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Josephides E, Daddi N, Bertoglio P, Lugaresi M, Patel A, Farinelli E, Fabbri G, Volpi S, Frezza G, Routledge T, Ahmad S, Van Hemelrijck M, Karapanagiotou E, Smith D, Piergiorgio S, Billè A. A Propensity-Matched Comparison Between Minimally Invasive Surgery and Stereotactic Radiotherapy in the Treatment of Clinical Stage IA Non-Small-Cell Lung Cancer (NSCLC). Clin Lung Cancer 2025:S1525-7304(25)00083-X. [PMID: 40410021 DOI: 10.1016/j.cllc.2025.04.011] [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: 12/09/2024] [Revised: 04/13/2025] [Accepted: 04/22/2025] [Indexed: 05/25/2025]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death globally, with stage IA NSCLC presenting a unique opportunity for curative interventions. The efficacy of minimally invasive surgery (MIS) vs. stereotactic ablative radiotherapy (SABR) remains debated due to limited direct comparative data. METHODS This multicenter observational study analyzed data from 1014 patients diagnosed with clinical stage IA NSCLC (2015-2021) and treated with MIS (including VATS and RATS) or SABR. After propensity score matching, 234 patients (117 per group) were included. Matching balanced age, ECOG performance status, Charlson Comorbidity Index, lung function, and histological subtype to compare overall survival (OS), freedom from recurrence (FFR), and recurrence rates. RESULTS The mean follow-up was 35 months for MIS and 33 months for SABR. The matched cohort (n = 234) showed superior 5-year locoregional control (LRC) rates for MIS (93%) vs. SABR (88%). FFS at 2 and 5 years was higher for MIS (93.5% and 90.3%) than SABR (82.1% and 77.9%; P = .010). OS was significantly higher in MIS, with a hazard ratio of 1.60 (95% CI: 1.11-2.31). Early mortality rates were 2.6% for MIS at 30 and 90 days. SABR exhibited no 30-day mortality and a 90-day rate of 1.7%. CONCLUSION MIS is associated with higher OS, LRC and FFR, but higher treatment-related mortality compared to SABR for stage IA NSCLC. This study supports the preference for surgical interventions where feasible. While future randomized controlled trials may provide more insights, this observational study contributes valuable evidence to guide clinical decision-making.
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Affiliation(s)
- Eleni Josephides
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Niccolò Daddi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Pietro Bertoglio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marialuisa Lugaresi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Akshay Patel
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Eleonora Farinelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giulia Fabbri
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Sara Volpi
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Giovanni Frezza
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Tom Routledge
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Shahreen Ahmad
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Mieke Van Hemelrijck
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Campus, Great Maze Pond, London, UK
| | - Eleni Karapanagiotou
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Daniel Smith
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK
| | - Solli Piergiorgio
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Andrea Billè
- Cancer Centre at Guy's, Guy's and St Thomas' NHS Foundation Trust, Great Maze Pond, London, UK.
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Bryant JM, Cruz-Chamorro RJ, Gan A, Liveringhouse C, Weygand J, Nguyen A, Keit E, Sandoval ML, Sim AJ, Perez BA, Dilling TJ, Redler G, Andreozzi J, Nardella L, Naghavi AO, Feygelman V, Latifi K, Rosenberg SA. Structure-specific rigid dose accumulation dosimetric analysis of ablative stereotactic MRI-guided adaptive radiation therapy in ultracentral lung lesions. COMMUNICATIONS MEDICINE 2024; 4:96. [PMID: 38778215 PMCID: PMC11111790 DOI: 10.1038/s43856-024-00526-7] [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: 09/05/2023] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Definitive local therapy with stereotactic ablative radiation therapy (SABR) for ultracentral lung lesions is associated with a high risk of toxicity, including treatment related death. Stereotactic MR-guided adaptive radiation therapy (SMART) can overcome many of the challenges associated with SABR treatment of ultracentral lesions. METHODS We retrospectively identified 14 consecutive patients who received SMART to ultracentral lung lesions from 10/2019 to 01/2021. Patients had a median distance from the proximal bronchial tree (PBT) of 0.38 cm. Tumors were most often lung primary (64.3%) and HILUS group A (85.7%). A structure-specific rigid registration approach was used for cumulative dose analysis. Kaplan-Meier log-rank analysis was used for clinical outcome data and the Wilcoxon Signed Rank test was used for dosimetric data. RESULTS Here we show that SMART dosimetric improvements in favor of delivered plans over predicted non-adapted plans for PBT, with improvements in proximal bronchial tree DMax of 5.7 Gy (p = 0.002) and gross tumor 100% prescription coverage of 7.3% (p = 0.002). The mean estimated follow-up is 17.2 months and 2-year local control and local failure free survival rates are 92.9% and 85.7%, respectively. There are no grade ≥ 3 toxicities. CONCLUSIONS SMART has dosimetric advantages and excellent clinical outcomes for ultracentral lung tumors. Daily plan adaptation reliably improves target coverage while simultaneously reducing doses to the proximal airways. These results further characterize the therapeutic window improvements for SMART. Structure-specific rigid dose accumulation dosimetric analysis provides insights that elucidate the dosimetric advantages of SMART more so than per fractional analysis alone.
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Affiliation(s)
- J M Bryant
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
| | - Ruben J Cruz-Chamorro
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Alberic Gan
- University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Casey Liveringhouse
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Joseph Weygand
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Ann Nguyen
- University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Emily Keit
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Maria L Sandoval
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Austin J Sim
- Department of Radiation Oncology; James Cancer Hospital, Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Bradford A Perez
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Thomas J Dilling
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Gage Redler
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Jacqueline Andreozzi
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Louis Nardella
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Arash O Naghavi
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Vladimir Feygelman
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Kujtim Latifi
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Stephen A Rosenberg
- Department of Radiation Oncology; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA.
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Lucia F, Mievis C, Jansen N, Duysinx B, Cousin F, Louis T, Baiwir M, Ernst C, Wonner M, Hustinx R, Lovinfosse P, Coucke P. Predictive clinical and dosimetric parameters for risk of relapse in early-stage non-small cell lung cancer treated by SBRT: A large single institution experience. Clin Transl Radiat Oncol 2024; 45:100720. [PMID: 38288310 PMCID: PMC10823062 DOI: 10.1016/j.ctro.2023.100720] [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: 04/25/2023] [Revised: 11/30/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Purpose To evaluate the impact of dosimetric parameters on efficacy of stereotactic body radiation therapy (SBRT) in early-stage non-small cell lung cancer (ES-NSCLC), using Hypofractionated Treatment Effects in the Clinic (HyTEC) reporting standards. Methods From April 2010 to December 2020, 497 patients who received SBRT for ES-NSCLC at the University Hospital of Liège were retrospectively enrolled. A total dose of 40 to 60 Gy in 3-5 fractions (72-180 Gy biologically effective dose with an α/β ratio of 10 (BED10)) was prescribed to the 80 % isodose line of the PTV. Potential clinical and dosimetric predictors of recurrence, overall survival (OS) and disease specific survival (DSS) were evaluated using univariate and multivariate analyses. Results After a median follow-up of 32 months (range 3-143 months), the local control and disease-free survival (DFS) rates at 3 years were 91 % (95 % CI: 90 %-93 %) and 75 % (95 % CI: 73 %-77 %), respectively. The median OS was 41.6 months and the median DSS was not reached. On multivariate analysis, a higher gross tumor volume (GTV) Dmax (BED10) (cut-off 198 Gy) and a larger percent of the GTV receiving ≥110 % of the prescribed dose were predictive of a better local control, only GTV volume was correlated with DSS and no parameter was correlated with OS and regional or distant recurrences. Conclusion Lung SBRT for ES-NSCLC in 3 to 5 fractions resulted in high local control rates. A higher percent of GTV receiving ≥110 % of the prescribed dose and a higher GTV Dmax (BED10) seem to allow a better local control.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France
- LaTIM, INSERM, UMR 1101, Univ Brest, Brest, France
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Carole Mievis
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Nicolas Jansen
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | | | - François Cousin
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Thomas Louis
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Manon Baiwir
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Christelle Ernst
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Michel Wonner
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
| | - Roland Hustinx
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Pierre Lovinfosse
- Division of Nuclear Medicine and Oncological Imaging, University Hospital of Liège, Liège, Belgium
| | - Philippe Coucke
- Department of Radiotherapy Oncology, University Hospital of Liège, Liège, Belgium
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Kim H, Lee E, Cho H, Kim E, Jang WI, Yang K, Lee YJ, Kim TJ, Kim MS. Five-Day Spacing of Two Fractionated Ablative Radiotherapies Enhances Antitumor Immunity. Int J Radiat Oncol Biol Phys 2024; 118:498-511. [PMID: 37717785 DOI: 10.1016/j.ijrobp.2023.09.014] [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: 04/25/2023] [Revised: 08/10/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
PURPOSE This study aimed to enhance tumor control and abscopal effects by applying diverse stereotactic ablative radiation therapy (SABR) schedules. METHODS AND MATERIALS FSaII, CT-26, and 4T1 cells were used for tumor growth delay and lung metastases analysis after 1- or 5-day intervals radiation therapy (RT) with 40, 20, and 20 Gy, respectively. Immunodeficient BALB/c-nude, immunocompetent C3H, and BALB/c mouse models were used. For immune monitoring, FSaII tumors were analyzed using flow cytometry, immunofluorescence staining, and real-time quantitative reverse transcription polymerase chain reaction. The spleens were used for the ELISpot assay and flow cytometry to determine effector CD8 T cells. For abscopal effect analysis in CT-26 tumors, the volume of the nonirradiated secondary tumors was measured after primary tumors were irradiated with 1-day or 5-day intervals. RESULTS Contrary to the high-dose 1-day interval RT, the 5-day interval RT significantly delayed tumor growth in immunocompetent mice, which was not observed in immunodeficient mice. In addition, the 5-day interval RT significantly reduced the number of lung metastases in FSaII and CT-26 tumors. Five-day spacing was more effective than 1-day interval in enhancing the antitumor immunity via increasing the secretion of tumor-specific IFN-γ, activating the CD8 T cells, and suppressing the monocytic myeloid-derived suppressor cells. The 5-day spacing inhibited nonirradiated secondary tumor growth more effectively than did the 1-day interval. CONCLUSIONS Compared with the 1-day interval RT, the 5-day interval RT scheme demonstrated enhanced antitumor immunity of CD8 T cells associated with inhibition of myeloid-derived suppressor cells. Enhancing antitumor immunity leads to significant improvements in both primary tumor control and the abscopal effect.
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Affiliation(s)
| | - Eunju Lee
- Radiation Biomedical Research, Korea Institute of Radiological & Medical Sciences, Seoul, Korea; Department of Biochemistry and Molecular Biology, College of Medicine, Korea University, Seoul, Korea
| | - Haeun Cho
- Departments of Radiation Oncology and; Department of Radiological & Medico-Oncological Science, University of Science and Technology, Daejeon, Korea
| | - Eunji Kim
- Departments of Radiation Oncology and
| | | | | | - Yoon-Jin Lee
- Radiation Biomedical Research, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Tae-Jin Kim
- Radiation Biomedical Research, Korea Institute of Radiological & Medical Sciences, Seoul, Korea.
| | - Mi-Sook Kim
- Departments of Radiation Oncology and; Department of Radiological & Medico-Oncological Science, University of Science and Technology, Daejeon, Korea.
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Zhang H, Ma L, Lim A, Ye J, Lukas L, Li H, Mayr NA, Chang EL. Dosimetric Validation for Prospective Clinical Trial of GRID Collimator-Based Spatially Fractionated Radiation Therapy: Dose Metrics Consistency and Heterogeneous Pattern Reproducibility. Int J Radiat Oncol Biol Phys 2024; 118:565-573. [PMID: 37660738 DOI: 10.1016/j.ijrobp.2023.08.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE Dose heterogeneity within a tumor target is likely responsible for the biologic effects and local tumor control from spatially fractionated radiation therapy (SFRT). This study used a commercially available GRID-pattern dose mudulated nonuniform radiation therapy (GRID) collimator to assess the interplan variability of heterogeneity dose metrics in patients with various bulky tumor sizes and depths. METHODS AND MATERIALS The 3-dimensional heterogeneity metrics of 14 bulky tumors, ranging from 155 to 2161 cm3 in volume, 6 to 23 cm in equivalent diameter, and 3 to 13 cm in depth, and treated with GRID collimator-based SFRT were studied. A prescription dose of 15 Gy was given at the tumor center with 6 MV photons. The dose-volume histogram indices, dose heterogeneity parameters, and peak/valley dose ratios were derived; the equivalent uniform doses of cancer cells with various radiosensitivities in each plan were estimated. To account for the spatial fractionation, high dose core number density of the tumor target was defined and calculated. RESULTS Among 14 plans, the dose-volume histogram indices D5, D10, D50, D90, and D95 (doses covering 5%, 10%, 50%, 90%, and 95% of the target volume) were found within 10% variation. The dose ratio of D10/D90 also showed a moderate consistency (range, 3.9-5.0; mean, 4.4). The equivalent uniform doses were consistent, ranging from 4.3 to 5.5 Gy, mean 4.6 Gy, for radiosensitive cancer cells and from 5.8 to 6.9 Gy, mean 6.2 Gy, for radioresistant cancer cells. The high dose core number density was within 20% among all plans. CONCLUSIONS GRID collimator-based SFRT delivers a consistent heterogeneity dose distribution and high dose core density across bulky tumor plans. The interplan reproducibility and simplicity of GRID therapy may be useful for certain clinical indications and interinstitutional clinical trial design, and its heterogeneity metrics may help guide multileaf-collimator-based SFRT planning to achieve similar or further optimized dose distributions.
