specificity, 81%), with a hazard ratio undefined (P = 0.023) in the testing set; however, other models relying on CT radiomic features only or the combination of PET and CT features failed to validate in the testing set. Conclusion: We showed that 2 radiomic features derived from 18F-FDG PET were independently associated with local control in patients with non-small cell lung cancer undergoing SBRT and could be combined in an accurate predictive model. This model could provide local relapse-related information and could be helpful in clinical decision making.
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Affiliation(s)
- Gurvan Dissaux
- Radiation Oncology Department, University Hospital, Brest, France .,LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | | | - Ronrick Da-Ano
- LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Olivier Pradier
- Radiation Oncology Department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Enrique Chajon
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - Isabelle Barillot
- Department of Radiation Oncology, University Hospital, Tours, France
| | - Loig Duvergé
- Radiotherapy Department, Centre Eugene Marquis, Rennes, France
| | - Ingrid Masson
- Department of Radiation Oncology, ICO, Saint-Herblain, France
| | - Ronan Abgral
- Nuclear Medicine Department, University Hospital, Brest, France
| | | | - Anne Devillers
- Nuclear Medicine Department, Centre Eugene Marquis, Rennes, France
| | - Amandine Pallardy
- Nuclear Medicine Department, University Hospital, Nantes, France; and
| | - Vincent Fleury
- Nuclear Medicine Department, ICO, Saint-Herblain, France
| | - Marc-André Mahé
- Department of Radiation Oncology, ICO, Saint-Herblain, France
| | | | - Mathieu Hatt
- LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, Brest, France.,LaTIM, INSERM, UMR 1101, University of Brest, Brest, France
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Phillips I, Sandhu S, Lüchtenborg M, Harden S. Stereotactic Ablative Body Radiotherapy Versus Radical Radiotherapy: Comparing Real-World Outcomes in Stage I Lung Cancer. Clin Oncol (R Coll Radiol) 2019; 31:681-687. [PMID: 31377081 DOI: 10.1016/j.clon.2019.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/05/2019] [Accepted: 07/11/2019] [Indexed: 11/18/2022]
Abstract
AIMS Stereotactic ablative body radiotherapy (SABR) is now considered the standard of care for medically inoperable stage I non-small cell lung cancer (NSCLC). The English National Cancer Registration and Analysis Service (NCRAS) collects data on all patients diagnosed with lung cancer, including information on treatment. We wanted to compare outcomes for patients with stage I NSCLC treated with radical radiotherapy with either SABR or fractionated radiotherapy. MATERIALS AND METHODS All patients diagnosed with stage I NSCLC in 2015 and 2016 were identified from the NCRAS dataset, validated by the National Lung Cancer Audit, and their treatment data were collated. For patients who received radiotherapy, those receiving radical dose fractionations, including SABR, were identified through linkage to the national Radiotherapy Dataset. Clinical outcomes for those receiving SABR or more fractionated radical radiotherapy were compared using univariate and fully adjusted Cox proportional hazards models. RESULTS In total, 12 384 patients with stage I NSCLC were identified during the study period; 53.5% underwent surgical resection, 24.3% received no documented treatment, 18.6% received radical radiotherapy and 3.5% received other non-curative-intent treatments. For those receiving radical radiotherapy, 69% received SABR and 31% received fractionated treatment. The hazard ratio of death for the 1587 patients who received SABR was 0.69 (95% confidence interval 0.61-0.79) compared with 717 patients who received radical fractionated radiotherapy; this benefit was seen for both stage Ia and stage Ib disease. The median overall survival was also longer for SABR versus radical radiotherapy (715 days versus 648 days). Exploratory travel time analysis shows that compared with stage I NSCLC patients receiving SABR, those receiving fractionated radiotherapy and those receiving no active treatment would have to travel longer and further to reach their nearest radiotherapy SABR centre. CONCLUSION This study adds to the data that SABR has a survival benefit when compared with fractionated radical radiotherapy. Although the use of SABR increased in England over this study period, it has still not reached levels of use seen in other countries. This study also highlights that one quarter of stage I NSCLC patients overall received no active treatment.
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Affiliation(s)
- I Phillips
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - S Sandhu
- National Cancer Registration and Analysis Service, Public Health England, London, UK
| | - M Lüchtenborg
- National Cancer Registration and Analysis Service, Public Health England, London, UK; Cancer Epidemiology, Population and Global Health, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - S Harden
- National Cancer Registration and Analysis Service, Public Health England, London, UK.
