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Jo IY, Park HC, Kim ES, Yeo SG, Kim M, Seong J, Kim JW, Kim TH, Yoon WS, Jeong BK, Kim SH, Lee JH. Stereotactic ablative radiotherapy for pulmonary oligometastases from primary hepatocellular carcinoma: a multicenter and retrospective analysis (KROG 17-08). Jpn J Clin Oncol 2022; 52:616-622. [PMID: 35311896 DOI: 10.1093/jjco/hyac028] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/22/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Hypofractionated radiotherapy has recently been applied to treat pulmonary metastases of hepatocellular carcinoma. However, there is no definite evidence on its safety and efficacy. We evaluate the clinical outcomes of hypofractionated radiotherapy for oligo pulmonary metastases of hepatocellular carcinoma in the multicenter and retrospective study. METHODS From March 2011 to February 2018, 58 patients with fewer than five pulmonary metastases of hepatocellular carcinoma who underwent hypofractionated radiotherapy in nine tertiary university hospitals were analyzed retrospectively. The primary endpoint was the local control rate. The secondary endpoints were overall survival, progression-free survival, prognostic factors affecting the treatment outcomes and treatment-related side effects. RESULTS The local tumor response rate including complete and partial response was 77.6% at 3 months after hypofractionated radiotherapy. The median survival and progression-free survival times were 20.9 and 5.3 months, respectively. The 1-year overall survival and progression-free survival rates were 65.5 and 22.4%, respectively. The good treatment response after hypofractionated radiotherapy (P = 0.001), the absence of intrahepatic tumor (P = 0.004) and Child-Pugh class A (P = 0.010) were revealed as significant prognostic factors for overall survival in the multivariate analysis. A progression-free interval of <6 months (P = 0.009) was a negative prognostic factor for overall survival in the multivariate analysis. Of 58 patients, five (8.6%) had grade 2 or higher radiation pneumonitis after hypofractionated radiotherapy. CONCLUSIONS The favorable local control rate and acceptable toxicity indicate the clinical usefulness of hypofractionated radiotherapy for hepatocellular carcinoma patients who have less than five pulmonary metastases.
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Affiliation(s)
- In Young Jo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Seog Kim
- Department of Radiation Oncology, Soonchunhyang University Hospital, Cheonan, Republic of Korea
| | - Seung-Gu Yeo
- Department of Radiation Oncology, Soonchunhyang University Hospital, Bucheon, Republic of Korea
| | - Myungsoo Kim
- Department of Radiation Oncology, St. Mary Hospital, Incheon, Republic of Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jun Won Kim
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyun Kim
- Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Won Sup Yoon
- Department of Radiation Oncology, Korea University College of Medicine, Ansan, Republic of Korea
| | - Bae Kwon Jeong
- Department of Radiation Oncology, Gyeongsang National University School of medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Hoon Lee
- Department of Radiation Oncology, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
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[Prognosis factors after lung stereotactic body radiotherapy for non-small cell lung carcinoma]. Cancer Radiother 2020; 24:267-274. [PMID: 32192839 DOI: 10.1016/j.canrad.2019.11.002] [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: 08/19/2019] [Revised: 10/27/2019] [Accepted: 11/05/2019] [Indexed: 10/24/2022]
Abstract
Lung cancer is the fourth most common cancer in France with a prevalence of 30,000 new cases per year. Lobectomy surgery with dissection is the gold standard treatment for T1-T2 localized non-small cell lung carcinoma. A segmentectomy may be proposed to operable patients but fragile from a respiratory point of view. For inoperable patients or patients with unsatisfactory pulmonary function tests, local treatment with stereotactic radiotherapy may be proposed to achieve local control rates ranging from 85 to 95% at 3-5 years. Several studies have examined prognostic factors after stereotaxic pulmonary radiotherapy. We conducted a general review of the literature to identify factors affecting local control.