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Affiliation(s)
- Hualin Zhang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California.
| | - Lijun Ma
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Andrew Lim
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Jason Ye
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Lauren Lukas
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Heng Li
- Department of Radiation Oncology and Molecular Radiation Sciences, John Hopkins University, Baltimore, Maryland
| | - Nina A Mayr
- College of Human Medicine, Michigan State University, East Lansing, Michigan
| | - Eric Lin Chang
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
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Schütte W, Gütz S, Nehls W, Blum TG, Brückl W, Buttmann-Schweiger N, Büttner R, Christopoulos P, Delis S, Deppermann KM, Dickgreber N, Eberhardt W, Eggeling S, Fleckenstein J, Flentje M, Frost N, Griesinger F, Grohé C, Gröschel A, Guckenberger M, Hecker E, Hoffmann H, Huber RM, Junker K, Kauczor HU, Kollmeier J, Kraywinkel K, Krüger M, Kugler C, Möller M, Nestle U, Passlick B, Pfannschmidt J, Reck M, Reinmuth N, Rübe C, Scheubel R, Schumann C, Sebastian M, Serke M, Stoelben E, Stuschke M, Thomas M, Tufman A, Vordermark D, Waller C, Wolf J, Wolf M, Wormanns D. [Prevention, Diagnosis, Therapy, and Follow-up of Lung Cancer - Interdisciplinary Guideline of the German Respiratory Society and the German Cancer Society - Abridged Version]. Pneumologie 2023; 77:671-813. [PMID: 37884003 DOI: 10.1055/a-2029-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
The current S3 Lung Cancer Guidelines are edited with fundamental changes to the previous edition based on the dynamic influx of information to this field:The recommendations include de novo a mandatory case presentation for all patients with lung cancer in a multidisciplinary tumor board before initiation of treatment, furthermore CT-Screening for asymptomatic patients at risk (after federal approval), recommendations for incidental lung nodule management , molecular testing of all NSCLC independent of subtypes, EGFR-mutations in resectable early stage lung cancer in relapsed or recurrent disease, adjuvant TKI-therapy in the presence of common EGFR-mutations, adjuvant consolidation treatment with checkpoint inhibitors in resected lung cancer with PD-L1 ≥ 50%, obligatory evaluation of PD-L1-status, consolidation treatment with checkpoint inhibition after radiochemotherapy in patients with PD-L1-pos. tumor, adjuvant consolidation treatment with checkpoint inhibition in patients withPD-L1 ≥ 50% stage IIIA and treatment options in PD-L1 ≥ 50% tumors independent of PD-L1status and targeted therapy and treatment option immune chemotherapy in first line SCLC patients.Based on the current dynamic status of information in this field and the turnaround time required to implement new options, a transformation to a "living guideline" was proposed.
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Affiliation(s)
- Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha Maria Halle-Dölau, Halle (Saale)
| | - Sylvia Gütz
- St. Elisabeth-Krankenhaus Leipzig, Abteilung für Innere Medizin I, Leipzig
| | - Wiebke Nehls
- Klinik für Palliativmedizin und Geriatrie, Helios Klinikum Emil von Behring
| | - Torsten Gerriet Blum
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | - Wolfgang Brückl
- Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Klinikum Nürnberg Nord
| | | | - Reinhard Büttner
- Institut für Allgemeine Pathologie und Pathologische Anatomie, Uniklinik Köln, Berlin
| | | | - Sandra Delis
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Nikolas Dickgreber
- Klinik für Pneumologie, Thoraxonkologie und Beatmungsmedizin, Klinikum Rheine
| | | | - Stephan Eggeling
- Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Klinik für Thoraxchirurgie, Berlin
| | - Jochen Fleckenstein
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Würzburg
| | - Nikolaj Frost
- Medizinische Klinik mit Schwerpunkt Infektiologie/Pneumologie, Charite Universitätsmedizin Berlin, Berlin
| | - Frank Griesinger
- Klinik für Hämatologie und Onkologie, Pius-Hospital Oldenburg, Oldenburg
| | | | - Andreas Gröschel
- Klinik für Pneumologie und Beatmungsmedizin, Clemenshospital, Münster
| | | | | | - Hans Hoffmann
- Klinikum Rechts der Isar, TU München, Sektion für Thoraxchirurgie, München
| | - Rudolf M Huber
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum Munchen
| | - Klaus Junker
- Klinikum Oststadt Bremen, Institut für Pathologie, Bremen
| | - Hans-Ulrich Kauczor
- Klinikum der Universität Heidelberg, Abteilung Diagnostische Radiologie, Heidelberg
| | - Jens Kollmeier
- Helios Klinikum Emil von Behring, Klinik für Pneumologie, Lungenklinik Heckeshorn, Berlin
| | | | - Marcus Krüger
- Klinik für Thoraxchirurgie, Krankenhaus Martha-Maria Halle-Dölau, Halle-Dölau
| | | | - Miriam Möller
- Krankenhaus Martha-Maria Halle-Dölau, Klinik für Innere Medizin II, Halle-Dölau
| | - Ursula Nestle
- Kliniken Maria Hilf, Klinik für Strahlentherapie, Mönchengladbach
| | | | - Joachim Pfannschmidt
- Klinik für Thoraxchirurgie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Martin Reck
- Lungeclinic Grosshansdorf, Pneumologisch-onkologische Abteilung, Grosshansdorf
| | - Niels Reinmuth
- Klinik für Pneumologie, Thorakale Onkologie, Asklepios Lungenklinik Gauting, Gauting
| | - Christian Rübe
- Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Homburg
| | | | | | - Martin Sebastian
- Medizinische Klinik II, Universitätsklinikum Frankfurt, Frankfurt
| | - Monika Serke
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | | | - Martin Stuschke
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Essen, Essen
| | - Michael Thomas
- Thoraxklinik am Univ.-Klinikum Heidelberg, Thorakale Onkologie, Heidelberg
| | - Amanda Tufman
- Medizinische Klinik und Poliklinik V, Thorakale Onkologie, LMU Klinikum München
| | - Dirk Vordermark
- Universitätsklinik und Poliklinik für Strahlentherapie, Universitätsklinikum Halle, Halle
| | - Cornelius Waller
- Klinik für Innere Medizin I, Universitätsklinikum Freiburg, Freiburg
| | | | - Martin Wolf
- Klinikum Kassel, Klinik für Onkologie und Hämatologie, Kassel
| | - Dag Wormanns
- Evangelische Lungenklinik, Radiologisches Institut, Berlin
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7
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Yang H, Wang L, Shao G, Dong B, Wang F, Wei Y, Li P, Chen H, Chen W, Zheng Y, He Y, Zhao Y, Du X, Sun X, Wang Z, Wang Y, Zhou X, Lai X, Feng W, Shen L, Qiu G, Ji Y, Chen J, Jiang Y, Liu J, Zeng J, Wang C, Zhao Q, Yang X, Hu X, Ma H, Chen Q, Chen M, Jiang H, Xu Y. A combined predictive model based on radiomics features and clinical factors for disease progression in early-stage non-small cell lung cancer treated with stereotactic ablative radiotherapy. Front Oncol 2022; 12:967360. [PMID: 35982975 PMCID: PMC9380646 DOI: 10.3389/fonc.2022.967360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To accurately assess disease progression after Stereotactic Ablative Radiotherapy (SABR) of early-stage Non-Small Cell Lung Cancer (NSCLC), a combined predictive model based on pre-treatment CT radiomics features and clinical factors was established. Methods This study retrospectively analyzed the data of 96 patients with early-stage NSCLC treated with SABR. Clinical factors included general information (e.g. gender, age, KPS, Charlson score, lung function, smoking status), pre-treatment lesion status (e.g. diameter, location, pathological type, T stage), radiation parameters (biological effective dose, BED), the type of peritumoral radiation-induced lung injury (RILI). Independent risk factors were screened by logistic regression analysis. Radiomics features were extracted from pre-treatment CT. The minimum Redundancy Maximum Relevance (mRMR) and the Least Absolute Shrinkage and Selection Operator (LASSO) were adopted for the dimensionality reduction and feature selection. According to the weight coefficient of the features, the Radscore was calculated, and the radiomics model was constructed. Multiple logistic regression analysis was applied to establish the combined model based on radiomics features and clinical factors. Receiver Operating Characteristic (ROC) curve, DeLong test, Hosmer-Lemeshow test, and Decision Curve Analysis (DCA) were used to evaluate the model’s diagnostic efficiency and clinical practicability. Results With the median follow-up of 59.1 months, 29 patients developed progression and 67 remained good controlled within two years. Among the clinical factors, the type of peritumoral RILI was the only independent risk factor for progression (P< 0.05). Eleven features were selected from 1781 features to construct a radiomics model. For predicting disease progression after SABR, the Area Under the Curve (AUC) of training and validation cohorts in the radiomics model was 0.88 (95%CI 0.80-0.96) and 0.80 (95%CI 0.62-0.98), and AUC of training and validation cohorts in the combined model were 0.88 (95%CI 0.81-0.96) and 0.81 (95%CI 0.62-0.99). Both the radiomics and the combined models have good prediction efficiency in the training and validation cohorts. Still, DeLong test shows that there is no difference between them. Conclusions Compared with the clinical model, the radiomics model and the combined model can better predict the disease progression of early-stage NSCLC after SABR, which might contribute to individualized follow-up plans and treatment strategies.
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Affiliation(s)
- Hong Yang
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Lin Wang
- Shaoxing University School of Medicine, Shaoxing, China
| | - Guoliang Shao
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Baiqiang Dong
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Fang Wang
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yuguo Wei
- Precision Health Institution, General Electric (GE) Healthcare, Hangzhou, China
| | - Pu Li
- Department of Radiation Physics, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Haiyan Chen
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Wujie Chen
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yao Zheng
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yiwei He
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yankun Zhao
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xianghui Du
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaojiang Sun
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Zhun Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yuezhen Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xia Zhou
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiaojing Lai
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Wei Feng
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Liming Shen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Guoqing Qiu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Yongling Ji
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jianxiang Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Youhua Jiang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jinshi Liu
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Jian Zeng
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Changchun Wang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Qiang Zhao
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xun Yang
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Xiao Hu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Honglian Ma
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Qixun Chen
- Department of Thoracic Surgery, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
| | - Ming Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University, Guangzhou, China
| | - Haitao Jiang
- Department of Radiology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- *Correspondence: Haitao Jiang, ; Yujin Xu,
| | - Yujin Xu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, China
- *Correspondence: Haitao Jiang, ; Yujin Xu,
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Allison RR, Ferguson JS. Photodynamic therapy to a primary cancer of the peripheral lung: Case report. Photodiagnosis Photodyn Ther 2022; 39:103001. [PMID: 35803556 DOI: 10.1016/j.pdpdt.2022.103001] [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: 07/02/2022] [Revised: 07/04/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022]
Abstract
Photodynamic therapy (PDT) is an FDA approved treatment for lung cancer. In the United States the photosensitizer porfimer sodium (Photofrin®, Pinnacle Biologics) is intravenously introduced at 2mg/kg. After approximately 48 h, illumination to activate the photosensitizer is initiated, with 630nm red light at 200J/cm, delivered by fiber-optic catheter, brought to the tumor endo- bronchially, and delivered for 500 s. This will create, in the presence of oxygen, a Type II Photodynamic Reaction (PDR) which generates singlet oxygen species that are tumor ablative. Classically, PDT for lung cancer has been employed for symptomatic central and obstructing tumors with great success. This case report describes an innovative approach to treat a peripheral, early stage lung cancer employing magnetic navigation and endobronchial treatment. We report on a 79 year old male with numerous comorbidities including pulmonary fibrosis, who was found to have a biopsy proven peripheral and solitary non-small cell cancer. Due to prior SBRT (stereotactic body radiation therapy) with dose levels causing radiation fibrosis, he was not a candidate for repeat SBRT, and he was not a surgical candidate due to comorbidities. Tumor control with PDT was achieved without treatment related morbidity. This report details our findings.