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20
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Chen G, Dong B, Shan G, Zhang X, Tang H, Li Y, Wang Z, Xu W, Xu G, Yan G, Zhang F, Hu X, Yang J, Xu Y, Chen M, Wang J. Choice of immobilization of stereotactic body radiotherapy in lung tumor patient by BMI. BMC Cancer 2019; 19:583. [PMID: 31200687 PMCID: PMC6570957 DOI: 10.1186/s12885-019-5767-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An accurate, reproducible, and comfortable immobilization device is essential for stereotactic radiotherapy (SBRT) in patients with lung cancer. This study compared thermoplastic masks (TMP) and vacuum cushion (VCS) system to assess the differences in interfraction and intrafraction setup accuracy and the impact of body mass index (BMI) with respect to the immobilization choice. METHODS This retrospective study was conducted on patients treated with lung SBRT between 2012 and 2015 at the Zhejiang cancer hospital. The treatment setup accuracy was analyzed in 121 patients. A total of 687 cone beam computed tomography (CBCT) scans before treatment and 126 scans after treatment were recorded to determine the uncertainties, and plan target volume margins. Data were further stratified and analyzed by immobilization methods and patients' BMI. The t-test (Welch) was used to assess the differences between the two immobilization systems when stratified by the patients' BMI. RESULTS For patients with BMI ≥ 24, the mean displacements for the TMP and VCS systems were 1.4 ± 1.2 vs. 2.4 ± 2.0 mm at medial-lateral (ML) direction (p < 0.001); 2.0 ± 1.9 vs. 2.0 ± 1.9 mm at cranial-caudal (CC) direction (p = 0.917); and 2.4 ± 1.4 vs. 2.6 ± 2.1 mm at anterior-posterior (AP) direction, (p = 0.546). The rate of acceptable errors increased dramatically when immobilized by TMP. In the case of patients with BMI < 24, the mean displacements for the TMP and VCS systems were 1.8 ± 1.4 vs. 2.1 ± 1.8 mm at ML direction (p = 0.098); 2.9 ± 2.3 vs. 2.2 ± 2.2 mm at CC direction (p = 0.001); and 1.8 ± 1.8 vs. 2.3 ± 2.0 mm at CC direction, (p = 0.006). The proportion of acceptable errors increased after immobilization by VCS. No difference was detected in the intrafraction setup error by different immobilization methods. CONCLUSIONS The immobilization choice of SBRT for lung tumors depends on the BMI of the patients. For patients with BMI ≥ 24, TMP offers a better reproducibility with significantly less interfractional setup displacement than VCS, resulting in fewer CBCT scans. However, VCS may be preferred over TMP for the patients with BMI < 24. Therefore, an optimal immobilization system needs to be considered in different BMI groups for lung SBRT.
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Affiliation(s)
- Guofu Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Baiqiang Dong
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China.,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China
| | - Guoping Shan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Xiuqin Zhang
- People's hospital of Yuxi city in Yunnan province, Yuxi, 653100, China
| | - Huarong Tang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Yuchen Li
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Zhenhua Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Wei Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Gang Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Guiming Yan
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Feiyan Zhang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China
| | - Xiao Hu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China.,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China
| | - Jun Yang
- Yitu Healthcare, Shanghai, China
| | - Yujin Xu
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China.,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China
| | - Ming Chen
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China. .,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China.
| | - Jin Wang
- Department of Radiation Oncology, Zhejiang Cancer Hospital, 1st Banshan East Road, Hangzhou, 310022, China. .,Zhejiang Provincial Key Laboratory of Radiation Oncology, Hangzhou, 310022, China.
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IJsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg KCA, Lebenthal A, Ten Broek RPG. Survival After Stereotactic Body Radiation Therapy for Clinically Diagnosed or Biopsy-Proven Early-Stage NSCLC: A Systematic Review and Meta-Analysis. J Thorac Oncol 2019; 14:583-595. [PMID: 30721798 DOI: 10.1016/j.jtho.2018.12.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) is a promising curative treatment for early-stage NSCLC. It is unclear if survival outcomes for SBRT are influenced by a lack of pathological confirmation of malignancy and staging of disease in these patients. In this systematic review and meta-analysis, we assess survival outcomes after SBRT in studies with patients with clinically diagnosed versus biopsy-proven early-stage NSCLC. METHODS The main databases were searched for trials and cohort studies without restrictions to publication status or language. Two independent researchers performed the screening and selection of eligible studies. Outcomes were overall survival, cancer-specific survival, and disease-free survival. The inverse variance method and the random effects method for meta-analysis were used to assess pooled survival estimates. RESULTS A total of 11,195 nonduplicate records were identified by the original search strategy. After screening by title and abstract, 1051 potentially eligible records were identified. A total of 43 articles were included. The comparative studies showed lower 3-year overall survival and lower 2-year and 5-year cancer-specific survival for biopsy-proven disease compared to clinical disease. However, 5-year overall survival was the same for both groups. For the pooled estimates, 3-year disease-free survival and 2-year cancer-specific survival were lower for biopsied disease. CONCLUSIONS Results of this systematic review and meta-analysis show a discrepancy in oncological outcomes for patients undergoing SBRT for suspected early-stage NSCLC in whom there is pathologic conformation of malignancy and those who there is only a clinical diagnose of NSCLC. These results emphasize the importance of obtaining pathologic proof of malignancy.