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Formula corrected maximal standardized uptake value in FDG-PET for partial volume effect and motion artifact is not a prognostic factor in stage I non-small cell lung cancer treated with stereotactic body radiotherapy. Ann Nucl Med 2015; 29:666-73. [DOI: 10.1007/s12149-015-0991-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
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Lung metastases in oligometastatic patients: outcome with stereotactic body radiation therapy (SBRT). Clin Transl Oncol 2015; 17:668-72. [DOI: 10.1007/s12094-015-1291-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 04/10/2015] [Indexed: 12/31/2022]
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Wang Z, Kong QT, Li J, Wu XH, Li B, Shen ZT, Zhu XX, Song Y. Clinical outcomes of cyberknife stereotactic radiosurgery for lung metastases. J Thorac Dis 2015; 7:407-12. [PMID: 25922719 DOI: 10.3978/j.issn.2072-1439.2015.01.09] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 11/27/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cyberknife stereotactic radiosurgery is an emerging noninvasive technique for treating oligometastatic cancer. The aim of this study is to evaluate the efficacy and tolerability of cyberknife for the treatment of patients with lung metastases. MATERIALS AND METHODS A total of 134 lung metastases in 95 patients were treated with cyberknife in the radiotherapy center of our hospital from March 2009 to March 2013. The number of lung metastases per patient ranged from one to four (single lesions in 63 patients, 66.3%). The average tumor volume was 14.6 cm(3) and the prescribed radiation dosage ranged from 30 to 60 Gy, fractionated one to five times with a 60% to 88% isodose line. The primary end point was local control (LC); secondary end points were survival and toxicity. RESULTS The median follow-up was 17 months (ranging from 4 to 46 months). The 1-year LC rate was 97.6%, the 2-year LC rate was 90.6%, and the 3-year LC rate was 87.0%. The median survival time was 38.0 months and the median progression-free survival (PFS) time was 14.0 months. The 2-year PFS rate was 29.0% and the overall survival (OS) rate was 61.3%. No grade 4 or higher toxicity was encountered. CONCLUSIONS Cyberknife is safe and effective treatment for patients with lung metastases.
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Affiliation(s)
- Zhen Wang
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qing-Tao Kong
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jing Li
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Xin-Hu Wu
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Bing Li
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ze-Tian Shen
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Xi-Xu Zhu
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yong Song
- 1 Department of Radiation Oncology, 2 Department of Dermatology, 3 Division of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
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Ashworth AB, Senan S, Palma DA, Riquet M, Ahn YC, Ricardi U, Congedo MT, Gomez DR, Wright GM, Melloni G, Milano MT, Sole CV, De Pas TM, Carter DL, Warner AJ, Rodrigues GB. An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer. Clin Lung Cancer 2014; 15:346-55. [PMID: 24894943 DOI: 10.1016/j.cllc.2014.04.003] [Citation(s) in RCA: 332] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/07/2014] [Accepted: 04/08/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION/BACKGROUND An individual patient data metaanalysis was performed to determine clinical outcomes, and to propose a risk stratification system, related to the comprehensive treatment of patients with oligometastatic NSCLC. MATERIALS AND METHODS After a systematic review of the literature, data were obtained on 757 NSCLC patients with 1 to 5 synchronous or metachronous metastases treated with surgical metastectomy, stereotactic radiotherapy/radiosurgery, or radical external-beam radiotherapy, and curative treatment of the primary lung cancer, from hospitals worldwide. Factors predictive of overall survival (OS) and progression-free survival were evaluated using Cox regression. Risk groups were defined using recursive partitioning analysis (RPA). Analyses were conducted on training and validating sets (two-thirds and one-third of patients, respectively). RESULTS Median OS was 26 months, 1-year OS 70.2%, and 5-year OS 29.4%. Surgery was the most commonly used treatment for the primary tumor (635 patients [83.9%]) and metastases (339 patients [62.3%]). Factors predictive of OS were: synchronous versus metachronous metastases (P < .001), N-stage (P = .002), and adenocarcinoma histology (P = .036); the model remained predictive in the validation set (c-statistic = 0.682). In RPA, 3 risk groups were identified: low-risk, metachronous metastases (5-year OS, 47.8%); intermediate risk, synchronous metastases and N0 disease (5-year OS, 36.2%); and high risk, synchronous metastases and N1/N2 disease (5-year OS, 13.8%). CONCLUSION Significant OS differences were observed in oligometastatic patients stratified according to type of metastatic presentation, and N status. Long-term survival is common in selected patients with metachronous oligometastases. We propose this risk classification scheme be used in guiding selection of patients for clinical trials of ablative treatment.
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Affiliation(s)
- Allison B Ashworth
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - David A Palma
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - Marc Riquet
- Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris, France
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Maria T Congedo
- Department of General Thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Daniel R Gomez
- Division of Radiation Oncology, M.D. Anderson Cancer Center, Houston, TX
| | - Gavin M Wright
- University of Melbourne Department of Surgery, St Vincent's Hospital, Melbourne, Australia
| | - Giulio Melloni
- Department of Thoracic Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, NY
| | - Claudio V Sole
- Department of Radiation Oncology, Instituto Madrileño de Oncología, Madrid, Spain
| | - Tommaso M De Pas
- Thoracic Oncology Division, European Institute of Oncology, Milan, Italy
| | - Dennis L Carter
- Department of Radiation Oncology, Rocky Mountain Cancer Centers, Aurora, CO
| | - Andrew J Warner
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada
| | - George B Rodrigues
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada.