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Affiliation(s)
- Ron R Allison
- Federal Medical Center, Butner, North Carolina, 27509, USA.
| | - J Scott Ferguson
- Interventional Pulmonology, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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Rationale for Combing Stereotactic Body Radiation Therapy with Immune Checkpoint Inhibitors in Medically Inoperable Early-Stage Non-Small Cell Lung Cancer. Cancers (Basel) 2022; 14:cancers14133144. [PMID: 35804917 PMCID: PMC9264861 DOI: 10.3390/cancers14133144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary The rate of recurrence remains high for lymph node negative early-stage non-small cell lung cancer that are over 2–3 cm in size following stereotactic body radiation therapy (SBRT). This is due to the increased incidence of out-of-field failures, which warrants the addition of systemic therapy. Immune checkpoint inhibitors (ICIs), a class of immunotherapy, may induce a strong distant therapeutic effect known as the “abscopal” effect. This makes them a very suitable class of drugs to be combined with SBRT when treating early lung cancer with high-risk features, such as larger tumor size. In this review, we discuss the rationale and evidence for doing so. Abstract Stereotactic body radiation therapy (SBRT) has been widely adopted as an alternative to lobar resection in medically inoperable patients with lymph-node negative (N0) early-stage (ES) non-small cell lung cancer (NSCLC). Excellent in-field local control has been consistently achieved with SBRT in ES NSCLC ≤ 3 cm in size. However, the out-of-field control following SBRT remains suboptimal. The rate of recurrence, especially distant recurrence remains high for larger tumors. Additional systemic therapy is warranted in N0 ES NSCLC that is larger in size. Radiation has been shown to have immunomodulatory effects on cancer, which is most prominent with higher fractional doses. Strong synergistic effects are observed when immune checkpoint inhibitors (ICIs) are combined with radiation doses in SBRT’s dose range. Unlike chemotherapy, ICIs can potentiate a strong systemic response outside of the irradiated field when combined with SBRT. Together with their less toxic nature, ICIs represent a very suitable class of systemic agents to be combined with SBRT when treating ES NSCLC with high-risk features, such as larger tumor size. In this review, we describe the rationale and emerging evidence, as well as ongoing investigations in this area.
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Rijksen BLT, Rossi MMG, Walraven I, Stam B, Knegjens JL, van Diessen JNA, Lalezari F, Sonke JJ, Belderbos JSA. Bronchial stenosis in central pulmonary tumors treated with Stereotactic Body Radiation Therapy: Bronchial stenosis in central lung tumors after SBRT. Pract Radiat Oncol 2022; 12:e382-e392. [PMID: 35452867 DOI: 10.1016/j.prro.2022.03.016] [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: 09/16/2021] [Revised: 03/01/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) in lung tumors has an excellent local control due to the high delivered dose. Proximity of the proximal bronchial tree (PBT) to the high dose area may result in pulmonary toxicity. Bronchial stenosis is an adverse event that can occur after high dose to the PBT. Literature on the risk of developing bronchial stenosis is limited. We therefore evaluated the risk of bronchial stenosis for tumors central to the PBT and correlated the dose to the bronchi. METHODS AND MATERIALS Patients with a planning tumor volume (PTV) ≤2cm from PBT receiving SBRT (8 × 7.5Gy) between 2015-2019 were retrospectively reviewed. Main bronchi and lobar bronchi were manually delineated. Follow-up CT-scans were analyzed for bronchial stenosis and atelectasis. Bronchial stenosis was assessed using CTCAEv4. Patient, tumor, dosimetric factors and survival were evaluated between patients with and without stenosis using uni- and multivariate and Kaplan Meier analysis. RESULTS Fifty-one patients were analyzed with a median age of 70 years and WHO≤1 in 92.2%. Median follow-up was 36 months (IQR 19.6-45.4) and median OS 48 months (IQR 21.5-59.3). In fifteen patients (29.4%) bronchial stenosis was observed on FU-CT-scan. Grade 1 stenosis was seen in 21.6% (n=11), grade 2 in 7.8% (n=4). No grade ≥3 stenosis was observed. Median time to stenosis was 9.6 months (IQR 4.4-19.2). Patients who developed stenosis had significantly larger gross tumor volume (GTV) with a median of 19cc (IQR 7.7-63.2) versus 5.2cc (IQR 1.7-11.3, p<0.01). Prognostic factors in multivariate analysis for stenosis were age (p=0.03; OR 1.1), baseline dyspnea (p=0.02 OR 7.7) and the mean lobar bronchus dose (p=0.01; OR 1.1). CONCLUSION Low grade (≤2) lobar bronchial stenosis is a complication in approximately one third of patients following SBRT for lung tumors with a PTV ≤2cm from PBT. Prognostic risk factors were age, baseline dyspnea and mean dose on a lobar bronchus.
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Affiliation(s)
- Barbara L T Rijksen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Maddalena M G Rossi
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Iris Walraven
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Barbara Stam
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Joost L Knegjens
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Judi N A van Diessen
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Ferry Lalezari
- Netherlands Cancer Institute, Department of Radiology, Amsterdam, The Netherlands
| | - Jan-Jakob Sonke
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - José S A Belderbos
- Netherlands Cancer Institute, Department of Radiation Oncology, Amsterdam, The Netherlands.
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Inagaki T, Doi H, Ishida N, Ri A, Tatsuno S, Wada Y, Uehara T, Inada M, Nakamatsu K, Hosono M, Nishimura Y. Escalated Maximum Dose in the Planning Target Volume Improves Local Control in Stereotactic Body Radiation Therapy for T1-2 Lung Cancer. Cancers (Basel) 2022; 14:933. [PMID: 35205682 PMCID: PMC8870557 DOI: 10.3390/cancers14040933] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023] Open
Abstract
Stereotactic body radiotherapy (SBRT) is a treatment option for early-stage lung cancer. The purpose of this study was to investigate the optimal dose distribution and prognostic factors for local control (LC) after SBRT for lung cancer. A total of 104 lung tumors from 100 patients who underwent SBRT using various treatment regimens were analyzed. Dose distributions were corrected to the biologically effective dose (BED). Clinical and dosimetric factors were tested for association with LC after SBRT. The median follow-up time was 23.8 months (range, 3.4-109.8 months) after SBRT. The 1- and 3-year LC rates were 95.7% and 87.7%, respectively. In univariate and multivariate analyses, pathologically confirmed squamous cell carcinoma (SQ), T2 tumor stage, and a Dmax < 125 Gy (BED10) were associated with worse LC. The LC rate was significantly lower in SQ than in non-SQ among tumors that received a Dmax < 125 Gy (BED10) (p = 0.016). However, there were no significant differences in LC rate between SQ and non-SQ among tumors receiving a Dmax ≥ 125 Gy (BED10) (p = 0.198). To conclude, SQ, T2 stage, and a Dmax < 125 Gy (BED10) were associated with poorer LC. LC may be improved by a higher Dmax of the planning target volume.
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Sato H, Ito F, Hasegawa K, Saga R, Hosokawa Y, Tanaka M, Aoki M. Identification of novel prognostic factors focusing on clinical outcomes in patients with non-small cell lung cancer after stereotactic body radiotherapy. Oncol Lett 2022; 23:79. [PMID: 35111248 PMCID: PMC8771648 DOI: 10.3892/ol.2022.13199] [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: 11/10/2021] [Accepted: 12/17/2021] [Indexed: 11/05/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) has attracted extensive attention as an effective treatment for patients with early-stage non-small cell lung cancer. However, the factors affecting prognosis after SBRT have not been fully elucidated. The aim of the present study was to investigate the prognostic factors associated with overall survival (OS) and local control (LC) after SBRT. Between March 2003 and March 2020, 497 patients with primary or oligo-metastatic lung cancer who underwent SBRT treatment were retrospectively reviewed. Univariate analysis was performed against various factors related to patient and tumor characteristics using Kaplan-Meier method. Furthermore, the factors with statistically significant differences identified via univariate analysis underwent a stratified Cox proportional hazard regression analysis. The median follow-up period for all patients was 26.17 months (range, 0.36-194.37), and the 5-year OS and LC rates were 66.3 and 86.0%, respectively. Multivariate analysis showed that surfactant protein-D (SP-D), tumor CT values (TCTV) and iodine density values (IDV) were independent prognostic factors for OS, and histology, TCTV and IDV were for LC. Although histology was not selected as a prognostic factor related to OS, it was indicated that patients with squamous cell carcinoma were associated with the SP-D high group compared with the SP-D normal group. In addition, TCTV was correlated to water density values, which tended to decrease with increasing IDV. From these findings, SP-D and TCTV were identified as potential new candidate prognostic factors after SBRT, and it is possible that combining SP-D and histology, and TCTV and IDV may improve the accuracy of prognostic prediction.
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Affiliation(s)
- Hikari Sato
- Department of Radiation Sciences, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Fumiki Ito
- Department of Radiological Technology, Hirosaki University School of Health Sciences, Hirosaki, Aomori 036-8564, Japan
| | - Kazuki Hasegawa
- Department of Radiation Sciences, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Ryo Saga
- Department of Radiation Sciences, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Yoichiro Hosokawa
- Department of Radiation Sciences, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori 036-8564, Japan
| | - Mitsuki Tanaka
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori 036-8562, Japan
| | - Masahiko Aoki
- Department of Radiation Oncology, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori 036-8562, Japan
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Mueller M, Poulsen P, Hansen R, Verbakel W, Berbeco R, Ferguson D, Mori S, Ren L, Roeske JC, Wang L, Zhang P, Keall P. The markerless lung target tracking AAPM Grand Challenge (MATCH) results. Med Phys 2022; 49:1161-1180. [PMID: 34913495 PMCID: PMC8828678 DOI: 10.1002/mp.15418] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/16/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Lung stereotactic ablative body radiotherapy (SABR) is a radiation therapy success story with level 1 evidence demonstrating its efficacy. To provide real-time respiratory motion management for lung SABR, several commercial and preclinical markerless lung target tracking (MLTT) approaches have been developed. However, these approaches have yet to be benchmarked using a common measurement methodology. This knowledge gap motivated the MArkerless lung target Tracking CHallenge (MATCH). The aim was to localize lung targets accurately and precisely in a retrospective in silico study and a prospective experimental study. METHODS MATCH was an American Association of Physicists in Medicine sponsored Grand Challenge. Common materials for the in silico and experimental studies were the experiment setup including an anthropomorphic thorax phantom with two targets within the lungs, and a lung SABR planning protocol. The phantom was moved rigidly with patient-measured lung target motion traces, which also acted as ground truth motion. In the retrospective in silico study a volumetric modulated arc therapy treatment was simulated and a dataset consisting of treatment planning data and intra-treatment kilovoltage (kV) and megavoltage (MV) images for four blinded lung motion traces was provided to the participants. The participants used their MLTT approach to localize the moving target based on the dataset. In the experimental study, the participants received the phantom experiment setup and five patient-measured lung motion traces. The participants used their MLTT approach to localize the moving target during an experimental SABR phantom treatment. The challenge was open to any participant, and participants could complete either one or both parts of the challenge. For both the in silico and experimental studies the MLTT results were analyzed and ranked using the prospectively defined metric of the percentage of the tracked target position being within 2 mm of the ground truth. RESULTS A total of 30 institutions registered and 15 result submissions were received, four for the in silico study and 11 for the experimental study. The participating MLTT approaches were: Accuray CyberKnife (2), Accuray Radixact (2), BrainLab Vero, C-RAD, and preclinical MLTT (5) on a conventional linear accelerator (Varian TrueBeam). For the in silico study the percentage of the 3D tracking error within 2 mm ranged from 50% to 92%. For the experimental study, the percentage of the 3D tracking error within 2 mm ranged from 39% to 96%. CONCLUSIONS A common methodology for measuring the accuracy of MLTT approaches has been developed and used to benchmark preclinical and commercial approaches retrospectively and prospectively. Several MLTT approaches were able to track the target with sub-millimeter accuracy and precision. The study outcome paves the way for broader clinical implementation of MLTT. MATCH is live, with datasets and analysis software being available online at https://www.aapm.org/GrandChallenge/MATCH/ to support future research.
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Affiliation(s)
- Marco Mueller
- Corresponding author; Room 221, ACRF Image X institute, 1 Central Ave, Eveleigh NSW 2015, Australia; +61 2 8627 1106,
| | - Per Poulsen
- Danish Center for Particle Therapy and Department of Oncology, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Rune Hansen
- Department of Medical Physics, Aarhus University Hospital, Aarhus 8200, Denmark
| | - Wilko Verbakel
- Amsterdam University Medical Centers, location VUmc, Amsterdam 1081 HV, Netherlands
| | - Ross Berbeco
- Department of Radiation Oncology, Brigham and Women’s Hospital, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA 02215, USA
| | | | - Shinichiro Mori
- Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba 263-0024, Japan
| | - Lei Ren
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - John C. Roeske
- Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL 60153, USA
| | - Lei Wang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Pengpeng Zhang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center New York, NY, USA
| | - Paul Keall
- ACRF Image X Institute, The University of Sydney, Sydney, NSW 2015, Australia
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Samper Ots PM, Vallejo Ocaña C, Martin Martin M, Celada Álvarez FJ, Farga Albiol D, Almendros Blanco P, Hernandez Machancoses A, Rico Oses M, Flamarique Andueza S, Romero Ruperto F, Maria Bueno C, Amaya Escobar E, Guerrero Gómez LL, Couñago F, Del Pino Alcántara M, Ruiz Villar MJ, Monroy Antón JL, Saez Bueno P, Luna Tirado J, Del Mar Puertas M, Bobo A, Diaz de Cerio Martínez I, Gascon Costoso N, Ferrer Albiach C. Stereotactic body radiotherapy for early-stage non-small cell lung cancer: a multicentre study by the Oncologic Group for the Study of Lung Cancer (Spanish Radiation Oncology Society). Clin Transl Oncol 2022; 24:342-349. [PMID: 34487307 DOI: 10.1007/s12094-021-02697-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE/OBJECTIVE(S) Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC. MATERIALS/METHODS Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses. RESULTS Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%. CONCLUSION SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.