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Affiliation(s)
- Michiel A IJsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Gelderland, Netherlands; Division of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, Massachusetts
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Gelderland, Netherlands
| | | | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Gelderland, Netherlands; Division of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
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22
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Boon IS, Au Yong TPT, Boon CS. Assessing the Role of Artificial Intelligence (AI) in Clinical Oncology: Utility of Machine Learning in Radiotherapy Target Volume Delineation. MEDICINES (BASEL, SWITZERLAND) 2018; 5:E131. [PMID: 30544901 PMCID: PMC6313566 DOI: 10.3390/medicines5040131] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 12/16/2022]
Abstract
The fields of radiotherapy and clinical oncology have been rapidly changed by the advances of technology. Improvement in computer processing power and imaging quality heralded precision radiotherapy allowing radiotherapy to be delivered efficiently, safely and effectively for patient benefit. Artificial intelligence (AI) is an emerging field of computer science which uses computer models and algorithms to replicate human-like intelligence and perform specific tasks which offers a huge potential to healthcare. We reviewed and presented the history, evolution and advancement in the fields of radiotherapy, clinical oncology and machine learning. Radiotherapy target delineation is a complex task of outlining tumour and organ at risks volumes to allow accurate delivery of radiotherapy. We discussed the radiotherapy planning, treatment delivery and reviewed how technology can help with this challenging process. We explored the evidence and clinical application of machine learning to radiotherapy. We concluded on the challenges, possible future directions and potential collaborations to achieve better outcome for cancer patients.
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Affiliation(s)
- Ian S Boon
- Department of Clinical Oncology, Leeds Cancer Centre, St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK.
| | - Tracy P T Au Yong
- Department of Radiology, Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD, UK.
| | - Cheng S Boon
- Worcestershire Oncology Centre, Worcestershire Acute Hospitals NHS Trust, Worcester WR5 1DD, UK.
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23
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Haridass A. Developments in Stereotactic Body Radiotherapy. Cancers (Basel) 2018; 10:E497. [PMID: 30544488 PMCID: PMC6316669 DOI: 10.3390/cancers10120497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 12/19/2022] Open
Abstract
Stereotactic body radiotherapy is the technique of accurately delivering high doses of radiotherapy to small volume targets in a single or small number of sessions. The high biological effective dose of this treatment is reflected in the high rates of local control achieved across multiple tumour sites. Toxicity of the treatment can be significant and ongoing prospective trials will help define the utility of this treatment as an alternative to surgery in treating primary tumours and oligometastatic disease. Longer follow-up and survival data from prospective trials will be essential in determining the value of this resource-intensive treatment. The opportunity to combine this treatment with systemic therapies and its potential synergy with immunotherapy opens up interesting avenues for research in the future.
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Walshaw RC, Honeychurch J, Illidge TM, Choudhury A. The anti-PD-1 era - an opportunity to enhance radiotherapy for patients with bladder cancer. Nat Rev Urol 2018; 15:251-259. [PMID: 29089607 DOI: 10.1038/nrurol.2017.172] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
An urgent need exists to improve the outcomes of patients with muscle-invasive bladder cancer (MIBC), and especially of those with metastatic disease. Treatments that enhance antitumour immune responses - such as immune-checkpoint inhibition - provide an opportunity to do this. Despite initial success, durable response rates in patients with advanced-stage MIBC treated with novel inhibitory antibodies targeting programmed cell death protein 1 (PD-1) or its endogenous ligand programmed cell death 1 ligand 1 (PD-L1) remain low. Radiotherapy is part of the management of bladder cancer in many patients. Evidence that radiotherapy has immunogenic properties is now available, but radiotherapy-induced immune responses are often negated by immunosuppression within the tumour microenvironment. Anti-PD-1 or anti-PD-L1 antibodies might enhance radiotherapy-induced antitumour immunity. This effect has been demonstrated in preclinical models of bladder cancer, and clinical trials involving this approach are currently recruiting. Combination treatment strategies provide an exciting opportunity for urological oncologists to not only improve the chances of cure in patients undergoing radical treatment for MIBC, but also to increase long-term response rates in those with metastatic disease.