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Singh D, Chen Y, Hare MZ, Usuki KY, Zhang H, Lundquist T, Joyce N, Schell MC, Milano MT. Local control rates with five-fraction stereotactic body radiotherapy for oligometastatic cancer to the lung. J Thorac Dis 2014; 6:369-74. [PMID: 24688781 DOI: 10.3978/j.issn.2072-1439.2013.12.03] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 12/03/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To report our institutional experience with five fractions of daily 8-12 Gy stereotactic body radiotherapy (SBRT) for the treatment of oligometastatic cancer to the lung. METHODS Thirty-four consecutive patients with oligometastatic cancers to the lung were treated with image-guided SBRT between 2008 and 2011. Patient age ranged from 38 to 81 years. There were 17 males and 17 females. Lung metastases were from the following primary cancer types: colon cancer (n=13 patients), head and neck cancer (n=6), breast cancer (n=4), melanoma (n=4), sarcoma (n=4) and renal cell carcinoma (n=3). The median prescription dose was 50 Gy in five fractions (range, 40-60 Gy) to the isocenter, with the 80% isodose line encompassing the planning target volume (PTV) [defined as gross tumor volume (GTV) + 7-11 mm volumetric expansion]. The follow-up interval ranged from 2.4-54 months, with a median of 16.7 months. RESULTS The 1-, 2-, and 3-year patient local control (LC) rates for all patients were 93%, 88%, and 80% respectively. The 1-, 2-, and 3-year overall survival (OS) rates were 62%, 44%, and 23% respectively. The 1- and 2-year patient LC rates were 95% and 88% for tumor size 1-2 cm (n=25), and 86% for tumor size 2-3 cm (n=7). The majority (n=4) of local failures occurred within 12 months. No patient experienced local failure after 12 months except for one patient with colon cancer whose tumors progressed locally at 26 months. All five patients with local recurrences had colorectal cancer. Statistical analyses showed that age, gender, previous chemotherapy, previous surgery or radiation had no significant effect on LC rates. No patient was reported to have any symptomatic pneumonitis at any time point. CONCLUSIONS SBRT for oligometastatic disease to the lung using 8-12 Gy daily fractions over five treatments resulted in excellent 1- and 2-year LC rates. Most local failures occurred within the first 12 months, with five local failures associated with colorectal cancer. The treatment is safe using this radiation fractionation schedule with no therapy-related pneumonitis.
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Affiliation(s)
- Deepinder Singh
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Mary Z Hare
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Kenneth Y Usuki
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Hong Zhang
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Thomas Lundquist
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Neil Joyce
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Michael C Schell
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Kong C, Guo WJ, Zha WW, Zhu XZ, Huang SF, Zhang YW, Xu JH, He X. A new index comparable to BED for evaluating the biological efficacy of hypofractionated radiotherapy schemes on early stage non-small cell lung cancer: analysis of data from the literature. Lung Cancer 2014; 84:7-12. [PMID: 24548340 DOI: 10.1016/j.lungcan.2014.01.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Hypofractionated radiotherapy has been the principal curative treatment option for early stage NSCLC patients who are medically inoperable or those who refuse surgery and achieved favorable clinical outcomes. Evidence demonstrated that the linear quadratic model widely used in normally fractionated radiotherapy cannot work well to fit outcome data by use of BED to predict the effect of hypofractionation schemes. New models and the related metrics need to be developed to quantify the effect of high-dose ablative regimens for early stage NSCLC. PATIENTS AND METHODS Trials using hypofractionated radiotherapy without chemotherapy to treat early stage (T1 or T2N0M0) primary NSCLC and providing information on patient numbers, age, T stage and local control rates were eligible. The endpoint was local relapse and the covariates analyzed were total radiotherapy dose, dose per fraction or combinations of the two parameters, treatment duration, T stage and median age of patients within the trial. The model used was a multivariate logistic regression. RESULTS 19 trials were included (767 patients) in which 90 patients suffered local relapse. Only total dose × dose per fraction (D × d) and stage T had statistically significant effect on local control. Smaller T stage (p=0.000) and increasing D × d (p=0.006) were associated with improved probability of local control. In contrast, BED10 had no significant impact on local control, which probably indicated that D × d might be a more effective metric than BED10 to predict tumor control rate and assess the efficacy of the large dose fractionation schemes for early stage NSCLC. CONCLUSIONS BED was not an ideal metric to estimate the effect of the schemes of high-dose ablative radiotherapy for early stage NSCLC, and total dose × fraction dose could be considered as a comparable index, though the result need to be further validated.