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Affiliation(s)
| | | | | | | | - D Farga Albiol
- Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | | | - M Rico Oses
- Complejo Hospitalario de Navarra, Navarra, Spain
| | | | | | | | | | | | - F Couñago
- Hospital Universitario Quironsalud y Hospital La Luz Quironsalud, Madrid, Spain
| | | | | | | | - P Saez Bueno
- Hospital Universitario Central de la Defensa "Gómez Ulla", Madrid, Spain
| | - J Luna Tirado
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - A Bobo
- Hospital Ruber Internacional, Madrid, Spain
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Regnery S, Buchele C, Weykamp F, Pohl M, Hoegen P, Eichkorn T, Held T, Ristau J, Rippke C, König L, Thomas M, Winter H, Adeberg S, Debus J, Klüter S, Hörner-Rieber J. Adaptive MR-Guided Stereotactic Radiotherapy is Beneficial for Ablative Treatment of Lung Tumors in High-Risk Locations. Front Oncol 2022; 11:757031. [PMID: 35087746 PMCID: PMC8789303 DOI: 10.3389/fonc.2021.757031] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To explore the benefit of adaptive magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) for treatment of lung tumors in different locations with a focus on ultracentral lung tumors (ULT). PATIENTS & METHODS A prospective cohort of 21 patients with 23 primary and secondary lung tumors was analyzed. Tumors were located peripherally (N = 10), centrally (N = 2) and ultracentrally (N = 11, planning target volume (PTV) overlap with proximal bronchi, esophagus and/or pulmonary artery). All patients received MRgSBRT with gated dose delivery and risk-adapted fractionation. Before each fraction, the baseline plan was recalculated on the anatomy of the day (predicted plan). Plan adaptation was performed in 154/165 fractions (93.3%). Comparison of dose characteristics between predicted and adapted plans employed descriptive statistics and Bayesian linear multilevel models. The posterior distributions resulting from the Bayesian models are presented by the mean together with the corresponding 95% compatibility interval (CI). RESULTS Plan adaptation decreased the proportion of fractions with violated planning objectives from 94% (predicted plans) to 17% (adapted plans). In most cases, inadequate PTV coverage was remedied (predicted: 86%, adapted: 13%), corresponding to a moderate increase of PTV coverage (mean +6.3%, 95% CI: [5.3-7.4%]) and biologically effective PTV doses (BED10) (BEDmin: +9.0 Gy [6.7-11.3 Gy], BEDmean: +1.4 Gy [0.8-2.1 Gy]). This benefit was smaller in larger tumors (-0.1%/10 cm³ PTV [-0.2 to -0.02%/10 cm³ PTV]) and ULT (-2.0% [-3.1 to -0.9%]). Occurrence of exceeded maximum doses inside the PTV (predicted: 21%, adapted: 4%) and violations of OAR constraints (predicted: 12%, adapted: 1%, OR: 0.14 [0.04-0.44]) was effectively reduced. OAR constraint violations almost exclusively occurred if the PTV had touched the corresponding OAR in the baseline plan (18/19, 95%). CONCLUSION Adaptive MRgSBRT is highly recommendable for ablative treatment of lung tumors whose PTV initially contacts a sensitive OAR, such as ULT. Here, plan adaptation protects the OAR while maintaining best-possible PTV coverage.
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Affiliation(s)
- Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Carolin Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Pohl
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany
| | - Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Thomas
- National Center for Tumor diseases, Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Hauke Winter
- National Center for Tumor diseases, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany.,Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
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16
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6554916. [DOI: 10.1093/ejcts/ezac118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/24/2022] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
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17
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Caines R, Sisson NK, Rowbottom CG. 4DCT and VMAT for lung patients with irregular breathing. J Appl Clin Med Phys 2021; 23:e13453. [PMID: 34816564 PMCID: PMC8803302 DOI: 10.1002/acm2.13453] [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: 05/14/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Irregular breathing in lung cancer patients is a common contra-indication to 4D computerized tomography (4DCT), which may then limit radiotherapy treatment options. For irregular breathers, we investigated whether 3DCT or 4DCT (1) better represents tumor motion, (2) better represents average tumor densities, and (3) better allows for volumetric modulated arc threarpy (VMAT) plans delivered with acceptable dosimetric accuracy. METHODS Ten clinical breathing traces were identified with irregularities in phase and amplitude, and fed to a programmable moving platform incorporating an anthropomorphic lung tumor phantom. 3DCT and 4DCT data resorted by phase (4DCT-P) and amplitude (4DCT-A) were acquired for each trace. Tumors were delineated by Hounsfield unit (HU) thresholding and apparent motion range assessed. HU profiles were extracted from each image and agreement with calculated expected profiles quantified using area-under-curve (AUC) scoring. Clinically representative VMAT plans were created for each image, delivered to the irregularly moving phantom, and measured with a small-volume ion chamber at the tumor center. RESULTS Median difference from expected tumor motion range for 3DCT, 4DCT-P, and 4DCT-A was 2.5 [1.6-3.6] cm, 1.1 [0.1-1.9] cm, and 1.3 [0.4-1.9] cm, respectively (p = 0.005, 4DCT-P vs. 3DCT). Median AUC scores (ideal = 0) for 3DCT, 4DCT-P, and 4DCT-A were 0.25 [0.14-0.49], 0.12 [0.05-0.42], and 0.13 [0.09-0.44], respectively (p = 0.005, 4DCT-P vs. 3DCT). Nine of ten 4DCT-P plans and all 4DCT-A plans measured within 2.5% of expected dose in the treatment planning system (TPS), compared with seven 3DCT plans. CONCLUSION For the cases studied tumor motion range and average density was better represented with 4DCT compared with 3DCT, even in the presence of irregular breathing. 4DCT images allowed for delivery of VMAT plans with acceptable dosimetric accuracy. No significant differences were detected between phase and amplitude resorting. In combination with 4D cone beam imaging at treatment, our findings have given us confidence to introduce 4DCT and VMAT for lung radiotherapy patients with irregular breathing.
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Affiliation(s)
- Rhydian Caines
- Medical Physics Department, Clatterbridge Cancer Centre, Liverpool, UK
| | - Naomi K Sisson
- Medical Physics Department, Clatterbridge Cancer Centre, Liverpool, UK
| | - Carl G Rowbottom
- Medical Physics Department, Clatterbridge Cancer Centre, Liverpool, UK
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18
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Avanzo M, Gagliardi V, Stancanello J, Blanck O, Pirrone G, El Naqa I, Revelant A, Sartor G. Combining computed tomography and biologically effective dose in radiomics and deep learning improves prediction of tumor response to robotic lung stereotactic body radiation therapy. Med Phys 2021; 48:6257-6269. [PMID: 34415574 DOI: 10.1002/mp.15178] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study is to improve the performance of machine learning (ML) models in predicting response of non-small cell lung cancer (NSCLC) to stereotactic body radiation therapy (SBRT) by integrating image features from pre-treatment computed tomography (CT) with features from the biologically effective dose (BED) distribution. MATERIALS AND METHODS Image features, consisting of crafted radiomic features or machine-learned features extracted using a convolutional neural network, were calculated from pre-treatment CT data and from dose distributions converted into BED for 80 NSCLC lesions over 76 patients treated with robotic guided SBRT. ML models using different combinations of features were trained to predict complete or partial response according to response criteria in solid tumors, including radiomics CT (RadCT ), radiomics CT and BED (RadCT,BED ), deep learning (DL) CT (DLCT ), and DL CT and BED (DLCT,BED ). Training of ML included feature selection by neighborhood component analysis followed by ensemble ML using robust boosting. A model was considered as acceptable when the sum of average sensitivity and specificity on test data in repeated cross validations was at least 1.5. RESULTS Complete or partial response occurred in 58 out of 80 lesions. The best models to predict the tumor response were those using BED variables, achieving significantly better area under curve (AUC) and accuracy than those using only features from CT, including a RadCT,BED model using three radiomic features from BED, which scored an accuracy of 0.799 (95% confidence intervals (0.75-0.85)) and AUC of 0.773 (0.688-0.846), and a DLCT,BED model also using three variables with an accuracy of 0.798 (0.649-0.829) and AUC of 0.812 (0.755-0.867). CONCLUSION According to our results, the inclusion of BED features improves the response prediction of ML models for lung cancer patients undergoing SBRT, regardless of the use of radiomic or DL features.
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Affiliation(s)
- Michele Avanzo
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Vito Gagliardi
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | | | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany
| | - Giovanni Pirrone
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Issam El Naqa
- Department of Machine Learning, Moffitt University, Tampa, Florida, USA
| | - Alberto Revelant
- Radiation Oncology Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
| | - Giovanna Sartor
- Medical Physics Department, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, PN, Italy
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Fallet V, Matton L, Schernberg A, Canellas A, Cornelis FH, Cadranel J. Local ablative therapy in oncogenic-driven oligometastatic non-small cell lung cancer: present and ongoing strategies-a narrative review. Transl Lung Cancer Res 2021; 10:3457-3472. [PMID: 34430380 PMCID: PMC8350076 DOI: 10.21037/tlcr-20-1152] [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: 11/08/2020] [Accepted: 04/02/2021] [Indexed: 01/09/2023]
Abstract
Oligometastatic (OM) disease is defined by a low metastatic tumor spread. OM non-small cell lung cancer (NSCLC) treatment aims to improve the patient's prognosis and quality of life, in an attempt-to-cure objective. Oncogenic-driven metastatic NSCLC accounts for about 20-25% of NSCLCs, with an ever-increasing number of potentially druggable molecular alterations. Due to specific targeted therapy, the care and prognosis of mutated NSCLC is quite different from non-oncogenic-driven NSCLC. However, OM-NSCLC treatment guidelines do not specifically discuss oncogenic-driven OM-NSCLC patients. We conducted a narrative review regarding retrospective and prospective studies published from inception to May 2020 dealing with oncogenic-driven OM-NSCLC in order to: (I) describe the specific patterns of metastatic spread of oncogenic-driven NSCLC (i.e., bone and pleural tropism in EGFR mutated NSCLC and serous and brain metastases in ALK NSCLC); (II) review the low level of current evidence for local ablative therapy (LAT) strategies in patients with oncogenic-driven OM-NSCLC, focusing on the benefit/risk of tyrosine kinase inhibitors (TKI) and LATs combination and (III) present strategies to help to select the best candidate for an attempt-to-cure approach. Finally, the optimal strategy may be to introduce a targeted therapy, then treat all tumor sites with LAT, and finally continue TKI for unknown prolonged duration in an attempt to prolong progression free survival in most patients, improve overall survival for some patients, and potentially lead to a cancer cure for a few patients.
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Affiliation(s)
- Vincent Fallet
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - Lise Matton
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - Antoine Schernberg
- Department of Radiation Oncology, DMU Orphé, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Anthony Canellas
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
| | - François H. Cornelis
- Department of Interventional Radiology and Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Sorbonne Université, Paris, France
| | - Jacques Cadranel
- Department of Pneumology and Thoracic Oncology, Assistance Publique-Hôpitaux de Paris, Hôpital Tenon and GRC 4, Theranoscan, Sorbonne Université, Paris, France
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20
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Karlsson K, Lax I, Lindbäck E, Grozman V, Lindberg K, Wersäll P, Poludniowski G. Estimation of delivered dose to lung tumours considering setup uncertainties and breathing motion in a cohort of patients treated with stereotactic body radiation therapy. Phys Med 2021; 88:53-64. [PMID: 34175747 DOI: 10.1016/j.ejmp.2021.06.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Dose-response relationships for local control of lung tumours treated with stereotactic body radiotherapy (SBRT) have proved ambiguous, however, these have been based on the prescribed or planned dose. Delivered dose to the target may be a better predictor for local control. In this study, the probability of the delivered minimum dose to the clinical target volume (CTV) in relation to the prescribed dose was estimated for a cohort of patients, considering geometrical uncertainties. MATERIALS AND METHODS Delivered doses were retrospectively simulated for 50 patients treated with SBRT for lung tumours, comparing two image-guidance techniques: pre-treatment verification computed tomography (IG1) and online cone-beam computed tomography (IG2). The prescribed dose was typically to the 67% isodose line of the treatment plan. Simulations used in-house software that shifted the static planned dose according to a breathing motion and sampled setup/matching errors. Each treatment was repeatedly simulated, generating a multiplicity of dose-volume histograms (DVH). From these, tumour-specific and population-averaged statistics were derived. RESULTS For IG1, the probability that the minimum CTV dose (D98%) exceeded 100% of the prescribed dose was 90%. With IG2, this probability increased to 99%. CONCLUSIONS Doses below the prescribed dose were delivered to a considerably larger part of the population prior to the introduction of online soft-tissue image-guidance. However, there is no clear evidence that this impacts local control, when compared to previous published data.