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Affiliation(s)
- Richard C Walshaw
- Targeted Therapy Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Jamie Honeychurch
- Targeted Therapy Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Timothy M Illidge
- Targeted Therapy Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
- Translational Radiobiology Group, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, University of Manchester, Manchester Academic Health Sciences Centre, 555 Wilmslow Road, Withington, Manchester M20 4BX, UK
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[Stereotactic lung radiotherapy: Technical setting up on Novalis Tx ® and single centre prospective study of the 100 first malignant pulmonary nodules treated at centre Jean-Perrin]. Cancer Radiother 2017; 21:291-300. [PMID: 28522279 DOI: 10.1016/j.canrad.2017.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 01/12/2017] [Accepted: 01/26/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Description of the treatment technique of stereotactic lung radiotherapy on Novalis Tx® and prospective study of the first 100 pulmonary nodules treated at centre Jean-Perrin (France). MATERIAL AND METHODS From October 2012 to December 2015, 100 inoperable pulmonary nodules (62 stage I non-small-cell lung cancer and 38 metastases) of 90 patients with a mean age of 68.2 years (range: 46-89 years) were prospectively treated with dynamic arctherapy on Novalis Tx®. Mean gross tumour and planning target volumes were respectively 6.9 cm3 (range: 0.2-31.4 cm3) and 38.7 cm3 (range: 1.7-131 cm3), which correspond to diameters equal to 2.3cm and 4.2cm. Prescribed doses to the 80% isodose line were 54Gy in three fractions for peripheral non-small-cell lung cancer, 50Gy in five fractions for central non-small-cell lung cancer and 45Gy in three fractions for lung metastases. Clinical and radiological follow-up was done every three months with RECIST criteria for efficacy and NCI-CTCAE v4 scale for toxicity. Median follow-up was 12.5 months. RESULTS Complete response was observed in 23.8% of cases. Local control rates were 100% and 90.7% respectively at 12 and 24 months, with 96% at 24 months for stage I non-small-cell lung cancer. Overall survival rates of patients with stage I non-small-cell lung cancer were 77.4% and 73.5% at 12 and 24 months (median overall survival was 32 months). Diffusing capacity of the lungs for carbon monoxide corrected for alveolar volume below 40% was significantly associated to a poor prognostic factor on univariate analysis (P=0.00013). At least three deaths were due to an acute respiratory failure, which correspond to about 4.8% of grade 5 radiation pneumonitis. Overall survival rate for metastatic patients were 95.2% and 59.5% respectively at 12 and 24 months (median overall survival was 25 months); 23.3% of grade 2 or less radiation pneumonitis, 7.8% of grade 2 or less radiation dermatitis, 2.2% of asymptomatic ribs fracture and 3.3% of chest pains were observed. CONCLUSION Stereotactic lung radiotherapy is an effective treatment for inoperable stage I non-small-cell lung cancer and lung oligometastases of well informed and selected patients. Initial respiratory state, and especially the diffusing capacity of the lungs for carbon monoxide corrected for alveolar volume, seems to be important for tolerance.
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Murray P, Franks K, Hanna GG. A systematic review of outcomes following stereotactic ablative radiotherapy in the treatment of early-stage primary lung cancer. Br J Radiol 2017; 90:20160732. [PMID: 27885858 PMCID: PMC5601509 DOI: 10.1259/bjr.20160732] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 11/15/2016] [Accepted: 11/21/2016] [Indexed: 12/25/2022] Open
Abstract
Stereotactic ablative body radiotherapy (SABR) describes a radiotherapy (RT) technique where high doses of radiation are precisely delivered to an extracranial target within the body, using either a single fraction of RT or using multiple small numbers of fractions. SABR has now become the standard of care treatment for patients with early-stage non-small-cell lung cancer (NSCLC) for whom surgery is not appropriate. This systematic review considers the evidence supporting the use of SABR in early-stage NSCLC, reported toxicity rates, the use of SABR in centrally located NSCLC, the use of SABR as salvage therapy following surgery or RT, and future potential drug combinations with SABR.