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Affiliation(s)
- Cheng Kong
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Wen-jie Guo
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Wen-wu Zha
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Xiang-zhi Zhu
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Sheng-fu Huang
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Ye-wei Zhang
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Jian-hua Xu
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China
| | - Xia He
- Department of Radiation Oncology, Affiliated Hospital of Nanjing Medical University, and Cancer Center of Jiangsu Province, Nanjing, People's Republic of China.
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Oh D, Ahn YC, Seo JM, Shin EH, Park HC, Lim DH, Pyo H. Potentially curative stereotactic body radiation therapy (SBRT) for single or oligometastasis to the lung. Acta Oncol 2012; 51:596-602. [PMID: 22548366 DOI: 10.3109/0284186x.2012.681698] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND To analyze the treatment outcomes of a potentially curative therapy, stereotactic body radiation therapy (SBRT), for patients with single or oligometastasis to the lungs. MATERIAL AND METHODS Sixty-seven metastatic lung lesions in 57 patients were treated with SBRT between September 2001 and November 2010. All patients had single or oligo-metastasis to the lungs following a meticulous clinical work-up, including PET-CT scans. The lungs were the most common primary organ (33 lesions, 49.3%), followed by the head and neck (11 lesions, 16.4%), the liver (nine lesions, 13.5%), the colorectum (seven lesions, 10.4%), and other organs (seven lesions, 10.4%). Three different fractionation schedules were used: 50 Gy/5 fractions to four lesions (6.0%); 60 Gy/5 fractions to 44 lesions (65.7%); and 60 Gy/4 fractions to 19 lesions (28.3%). RESULTS Local tumor progression occurred in three lesions (4.5%). The three-year actuarial local control rate was 94.5%. Tumors larger than or equal to 2.5 cm showed poorer local control (98.3% vs. 77.8%, p <0.01). Metastatic tumors from the liver and colorectum showed lower local control rates than those from other organs (77.8%, 85.7%, and 100%, p =0.04). The two-year overall survival rate was 57.2%. Patients with tumors smaller than 2.5 cm had more favorable survival rates (64.0% vs. 38.9% at two-year, p =0.032). Patients with extrathoracic disease had poorer survival rates (66.1% vs. 0% at two-year, p =0.003). Patients with disease-free intervals longer than two years showed a trend toward good prognosis (71.1% vs. 51.1% at two-year, p =0.106). Grade 2 lung toxicity occurred in four patients (6.0%). One patient experienced Grade 5 lung toxicity following SBRT. CONCLUSION SBRT for single or oligo-metastasis to the lung seems quite effective and safe. Tumor size, disease-free interval, and presence of extrathoracic disease are prognosticators for survival.
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Affiliation(s)
- Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, Korea
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Factors affecting the local control of stereotactic body radiotherapy for lung tumors including primary lung cancer and metastatic lung tumors. Jpn J Radiol 2012; 30:430-4. [DOI: 10.1007/s11604-012-0071-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 03/01/2012] [Indexed: 12/25/2022]
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Outcomes of stereotactic ablative radiotherapy following a clinical diagnosis of stage I NSCLC: comparison with a contemporaneous cohort with pathologically proven disease. Radiother Oncol 2011; 101:250-4. [PMID: 22056535 DOI: 10.1016/j.radonc.2011.09.017] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 12/23/2022]
Abstract
INTRODUCTION As a finding of benign disease is uncommon in Dutch patients undergoing surgery after a clinical diagnosis of stage I NSCLC, patients are also accepted for stereotactic ablative radiotherapy (SABR) without pathology. We studied outcomes in patients who underwent SABR after either a pathological (n=209) or clinical diagnosis (N=382). MATERIALS AND METHODS Five hundred and ninety-one patients with a single pulmonary lesion underwent SABR after either a pathological- or a clinical diagnosis of stage I NSCLC based on a (18)FDG-PET positive lesion with CT features of malignancy. SABR was delivered to a total dose of 60Gy in 3, 5 or 8 fractions, and outcomes were compared between groups with and without pathological diagnosis. RESULTS Patients with pathology had significantly larger tumor diameters (p<.001) and higher predicted FEV1% values (p=.025). No significant differences were observed between both groups in overall survival (p=.99) or local control (p=.98). Regional and distant recurrence rates were also similar. CONCLUSIONS In a population with a low incidence of benign (18)FDG-PET positive lung nodules, clinical SABR outcomes were similar in large groups of patients with or without pathology. The survival benefits reported after the introduction of SABR are unlikely to be biased by inclusion of benign lesions.
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Computed Tomography-Guided Interstitial High-Dose-Rate Brachytherapy in the Local Treatment of Primary and Secondary Intrathoracic Malignancies. J Thorac Oncol 2011; 6:545-52. [DOI: 10.1097/jto.0b013e318208c7a3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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