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Affiliation(s)
- Kristin Karlsson
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Ingmar Lax
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Elias Lindbäck
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden; Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | - Vitali Grozman
- Section of Thoracic Radiology, Department of Radiology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
| | - Karin Lindberg
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Head, Neck, Lung and Skin Tumours, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Peter Wersäll
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Section of Radiotherapy, Department of Cancer, Karolinska University Hospital, Stockholm, Sweden.
| | - Gavin Poludniowski
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden; Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden.
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21
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Ikawa T, Tabuchi T, Konishi K, Morimoto M, Hirata T, Kanayama N, Wada K, Toratani M, Okawa S, Ogawa K, Teshima T. Prolonged overall treatment time negatively affects the outcomes of stereotactic body radiotherapy for early-stage non-small-cell lung cancer: A propensity score-weighted, single-center analysis. PLoS One 2021; 16:e0253203. [PMID: 34143851 PMCID: PMC8213186 DOI: 10.1371/journal.pone.0253203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/30/2021] [Indexed: 12/03/2022] Open
Abstract
Previous studies have reported conflicting results for the effect of overall treatment time with stereotactic body radiotherapy on tumor control in early-stage non-small-cell lung cancer. To examine this effect, we conducted a propensity score-weighted, retrospective, observational study at a single institution. We analyzed the data of 200 patients with early-stage non-small-cell lung cancer who underwent stereotactic body radiotherapy (48 Gy in 4 fractions) at our institution between January 2007 and October 2013. Patients were grouped into consecutive (overall treatment time = 4–5 days, n = 116) or non-consecutive treatment groups (overall treatment time = 6–10 days, n = 84). The outcomes of interest were local control and overall survival. The Cox regression model was used with propensity score and inverse probability of treatment weighting. The median overall treatment times in the consecutive and non-consecutive groups were 4 and 6 days, respectively. The 5-year local control and overall survival rates in the consecutive vs. the non-consecutive group were 86.3 vs. 77.2% and 55.5 vs. 51.8%, respectively. After propensity score weighting, consecutive stereotactic body radiotherapy was associated with positive local control (adjusted hazard ratio 0.30, 95% confidence interval 0.14–0.65; p = 0.002) and overall survival (adjusted hazard ratio 0.56, 95% confidence interval 0.34–0.91; p = 0.019) benefits. The prolonged overall treatment time of stereotactic body radiotherapy treatment negatively affected the outcomes of patients with early-stage non-small-cell lung cancer. To our knowledge, this is the first study to show that in patients with early-stage non-small-cell lung cancer treated with the same dose-fractionation regimen, consecutive stereotactic body radiotherapy has a more beneficial effect on tumor control than non-consecutive stereotactic body radiotherapy.
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Affiliation(s)
- Toshiki Ikawa
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
- * E-mail:
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masahiro Morimoto
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takero Hirata
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Naoyuki Kanayama
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kentaro Wada
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masayasu Toratani
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Sumiyo Okawa
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Kazuhiko Ogawa
- Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Teruki Teshima
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
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22
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Duvergé L, Bondiau PY, Claude L, Supiot S, Vaugier L, Thillays F, Doyen J, Ricordel C, Léna H, Bellec J, Chajon E, de Crevoisier R, Castelli J. Discontinuous stereotactic body radiotherapy schedule increases overall survival in early-stage non-small cell lung cancer. Lung Cancer 2021; 157:100-108. [PMID: 34016489 DOI: 10.1016/j.lungcan.2021.05.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The duration of stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) may affect patient outcomes. We aimed to determine the impact of a continuous versus discontinuous SBRT schedule on local control (LC) and overall survival (OS) in NSCLC patients. MATERIALS AND METHODS Consecutive NSCLC stage I patients (475) treated with SBRT in four centers were retrospectively analyzed. The delivered dose ranged from 48 to 75 Gy in 3-10 fractions. Based on the ratio between the treatment duration (TD) and number of fractions (n), patients were divided into two groups: continuous schedule (CS) (TD ≤ 1.6n; 239 patients) and discontinuous schedule (DS) (TD > 1.6n; 236 patients). LC and OS were compared using Cox regression analyses after propensity score matching (216 pairs). RESULTS The median follow-up period was 41 months. Multivariate analysis showed that the DS (hazard ratio (HR): 0.42; 95 % confidence interval (CI): 0.22-0.78) and number of fractions (HR: 1.24; 95 % CI: 1.07-1.43) were significantly associated with LC. The DS (HR: 0.67; 95 % CI: 0.51-0.89), age (HR: 1.02; 95 % CI: 1-1.03), WHO performance status (HR: 2.27; 95 % CI: 1.39-3.7), and T stage (HR: 1.4; 95 % CI: 1.03-1.87) were significantly associated with OS. The 3-year LC and OS were 92 % and 64 % and 81 % and 53 % for DS and CS treatments, respectively (p < 0.01). Cox analysis confirmed that the discontinuous SBRT schedule significantly increased LC and OS. CONCLUSION DS is associated with significantly improved LC and OS in early-stage NSCLC patients treated with SBRT.
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Affiliation(s)
- L Duvergé
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France.
| | - P-Y Bondiau
- Radiation Oncology Department, Centre Antoine Lacassagne, 06000 Nice, France
| | - L Claude
- Radiation Oncology Department, Centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - S Supiot
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest- René Gauducheau, Bd J Monod, 44800 Nantes, St-Herblain, France
| | - L Vaugier
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest- René Gauducheau, Bd J Monod, 44800 Nantes, St-Herblain, France
| | - F Thillays
- Radiation Oncology Department, Institut de Cancérologie de l'Ouest- René Gauducheau, Bd J Monod, 44800 Nantes, St-Herblain, France
| | - J Doyen
- Radiation Oncology Department, Centre Antoine Lacassagne, 06000 Nice, France
| | - C Ricordel
- Pneumology Department, Centre Hospitalier Universitaire de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - H Léna
- Pneumology Department, Centre Hospitalier Universitaire de Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
| | - J Bellec
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
| | - E Chajon
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
| | - R de Crevoisier
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
| | - J Castelli
- Radiation Oncology Department, Centre Eugène Marquis, Avenue Flandres Dunkerque, 35000 Rennes, France
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Ferentinos K, Karagiannis E, Strouthos I, Vrachimis A, Doolan PJ, Zamboglou N. Computed tomography guided interstitial percutaneous high-dose-rate brachytherapy in the management of lung malignancies. A review of the literature. Brachytherapy 2021; 20:892-899. [PMID: 33985903 DOI: 10.1016/j.brachy.2021.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 11/16/2022]
Abstract
A growing number of patients with lung cancer are not amenable to surgery due to their age or comorbidities. For this reason, local ablative techniques have gained increasing interest recently in the management of inoperable lung tumors. High-dose-rate percutaneous interstitial brachytherapy, performed under CT-guidance, is a newer form of brachytherapy and is a highly conformal radiotherapy technique. The aim of this study was to describe this method and review the existing literature. Eight articles comprising 234 patients reported toxicity and clinical outcome. The follow-up ranged from 6 to 28 months. Diverse fractionation schemes were reported, with 20 Gy in a single fraction being the most frequently utilized. Toxicity was limited; major pneumothoraces occurred after only 8% of the interventions. Local control rates at one year ranged between 37% and 91%. In conclusion, high-dose-rate percutaneous interstitial brachytherapy is a safe, fast, and efficient treatment option for inoperable lung tumors.
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Affiliation(s)
- Konstantinos Ferentinos
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus.
| | - Efstratios Karagiannis
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Iosif Strouthos
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center, European University of Cyprus, Limassol, Cyprus
| | - Paul J Doolan
- Department of Medical Physics, German Oncology Center, Limassol, Cyprus
| | - Nikolaos Zamboglou
- Department of Radiation Oncology, German Oncology Center, European University of Cyprus, Limassol, Cyprus
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24
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Mayinger M, Ludwig R, Christ SM, Dal Bello R, Ryu A, Weitkamp N, Pavic M, Garcia Schüler H, Wilke L, Guckenberger M, Unkelbach J, Tanadini-Lang S, Andratschke N. Benefit of replanning in MR-guided online adaptive radiation therapy in the treatment of liver metastasis. Radiat Oncol 2021; 16:84. [PMID: 33947429 PMCID: PMC8097956 DOI: 10.1186/s13014-021-01813-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To assess the effects of daily adaptive MR-guided replanning in stereotactic body radiation therapy (SBRT) of liver metastases based on a patient individual longitudinal dosimetric analysis. METHODS Fifteen patients assigned to SBRT for oligometastatic liver metastases underwent daily MR-guided target localization and on-table treatment plan re-optimization. Gross tumor volume (GTV) and organs at risk (OARs) were adapted to the anatomy-of-the-day. A reoptimized plan (RP) and a rigidly shifted baseline plan (sBP) without re-optimization were generated for each fraction. After extraction of DVH parameters for GTV, planning target volume (PTV), and OARs (stomach, duodenum, bowel, liver, heart) plans were compared on a per-patient basis. RESULTS Median pre-treatment GTV and PTV were 14.9 cc (interquartile range (IQR): 7.7-32.9) and 62.7 cc (IQR: 42.4-105.5) respectively. SBRT with RP improved PTV coverage (V100%) for 47/75 of the fractions and reduced doses to the most proximal OARs (D1cc, Dmean) in 33/75 fractions compared to sBP. RP significantly improved PTV coverage (V100%) for metastases within close proximity to an OAR by 4.0% (≤ 0.2 cm distance from the edge of the PTV to the edge of the OAR; n = 7; p = 0.01), but only by 0.2% for metastases farther away from OAR (> 2 cm distance; n = 7; p = 0.37). No acute grade 3 treatment-related toxicities were observed. CONCLUSIONS MR-guided online replanning SBRT improved target coverage and OAR sparing for liver metastases with a distance from the edge of the PTV to the nearest luminal OAR < 2 cm. Only marginal improvements in target coverage were observed for target distant to critical OARs, indicating that these patients do not benefit from daily adaptive replanning.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany.