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Affiliation(s)
- Patrick Murray
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, Northern Ireland, UK
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Walshaw RC, Honeychurch J, Illidge TM. Stereotactic ablative radiotherapy and immunotherapy combinations: turning the future into systemic therapy? Br J Radiol 2016; 89:20160472. [PMID: 27556933 DOI: 10.1259/bjr.20160472] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy (RT) is effective at cytoreducing tumours and until relatively recently the focus in radiobiology has been on the direct effects of RT on the tumour. Increasingly, however, the effect of RT on the tumour vasculature, tumour stroma and immune system are recognized as important to the overall outcome. RT is known to lead to the induction of immunogenic cell death (ICD), which can generate tumour-specific immunity. However, systemic immunity leading to "abscopal effects" resulting in tumour shrinkage outside of the RT treatment field is rare, which is thought to be caused by the immunosuppressive nature of the tumour microenvironment. Recent advances in understanding the nature of this immunosuppression and therapeutics targeting immune checkpoints such as programmed death 1 has led to durable clinical responses in a range of cancer types including malignant melanoma and non-small-cell lung cancer. The effects of RT dose and fraction on the generation of ICD and systemic immunity are largely unknown and are currently under investigation. Stereotactic ablative radiotherapy (SABR) provides an opportunity to deliver single or hypofractionated large doses of RT and potentially increase the amount of ICD and the generation of systemic immunity. Here, we review the interplay of RT and the tumour microenvironment and the rationale for combining SABR with immunomodulatory agents to generate systemic immunity and improve outcomes.
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Affiliation(s)
- Richard C Walshaw
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, The Christie Hospital, Manchester, UK
| | - Jamie Honeychurch
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, The Christie Hospital, Manchester, UK
| | - Tim M Illidge
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, The Christie Hospital, Manchester, UK
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Mazzola R, Fiorentino A, Ricchetti F, Giaj Levra N, Fersino S, Di Paola G, Lo Casto A, Ruggieri R, Alongi F. Cone-beam computed tomography in lung stereotactic ablative radiation therapy: predictive parameters of early response. Br J Radiol 2016; 89:20160146. [PMID: 27245138 DOI: 10.1259/bjr.20160146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE: To analyze lung lesion volume variations by contouring on cone-beam CT (CBCT) images to evaluate the early predictive parameters of stereotactic ablative radiation therapy (SABR) treatment response. METHODS: The prescribed dose of SABR was varied according to the tumour site (central or peripheral) and maximum diameter of the lesions by using a strategy of risk-adapted dose prescription with a dose range between 48 and 70 Gy in 3-10 consecutive fractions. For the purpose of the analysis, the gross tumour volume (GTV) was recontoured for each patient at first and last CBCT using two lung levels/windows: (a) -600/1000 HU and (b) -1000/250 HU. Univariate analysis was performed to evaluate a correlation between lung lesion variations on CBCT using the two levels/windows and treatment response 6 months after SABR. Independent variables were the number of fractions, time between initial and final fraction, biologically effective dose and pre-SABR GTV. Cut points of lesion volume reduction were evaluated to determine the correlation with complete response 6 months after SABR. RESULTS: 41 lung lesions were evaluated. 82 lung lesions were recontoured for each CBCT level/window. A lung lesion shrinkage of at least 20% was revealed to be statistically related to complete response 6 months after SABR for both the CBCT levels/windows used. The probability of complete response ranged between six and eight times higher in respect to CBCT levels/windows -600/1000 HU and -1000/250 HU, respectively, compared with patients without a lesion shrinkage of 20% at the last session of SABR. CONCLUSION: According to current findings, a lung lesion shrinkage of at least 20% at the last session of SABR could be predictable of complete response 6 months thereafter. Further investigations about this topic are needed. ADVANCES IN KNOWLEDGE: Prediction of the early tumour response could be useful to personalize imaging restaging after the completion of SABR or to incorporate additional therapies in case of poor responders to improve clinical outcomes.
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Affiliation(s)
- Rosario Mazzola
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
| | - Alba Fiorentino
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
| | - Francesco Ricchetti
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
| | - Niccolò Giaj Levra
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
| | - Sergio Fersino
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
| | | | - Antonio Lo Casto
- 3 Sezione di Scienze Radiologiche, DIBIMEL, University of Palermo, Palermo, Italy
| | - Ruggero Ruggieri
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
| | - Filippo Alongi
- 1 Division of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Verona, Italy
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Lehman M. Improving Therapeutic Outcomes in Non-small Cell Lung Cancer not Suitable for Curative Intent Therapy — A Review of the Role of Radiation Therapy in an Era of Increasing Systemic Therapy Options. Clin Oncol (R Coll Radiol) 2016; 28:327-33. [DOI: 10.1016/j.clon.2015.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 10/23/2015] [Accepted: 10/26/2015] [Indexed: 01/27/2023]
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