| | - Roman Ludwig
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Sebastian M Christ
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Riccardo Dal Bello
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Alex Ryu
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Nienke Weitkamp
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Matea Pavic
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Helena Garcia Schüler
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Jan Unkelbach
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Germany
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25
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Lee P, Loo BW, Biswas T, Ding GX, El Naqa IM, Jackson A, Kong FM, LaCouture T, Miften M, Solberg T, Tome WA, Tai A, Yorke E, Li XA. Local Control After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 110:160-171. [PMID: 30954520 PMCID: PMC9446070 DOI: 10.1016/j.ijrobp.2019.03.045] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/06/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Numerous dose and fractionation schedules have been used to treat medically inoperable stage I non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy. We evaluated published experiences with SBRT to determine local control (LC) rates as a function of SBRT dose. METHODS AND MATERIALS One hundred sixty published articles reporting LC rates after SBRT for stage I NSCLC were identified. Quality of the series was assessed by evaluating the number of patients in the study, homogeneity of the dose regimen, length of follow-up time, and reporting of LC. Clinical data including 1, 2, 3, and 5-year tumor control probabilities for stages T1, T2, and combined T1 and T2 as a function of the biological effective dose were fitted to the linear quadratic, universal survival curve, and regrowth models. RESULTS Forty-six studies met inclusion criteria. As measured by the goodness of fit χ2/ndf, with ndf as the number of degrees of freedom, none of the models were ideal fits for the data. Of the 3 models, the regrowth model provides the best fit to the clinical data. For the regrowth model, the fitting yielded an α-to-β ratio of approximately 25 Gy for T1 tumors, 19 Gy for T2 tumors, and 21 Gy for T1 and T2 combined. To achieve the maximal LC rate, the predicted physical dose schemes when prescribed at the periphery of the planning target volume are 43 ± 1 Gy in 3 fractions, 47 ± 1 Gy in 4 fractions, and 50 ± 1 Gy in 5 fractions for combined T1 and T2 tumors. CONCLUSIONS Early-stage NSCLC is radioresponsive when treated with SBRT or stereotactic ablative radiation therapy. A steep dose-response relationship exists with high rates of durable LC when physical doses of 43-50 Gy are delivered in 3 to 5 fractions.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Issam M El Naqa
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Andrew Jackson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Feng-Ming Kong
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Tamara LaCouture
- Department of Radiation Oncology, Jefferson Health New Jersey, Sewell, New Jersey
| | - Moyed Miften
- Department of Radiation Oncology, Colorado University School of Medicine, Aurora, Colorado
| | - Timothy Solberg
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, California
| | - Wolfgang A Tome
- Department of Radiation Oncology, Albert Einstein College of Medicine, New York, New York
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ellen Yorke
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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26
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Parzen JS, Almahariq MF, Quinn TJ, Siddiqui ZA, Thompson AB, Guerrero T, Lee K, Stevens C, Grills IS. Higher biologically effective dose is associated with improved survival in patients with squamous cell carcinoma of the lung treated with stereotactic body radiation therapy. Radiother Oncol 2021; 160:25-31. [PMID: 33892021 DOI: 10.1016/j.radonc.2021.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multiple studies have suggested that patients with early-stage SCC of the lung treated with SBRT are more susceptible to local failure compared to other NSCLC histologies. It is unknown if higher BED leads to improved outcomes in this patient population. We evaluated the effect of "high" BED versus "low" BED SBRT on overall survival (OS) in SCC and non-SCC NSCLC patients. METHODS The National Cancer Database was used to identify patients with cT1-2N0M0 NSCLC diagnosed between 2006-2016 treated with 3-5 fraction SBRT. Patients were grouped by BEDhigh (>150 Gy) and BEDlow (≤132 Gy). Univariate and multivariable analysis using Kaplan-Meier and Cox proportional hazards regression modeling were performed. Propensity-score matched analysis with inverse probability of treatment (IPTW) weighting was used to account for selection bias. RESULTS We identified 4,717 eligible SCC patients and 8,807 eligible non-SCC NSCLC patients. In SCC patients, BEDhigh was associated with improved OS in both univariate and multivariate analysis (MVA HR 0.84 95% CI 0.76-0.92, p < 0.001), with estimated IPTW-adjusted 3-year OS of 49% compared to 41% for the BEDlow group. In contrast, BEDhigh was not associated with improved OS compared to BEDlow for non-SCC NSCLC patients (MVA HR 0.94 95% CI 0.86-1.04, p = 0.23), with estimated IPTW-adjusted 3-year OS of 54% and 53%, respectively. CONCLUSIONS Our analysis suggests that in patients with early-stage NSCLC, SBRT regimens with BED > 150 Gy may confer a survival benefit in patients with SCC histology. Histology-based dose modification should be considered, and prospective validation may be warranted.
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Affiliation(s)
- Jacob S Parzen
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Muayad F Almahariq
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States.
| | - Thomas J Quinn
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Zaid A Siddiqui
- University of Pittsburgh Medical Center, Pittsburgh, United States
| | - Andrew B Thompson
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Thomas Guerrero
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Kuei Lee
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Craig Stevens
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
| | - Inga S Grills
- Beaumont Health, Department of Radiation Oncology, Royal Oak, United States
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Tateishi Y, Takeda A, Horita N, Tsurugai Y, Eriguchi T, Kibe Y, Sanuki N, Kaneko T. Stereotactic Body Radiation Therapy With a High Maximum Dose Improves Local Control, Cancer-Specific Death, and Overall Survival in Peripheral Early-Stage Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 111:143-151. [PMID: 33891980 DOI: 10.1016/j.ijrobp.2021.04.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/14/2021] [Accepted: 04/12/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE We investigated whether delivery of a high biologically effective dose (BED) to primary tumors affects systemic outcomes of cancer-specific death (CSD) and overall survival (OS) rates after stereotactic body radiation therapy (SBRT) in patients with early-stage non-small cell lung cancer (ES-NSCLC). METHODS AND MATERIALS Among consecutive ES-NSCLC patients treated with SBRT between 2005 and 2019, we retrospectively identified patients who received a prescription of 50 to 60 Gy in 5 fractions with maximum doses of 62.5 to 100 Gy. Patients were categorized by maximum BED within the planning target volume with a threshold dose of 200 Gy. Outcomes were analyzed in all and matched patients. RESULTS Overall, 433 patients were eligible, and 262 and 171 patients were categorized into HighBED and LowBED groups, respectively. After propensity score matching, pairs of 154 patients were selected. Median follow-up times for the HighBED and LowBED groups were 52.3 months (range, 0.8-107.2 months) and 121.6 months (range, 3.0-162.8 months), respectively. The local recurrence rate in the HighBED group was significantly lower than that in the LowBED group (5-year rate, 1.3% and 7.2%; hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.03-0.65; P = .011). Rates of any recurrence and CSD in the HighBED group were significantly lower (5-year any recurrence: 18.1% and 32.1%; HR, 0.52; 95% CI, 0.33-0.83; P = .0058; 5-year CSD: 9.5% and 21.8%; HR, 0.38; 95% CI, 0.20-0.70; P = .002), and OS in the HighBED group was significantly better compared with the LowBED group (5-year rate: 61.7% and 51.8%; HR, 0.71; 95% CI, 0.50-1.00; P = .047). CONCLUSION In patients with peripheral ES-NSCLC, SBRT with a high maximum dose may improve not only local control, but also any recurrence, CSD, and OS rates without increased toxicity. Further trials designed to evaluate whether higher intensity SBRT increases local control rates and contributes to improved CSD and OS outcomes are anticipated.
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Affiliation(s)
- Yudai Tateishi
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Atsuya Takeda
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yuichiro Tsurugai
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Takahisa Eriguchi
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Yuichi Kibe
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Naoko Sanuki
- Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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28
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Kuperman VY, Lubich LM. Impact of target dose inhomogeneity on BED and EUD in lung SBRT. Phys Med Biol 2021; 66:01NT02. [PMID: 33576337 DOI: 10.1088/1361-6560/abd0d1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the effect of dose heterogeneity in the treatment target on biologically effective dose (BED) for frequently used hypofractionation regimens in stereotactic body radiation therapy (SBRT). METHODS In the case of non-uniform target dose, BED in the planning target volume (PTV) is determined by using the linear-quadratic model. An expression for BED is obtained for an arbitrary dose distribution in the PTV in the case of small variance of the target dose. Another analytical expression for BED is obtained by assuming a Gaussian dose distribution in the target. RESULTS Analytical expressions for BED as a function of the variance of the target dose have been derived. It is shown that a relatively small dose inhomogeneity (<5%-6%) can cause a significant reduction (i.e. >10%) in the corresponding BED and equivalent uniform dose (EUD) compared to the case of uniform target dose. CONCLUSIONS Small variations in the absorbed dose can significantly reduce BED and EUD in the PTV. The effect of dose non-uniformity on BED increases with increasing dose per fraction. The observed reduction in BED compared to that for uniform target dose can be several times greater for SBRT than for standard fractionation with dose per fraction varying between 1.8 and 2 Gy.
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Affiliation(s)
- Vadim Y Kuperman
- Medical Physics Support, Inc., Tampa, FL 33634, United States of America
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29
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Dziedzic R, Marjański T, Rzyman W. A narrative review of invasive diagnostics and treatment of early lung cancer. Transl Lung Cancer Res 2021; 10:1110-1123. [PMID: 33718049 PMCID: PMC7947400 DOI: 10.21037/tlcr-20-728] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The diagnosis and treatment of early-stage lung cancer remains a clinical challenge. The broadening implementation of lung cancer screening has resulted in positive findings in numerous patients that are mostly non-malignant. Many other patients have indeterminate nodules that are difficult to assess through simple observation. The critical interpretation of such screening results remains a challenge for radiologists and multidisciplinary teams involved in screening for lung cancer. The evaluation and diagnosis of each participant suspected for malignancy should be based on the basic clinical principles such as a carefully collected medical history, physical examination, and detailed analysis of all imaging tests performed. Indeed, the decision to go ahead with more invasive diagnostics requires consideration of the both the risks and benefits, with reflection upon the complete clinical and radiological picture. Although transthoracic needle aspiration biopsy remains the first-choice method of diagnosis, several newer technologies have slowly begun to emerge as potential replacements. The guiding strategy for method selection is to choose the least harmful approach that offers the most relevant potential insights. Transthoracic biopsy is an effective method that allows the collection of cytological and tissue material from small, peripheral tumors, but it carries a moderate risk of complications. Bronchofiberoscopy, especially in combination with electromagnetic navigation, fluoroscopy or radial EBUS, also allows effective diagnosis of the peripheral pulmonary nodules. One of the most important diagnostic methods is the EBUS examination, which allows determining of staging in addition to diagnosis. Anatomical lung lobe resection and lymphadenectomy or sampling of the hilar and mediastinal lymph nodes is currently the treatment of choice for patients with stage I and II non-small cell lung cancer (NSCLC), but sublobar resections are recommended when a patient has limited pulmonary function or other significant comorbidities. Notably, several studies have highlighted the potential utility of more limited resections in small malignant lesions less than 2cm in diameter, with pure AIS histology, when more than 50% of the diameter of pulmonary nodule has ground-glass opacity (GGO) attenuation on CT, or long volume doubling time (VDT). Videothoracoscopy is the preferred surgical approach for resection of early-stage lung cancer. Patients who are not candidates for surgery or do not agree to surgery can be offered radical radiotherapy. Stereotactic body radiation therapy (SBRT) is a type of radical radiotherapy with proven effectiveness, a high rate of local control and an acceptable risk of the development of later complications. Future trials are expected to define the role of SBRT in the treatment of early lung cancer in healthy subjects.
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Affiliation(s)
- Robert Dziedzic
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Tomasz Marjański
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdansk, Gdansk, Poland
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30
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Kowalchuk RO, Waters MR, Richardson KM, Spencer KM, Larner JM, Kersh CR. A single institutional experience with central lung stereotactic body radiation therapy demonstrating encouraging results with increased inter-fraction time. J Thorac Dis 2021; 13:642-652. [PMID: 33717537 PMCID: PMC7947542 DOI: 10.21037/jtd-20-2659] [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: 02/04/2023]
Abstract
Background Stereotactic body radiation therapy (SBRT) is an effective treatment modality for non-small cell lung cancer (NSCLC); however, there are concerns regarding potential toxicity for centrally located tumors. Methods This retrospective study considered patients with SBRT for central lung NSCLC (defined as a tumor within 2 cm of any mediastinal critical structure). The institutional protocol was that patients with central tumors received SBRT less frequently than daily—generally once or twice weekly. Results A total of 115 patients with 148 lesions were treated with SBRT to a median 45 [5–60] Gy in 4 [1–5] fractions over a median 5.3 [0–18] days. Many patients treated with this method presented with advanced disease: 58 treatments involved nodal targets, and 42 had stage 3 disease. 52% of patients had chronic obstructive pulmonary disease (COPD), and only 49% had a biopsy, often due to concerns regarding other medical comorbidities. Rates of prior chemotherapy, thoracic surgery, and thoracic radiotherapy were 32%, 21%, and 49%, respectively. Via the Kaplan-Meier method, 2-year overall survival was 65%, and 2-year local control was 77%. Two-year local-progression free survival was 53%, and 2-year progression-survival was 48%. Treatments for stage 3 disease had an impressive 82% 2-year local control that was comparable to early stage treatments. Patients with stage 3 disease had a 2-year overall survival of 59%, which trended towards decreased overall survival compared to early stage patients. There were 13 grade 1 (9%) and 14 grade 2 (9%) toxicities. There were no reported grade ≥3 acute or late toxicities and only 3 cases of pneumonitis. Conclusions Our series demonstrates encouraging local control with low rates of toxicity for central lung SBRT, including many stage 3 patients. This may be the result of the relatively large inter-fraction interval. This interval may allow for greater tumor effects (such as reoxygenation) and improved tolerance from normal tissues.
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Affiliation(s)
- Roman O Kowalchuk
- Radiosurgery Center, University of Virginia/Riverside, Newport News, VA, USA
| | - Michael R Waters
- Radiosurgery Center, University of Virginia/Riverside, Newport News, VA, USA
| | - K Martin Richardson
- Radiosurgery Center, University of Virginia/Riverside, Newport News, VA, USA
| | - Kelly M Spencer
- Radiosurgery Center, University of Virginia/Riverside, Newport News, VA, USA
| | - James M Larner
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA
| | - Charles R Kersh
- Radiosurgery Center, University of Virginia/Riverside, Newport News, VA, USA
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CEYLAN C, HAMAMCI A, AYATA H, BERBEROĞLU K, GÜNDOĞDU Ö, ENGİN K. Erken Evre Küçük Hücreli Dışı Akciğer Kanserlerinin Tedavisinde Robotik Radyocerrahi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.760034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Koiwai K, Endo Y, Mizuhata K, Ina H, Fukazawa A, Ozawa T, Fujinaga Y. Ten-Year Experience of Stereotactic Body Radiotherapy at a Single Institution: Impact of Technological Development on the Outcome of Patients With Early Lung Cancer. Technol Cancer Res Treat 2020; 19:1533033820979163. [PMID: 33267715 PMCID: PMC7720300 DOI: 10.1177/1533033820979163] [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] [Indexed: 11/17/2022] Open
Abstract
Purpose: Advanced radiotherapeutic techniques and apparatus have been developed and widely applied in stereotactic body radiation therapy for early-stage non-small cell lung cancer, but their clinical benefits have not necessarily been confirmed. This study was performed to review our 10-year experience with therapy for the disease and to evaluate whether the advanced radiotherapeutic system implemented in our hospital 5 years after we began the therapy improved the clinical outcomes of patients. Materials and Methods: Patients who underwent the therapy at our hospital between April 2008 and March 2018 were retrospectively reviewed. They were divided into 2 groups treated with the conventional system or the advanced system, and the characteristics and clinical outcomes were compared between the groups. The same analyses were also performed in propensity-matched patients from the 2 groups. Results: Among the 73 patients eligible for this study, 42 were treated with the conventional system and 31 with the advanced system. All were treated as planned, and severe adverse events were rare. The local progression-free survival rate in the advanced system group was significantly higher than in the conventional system group (P = 0.025). In the propensity-matched patients, both the local progression-free survival rate and the overall survival rate were significantly higher compared in the advanced system group than the conventional system group (P = 0.089 and 0.080, respectively). Conclusion: The advanced system improved the outcomes of patients with the disease, suggesting that technological development has had a strong impact on clinical outcomes.
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Affiliation(s)
- Keiichiro Koiwai
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Yuuki Endo
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Kai Mizuhata
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Hironobu Ina
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Ayumu Fukazawa
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Takesumi Ozawa
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
| | - Yasunari Fujinaga
- Department of Radiology, 34808Shinshu University, School of Medicine, Matsumoto, Japan
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Recursive Partitioning Analysis for Local Control Achieved With Stereotactic Body Radiation Therapy for the Liver, Spine, or Lymph Nodes. Adv Radiat Oncol 2020; 6:100612. [PMID: 34195484 PMCID: PMC8233465 DOI: 10.1016/j.adro.2020.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/04/2020] [Accepted: 10/29/2020] [Indexed: 01/05/2023] Open
Abstract
Purpose This study aims to develop a local control risk stratification using recursive partitioning analysis (RPA) for patients receiving stereotactic body radiation therapy (SBRT) for metastatic cancer. Methods and Materials A single institutional database of 397 SBRT treatments to the liver, spine, and lymph nodes was constructed. All treatments required imaging follow-up to assess for local control. Cox proportional hazards analysis was implemented before the decision tree analysis. The data were split into training (70%), validation (10%), and testing (20%) sets for RPA to optimize the training set. Results In the study, 361 treatments were included in the local control analysis. Two-year local control was 71%. A decision tree analysis was used and the resulting model demonstrated 93.10% fidelity for the validation set and 87.67% for the test set. RPA class 3 was composed of patients with non-small cell lung cancer (NSCLC) primary tumors and treatment targets other than the cervical, thoracic, and lumbar spines. RPA class 2 included patients with primary cancers other than NSCLC or breast and treatments targets of the sacral spine or liver. RPA class 1 consisted of all other patients (including lymph node targets and patients with primary breast cancer). Classes 3, 2, and 1 demonstrated 3-year local controls rates of 29%, 50%, and 83%, respectively. On subgroup analysis using the Kaplan-Meier method, treatments for lymph nodes and primary ovarian disease demonstrated improved local control relative to other treatment targets (P < .005) and primary disease sites (P < .005), respectively. Conclusions A local control risk stratification model for SBRT to sites of metastatic disease was developed. Treatment target and primary tumor were identified as critical factors determining local control. NSCLC primary lesions have increased local failure for targets other than the cervical, thoracic, or lumbar spines, and improved local control was identified for lymph node sites and breast or ovarian primary tumors.
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Mix M, Bogart JA. A biologically effective dose threshold for stereotactic body radiation therapy-can we put the issue to BED? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1533. [PMID: 33313278 PMCID: PMC7729357 DOI: 10.21037/atm-20-3689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Michael Mix
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jeffrey A Bogart
- Department of Radiation Oncology, Upstate Cancer Center, SUNY Upstate Medical University, Syracuse, NY, USA
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Taylor JM, Song A, David AR, Chen VE, Lu B, Werner-Wasik M. Impact of Sarcopenia on Survival in Patients With Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy. Cureus 2020; 12:e10712. [PMID: 33014666 PMCID: PMC7526967 DOI: 10.7759/cureus.10712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Sarcopenia has been associated with poor survival among cancer patients. Normalized total psoas area (NTPA) has been used as a surrogate for defining sarcopenia. Few data exist characterizing the impact of sarcopenia and other metrics of fitness on clinical outcomes in patients with early-stage non-small cell lung cancer (NSCLC) treated non-invasively with stereotactic body radiotherapy (SBRT). Methods To assess the association between sarcopenia and clinical outcomes, we conducted a retrospective analysis of consecutive patients treated with SBRT from 2013 to 2019 . Overall survival (OS), local failure free survival (LFS), distant failure free survival (DFS), NTPA, body mass index (BMI), and Charlson comorbidity index (CCI) were included for analysis. NTPA was calculated by measuring the psoas volume at the L3 vertebra and normalizing for patient height and gender. Survival functions were evaluated using the Kaplan-Meier method. Log-rank test and Cox-proportional hazards were performed for categorical and continuous variables, respectively. Significance was set as p < 0.05. Results A total of 91 patients met the criteria. The median age was seven years and Karnofsky Performance Status score (KPS) was 80 (range: 60-100). Approximately 79% of patients had T1 tumors. Median radiation dose and number of fractions were 60 Gy (range: 45-60) and 5 fractions (range: 3-5). Median NTPA was 531.16 mm2/m2 (range: 90.4-1356.2). After normalization (sarcopenia: <385 mm2/m2, female; <585 mm2/m2, male), 39 patients (42.8%) had sarcopenia. NTPA had no association with OS (p = 0.7), LFS (p = 0.9), or DFS (p = 0.5). Increasing BMI was associated with improved OS (HR 0.90, 95% CI 0.83-0.98). With a median follow-up of 23.4 months, median OS was 60, 60, and 45.9 months (p = 0.37) in all patients, non-sarcopenic patients, and sarcopenic patients, respectively. Conclusion Sarcopenia was not associated with OS, LFS, or DFS. Increasing BMI is associated with improved OS. Future, prospective work is needed to define the impact of sarcopenia and other fitness metrics on clinical outcomes among NSCLC patients treated non-invasively with SBRT.
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Affiliation(s)
- James M Taylor
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - Andrew Song
- Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, USA
| | - Allison R David
- Radiation Oncology, Sidney Kimmel Medical College, Philadelphia, USA.,Internal Medicine, Boston Medical Center, Boston, USA
| | - Victor E Chen
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - Bo Lu
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
| | - Maria Werner-Wasik
- Radiation Oncology, Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, USA
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Klement RJ, Sonke JJ, Allgäuer M, Andratschke N, Appold S, Belderbos J, Belka C, Blanck O, Dieckmann K, Eich HT, Mantel F, Eble M, Hope A, Grosu AL, Nevinny-Stickel M, Semrau S, Sweeney RA, Hörner-Rieber J, Werner-Wasik M, Engenhart-Cabillic R, Ye H, Grills I, Guckenberger M. Correlating Dose Variables with Local Tumor Control in Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: A Modeling Study on 1500 Individual Treatments. Int J Radiat Oncol Biol Phys 2020; 107:579-586. [PMID: 32188579 DOI: 10.1016/j.ijrobp.2020.03.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/04/2020] [Accepted: 03/02/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Large variation regarding prescription and dose inhomogeneity exists in stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. The aim of this modeling study was to identify which dose metric correlates best with local tumor control probability to make recommendations regarding SBRT prescription. METHODS AND MATERIALS We combined 2 retrospective databases of patients with non-small cell lung cancer, yielding 1500 SBRT treatments for analysis. Three dose parameters were converted to biologically effective doses (BEDs): (1) the (near-minimum) dose prescribed to the planning target volume (PTV) periphery (yielding BEDmin); (2) the (near-maximum) dose absorbed by 1% of the PTV (yielding BEDmax); and (3) the average between near-minimum and near-maximum doses (yielding BEDave). These BED parameters were then correlated to the risk of local recurrence through Cox regression. Furthermore, BED-based prediction of local recurrence was attempted by logistic regression and fast and frugal trees. Models were compared using the Akaike information criterion. RESULTS There were 1500 treatments in 1434 patients; 117 tumors recurred locally. Actuarial local control rates at 12 and 36 months were 96.8% (95% confidence interval, 95.8%-97.8%) and 89.0% (87.0%-91.1%), respectively. In univariable Cox regression, BEDave was the best predictor of risk of local recurrence, and a model based on BEDmin had substantially less evidential support. In univariable logistic regression, the model based on BEDave also performed best. Multivariable classification using fast and frugal trees revealed BEDmax to be the most important predictor, followed by BEDave. CONCLUSIONS BEDave was generally better correlated with tumor control probability than either BEDmax or BEDmin. Because the average between near-minimum and near-maximum doses was highly correlated to the mean gross tumor volume dose, the latter may be used as a prescription target. More emphasis could be placed on achieving sufficiently high mean doses within the gross tumor volume rather than the PTV covering dose, a concept needing further validation.
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Affiliation(s)
- Rainer J Klement
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany.
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Michael Allgäuer
- Department of Radiotherapy, Barmherzige Brüder Regensburg, Regensburg, Germany
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Steffen Appold
- Department of Radiation Oncology, Technische Universität Dresden, Dresden, Germany
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Karin Dieckmann
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Hans T Eich
- Department of Radiotherapy, University Hospital Münster, Münster, Germany
| | - Frederick Mantel
- Department of Radiotherapy and Radiation Oncology, University Hospital Wuerzburg, Wuerzberg, Germany
| | - Michael Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto and Princess Margaret Cancer Center, Toronto, Canada
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | | | - Sabine Semrau
- Department of Radiation Oncology, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Reinhart A Sweeney
- Department of Radiotherapy and Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Rita Engenhart-Cabillic
- Department of Radiotherapy and Radiation Oncology, Phillips-University Marburg, Marburg, Germany
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
| | - Inga Grills
- Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, Michigan
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Grégoire V, Guckenberger M, Haustermans K, Lagendijk JJW, Ménard C, Pötter R, Slotman BJ, Tanderup K, Thorwarth D, van Herk M, Zips D. Image guidance in radiation therapy for better cure of cancer. Mol Oncol 2020; 14:1470-1491. [PMID: 32536001 PMCID: PMC7332209 DOI: 10.1002/1878-0261.12751] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
The key goal and main challenge of radiation therapy is the elimination of tumors without any concurring damages of the surrounding healthy tissues and organs. Radiation doses required to achieve sufficient cancer-cell kill exceed in most clinical situations the dose that can be tolerated by the healthy tissues, especially when large parts of the affected organ are irradiated. High-precision radiation oncology aims at optimizing tumor coverage, while sparing normal tissues. Medical imaging during the preparation phase, as well as in the treatment room for localization of the tumor and directing the beam, referred to as image-guided radiotherapy (IGRT), is the cornerstone of precision radiation oncology. Sophisticated high-resolution real-time IGRT using X-rays, computer tomography, magnetic resonance imaging, or ultrasound, enables delivery of high radiation doses to tumors without significant damage of healthy organs. IGRT is the most convincing success story of radiation oncology over the last decades, and it remains a major driving force of innovation, contributing to the development of personalized oncology, for example, through the use of real-time imaging biomarkers for individualized dose delivery.
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Affiliation(s)
- Vincent Grégoire
- Department of Radiation OncologyLéon Bérard Cancer CenterLyonFrance
| | - Matthias Guckenberger
- Department for Radiation OncologyUniversity Hospital ZurichUniversity of ZurichSwitzerland
| | - Karin Haustermans
- Department of Radiation OncologyLeuven Cancer InstituteUniversity Hospital GasthuisbergLeuvenBelgium
| | | | | | - Richard Pötter
- Department of Radiation OncologyMedical UniversityGeneral Hospital of ViennaAustria
| | - Ben J. Slotman
- Department of Radiation OncologyAmsterdam University Medical CentersThe Netherlands
| | - Kari Tanderup
- Department of OncologyAarhus University HospitalDenmark
| | - Daniela Thorwarth
- Section for Biomedical PhysicsDepartment of Radiation OncologyUniversity of TübingenGermany
| | - Marcel van Herk
- Department of Biomedical Engineering and PhysicsCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamThe Netherlands
- Institute of Cancer SciencesUniversity of ManchesterUK
- Department of Radiotherapy Related ResearchThe Christie NHS Foundation TrustManchesterUK
| | - Daniel Zips
- Department of Radiation OncologyUniversity of TübingenGermany
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Sarkar V, Szegedi M, Paxton A, Nelson G, Rassiah‐Szegedi P, Reddy CB, Tao R, Hitchcock YJ, Kokeny KE, Salter BJ. Preliminary clinical experience with Calypso anchored beacons for tumor tracking in lung SBRT. Med Phys 2020; 47:4407-4415. [DOI: 10.1002/mp.14300] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/13/2020] [Accepted: 05/21/2020] [Indexed: 12/25/2022] Open
Affiliation(s)
- Vikren Sarkar
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | - Martin Szegedi
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | - Adam Paxton
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | - Geoff Nelson
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | | | | | - Randa Tao
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | - Ying J. Hitchcock
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | - Kristine E. Kokeny
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
| | - Bill J. Salter
- Department of Radiation Oncology University of Utah Salt Lake City UT 84112USA
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Weiss E, Deng X, Mukhopadhyay N, Jan N. Effects of the recurrence pattern on patient survival following SABR for stage I lung cancer. Acta Oncol 2020; 59:427-433. [PMID: 31928266 DOI: 10.1080/0284186x.2019.1711172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Information on the effect of the recurrence pattern on survival for stage I lung cancer following stereotactic ablative radiotherapy (SABR) is limited.Materials and Methods: The recurrence pattern was analyzed for 100 consecutive stage I non-small-cell lung cancer patients treated with SABR using predominantly 12 Gy × 4. Recurrences were classified as local, regional lymph nodes and distant. Distant recurrences included recurrences in the lung and outside the chest. Single lung recurrences were named solitary, if no other location was involved. Kaplan-Meier survival estimates were calculated for different locations of recurrence. Clinical and dosimetrical factors affecting survival were also analyzed.Results: Median follow-up was 32 months (3-123), median age 70 years (49-95). In total, 31 patients had recurrences after a median 21 months (4-60): 5 local; 10 regional; 8 distant outside the chest; 25 non-local lung recurrences, of which 15 were single - 10 of which solitary - and 10 multiple lung nodules. Patients with a solitary lung recurrence had longer survival compared to local or distant recurrences (p = .04 each), and compared to multiple lung nodules (p = .09). 3-year local recurrence-free survival was 92%, disease-free survival 69% and overall survival 59%. On multivariate analysis, disease-free survival was associated with statin use (p = .038) and tumor location (p = .035). Smoking history predicted overall survival (p < .0006).Conclusions: A total of 81% of recurrences involved the lungs. Patients with solitary lung recurrences/second primary lung cancers had the longest overall survival suggesting definitive treatment should be considered. The effects of statin use need to be explored further.
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Affiliation(s)
- Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Xiaoyan Deng
- Department of Biostatistics, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Nitai Mukhopadhyay
- Department of Biostatistics, Virginia Commonwealth University Health, Richmond, VA, USA
| | - Nuzhat Jan
- Department of Radiation Oncology, Virginia Commonwealth University Health, Richmond, VA, USA
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Retrospective Analyses of Registry Data for Technical Radiation Oncology Questions: Apples Versus Pears or Solid Evidence? J Thorac Oncol 2019; 15:15-17. [PMID: 31864548 DOI: 10.1016/j.jtho.2019.09.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022]
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Fernandez C, Grills IS, Ye H, Hope AJ, Guckenberger M, Mantel F, Kestin LL, Belderbos J, Werner-Wasik M. Stereotactic Image Guided Lung Radiation Therapy for Clinical Early Stage Non-Small Cell Lung Cancer: A Long-Term Report From a Multi-Institutional Database of Patients Treated With or Without a Pathologic Diagnosis. Pract Radiat Oncol 2019; 10:e227-e237. [PMID: 31837478 DOI: 10.1016/j.prro.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/07/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE Early stage lung cancer is treated with stereotactic body radiation therapy (SBRT) in patients who are unable or unwilling to undergo surgical resection. Some patients' comorbidities are so severe that they are unable to even undergo a biopsy. A clinical diagnosis without biopsy before SBRT has been used, but there are limited data on its efficacy. METHODS AND MATERIALS Data on patients treated with SBRT for non-small cell lung cancer, with and without tissue confirmation, were collected from multiple institutions across Europe, Canada, and the United States. Patients with a minimum of 2 years of comprehensive follow up were selected for analysis. Treatment and patient characteristics were compared. Overall survival (OS), disease-free survival (DFS), cause-specific survival (CSS), and rates of local recurrence (LR), regional recurrence (RR), and distant metastasis (DM) were calculated and analyzed. RESULTS A total of 701 patients were identified, of which 67% had tissue confirmation of their tumors. The 3- and 5-year outcomes for OS, CSS, and DFS were 83.8%, 93.1%, 69%, and 60.6%, 86.7%, 45.5%, respectively. The rates for LR, RR, and DM at 3 and 5 years were 6.4%, 9.3%, 14.3%, and 10.5%, 14.3%, 19.7%, respectively. There were no statistically significant differences in survival outcomes or recurrences between the biopsy and no-biopsy cohorts. CONCLUSIONS SBRT for clinically diagnosed lung cancers is efficacious in appropriately selected patients, with similar outcomes as those with a pathologic diagnosis. Thorough clinical and radiographic evaluations in a multidisciplinary setting are critical to the management of these patients.
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Affiliation(s)
- Christian Fernandez
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - Inga S Grills
- Department of Radiation Oncology, William Beaumont Health, Royal Oak, Michigan
| | - Hong Ye
- Department of Radiation Oncology, William Beaumont Health, Royal Oak, Michigan
| | - Andrew J Hope
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Frederick Mantel
- Department of Radiation Oncology, University of Würzburg, Würzburg, Germany
| | - Larry L Kestin
- Michigan Health Professionals, Radiation Oncology Institute, Farmington Hills, Michigan
| | - Jose Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Sidney Kimmel Medical College & Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania
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Radiotherapy in Lung Cancer: Current and Future Role. MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL 2019; 53:353-360. [PMID: 32377108 PMCID: PMC7192301 DOI: 10.14744/semb.2019.25991] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/19/2019] [Indexed: 12/25/2022]
Abstract
Lung cancer is divided into two subgroups concerning its natural course and treatment strategies as follows: non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). In this review, for NSCLC, the role of stereotactic body radiation therapy (SBRT) in early-stage, chemoradiation in the locally advanced stage, post-operative radiotherapy for patients with high risk after surgery and radiotherapy for metastatic disease will be discussed. Also, for SCLC, the role and timing of thoracic irradiation and prophylactic cranial irradiation (PCI) for the limited and extensive stages will be discussed.
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Kaiss H, Mornex F. [Stereotactic radiotherapy of stage I non-small cell lung cancer. State of the art in 2019 and recommendations: Stereotaxy as an alternative to surgery?]. Cancer Radiother 2019; 23:720-731. [PMID: 31471255 DOI: 10.1016/j.canrad.2019.07.132] [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: 07/19/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/24/2022]
Abstract
Stereotactic radiotherapy (or Stereotactic body radiotherapy [SBRT]) is a technique currently well established in the therapeutic arsenal for the management of bronchial cancers. It represents the standard treatment for inoperable patients or who refuses surgery. It is well tolerated, especially in elderly and frail patients, and the current issue is to define its indications in operated patients, based on retrospective and randomized trials comparing stereotactic radiotherapy and surgery, with results equivalents. This work analyzes in detail the different aspects of pulmonary stereotactic radiotherapy and suggests arguments that help in the therapeutic choice between surgery and stereotaxic irradiation. In all cases, the therapeutic decision must be discussed in a multidisciplinary consultation meeting, while informing the patient of the possible therapeutic options.
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Affiliation(s)
- H Kaiss
- Département de radiothérapie oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - F Mornex
- Département de radiothérapie oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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Luo H, Cui Y, Song H, Mao R, Gao Q, Ge H. Should stereotactic body radiotherapy doses be adjusted according to tumor size in early-stage non-small-cell lung cancer? A systematic review and meta-analysis. Future Oncol 2019; 15:3071-3079. [PMID: 31426674 DOI: 10.2217/fon-2019-0240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: Treatment schedules of stereotactic body radiotherapy (SBRT) for patients with early-stage non-small-cell lung cancer (NSCLC) are varied. The aim of this study was to clarify the optimal biologically effective dose (BED) for the treatment of stage I NSCLC. Methods: Research findings published after 1990 detailing the effects of SBRT on early-stage NSCLC patients were compiled from the Medline, Embase, Web of Science and Cochrane Library. For comparative analyses, two groups were divided into moderate BED (100-150 Gy) and high BED (BED ≥150 Gy). Results: Two moderate BED studies and four high BED studies were selected for analysis. The results from the analysis of four moderate and high groups suggest that the 2-year local control rate was significantly lower in moderate BED group than that of high BED group (p = 0.04). Subgroup analysis by tumor size was also conducted. For patients with Stage IA disease, no difference in overall survival (OS) was found. No statistically significant difference was achieved in the instance of Stage IB tumor; however, the 2-year OS showed a trend in favor of high BED (p = 0.08). The remaining two studies, comparing 106 Gy (Stage IA) to 120-132 Gy (Stage IB) treatment, indicated a significantly higher 3-year OS in the 106 Gy group than that of 120-132 Gy group (p = 0.009). Conclusion: In patients with early-stage NSCLC treated with SBRT, our analyses suggested that a moderate BED, especially 106 Gy, is sufficient for the treatment of Stage IA tumor; although a high BED conferred no significant benefit to OS for the treatment of Stage IB tumor, a higher local control rate was achieved. Further detailed studies should be performed to explore the optimal BED for the treatment of Stage IB tumor.
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Affiliation(s)
- Hui Luo
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Yingying Cui
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Hengli Song
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ronghu Mao
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Qiang Gao
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Hong Ge
- Department of Radiation Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, PR China
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Finazzi T, Palacios MA, Spoelstra FO, Haasbeek CJ, Bruynzeel AM, Slotman BJ, Lagerwaard FJ, Senan S. Role of On-Table Plan Adaptation in MR-Guided Ablative Radiation Therapy for Central Lung Tumors. Int J Radiat Oncol Biol Phys 2019; 104:933-941. [DOI: 10.1016/j.ijrobp.2019.03.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/15/2019] [Accepted: 03/20/2019] [Indexed: 12/25/2022]
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Song CW, Griffin RJ, Lee YJ, Cho H, Seo J, Park I, Kim HK, Kim DH, Kim MS, Dusenbery KE, Cho LC. Reoxygenation and Repopulation of Tumor Cells after Ablative Hypofractionated Radiotherapy (SBRT and SRS) in Murine Tumors. Radiat Res 2019; 192:159-168. [DOI: 10.1667/rr15346.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Chang W. Song
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Robert J. Griffin
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Yoon-Jin Lee
- Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Haeun Cho
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Jewoo Seo
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Inhwan Park
- Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyun K. Kim
- Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Do H. Kim
- Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Korean Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Kathryn E. Dusenbery
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
| | - L. Chinsoo Cho
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, Minnesota
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Yan SX, Qureshi MM, Dyer M, Truong MT, Mak KS. Stereotactic body radiation therapy with higher biologically effective dose is associated with improved survival in stage II non-small cell lung cancer. Lung Cancer 2019; 131:147-153. [PMID: 31027693 DOI: 10.1016/j.lungcan.2019.03.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/14/2019] [Accepted: 03/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The role of stereotactic body radiation therapy (SBRT) in treating stage II non-small cell lung cancer (NSCLC) remains unclear. This study evaluates SBRT dose prescription patterns and survival outcomes in Stage II NSCLC using the National Cancer Database (NCDB). MATERIALS AND METHODS Patients diagnosed with Stage II NSCLC and treated with SBRT between 2004-2013 were identified in NCDB. The biologically effective dose with α/β = 10 Gy (BED10) was calculated. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox regression models. RESULTS Of 56,543 patients with Stage II NSCLC, 451 (0.8%) received SBRT. There were 360 patients (79.8%) with node-negative and 91 patients (20.2%) with node-positive disease. The most common prescriptions were 10 Gy x 5 (35.9%) and 12 Gy x 4 (19.3%). The mean and median BED10 were 114.9 Gy and 105.6 Gy, respectively. With median follow-up of 19.3 months, overall median survival was 23.7 months. Median survival was 22.4 months for those treated with BED10 < 114.9 Gy versus 31.5 months for BED10 ≥ 114.9 Gy (p = 0.036). On multivariate analysis, BED10 as a continuous variable (hazard ratio [HR] 0.991, p = 0.009) and ≥ 114.9 Gy (HR 0.63, p = 0.015) were associated with improved survival in node-negative patients. BED10 as a continuous variable (HR 0.997, p = 0.465) and ≥ 114.9 Gy (HR 0.81, p = 0.546) were not significant factors for predicting survival in node-positive patients. CONCLUSION SBRT is infrequently utilized to treat Stage II NSCLC in the United States. Treatment with higher BED10 was associated with improved survival, and the benefit was limited to patients with node-negative disease.
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Affiliation(s)
- Sherry X Yan
- Boston Medical Center, One Boston Medical Center Pl., Boston, MA 02118, USA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Michael Dyer
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA.
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Ma L, Men Y, Feng L, Kang J, Sun X, Yuan M, Jiang W, Hui Z. A current review of dose-escalated radiotherapy in locally advanced non-small cell lung cancer. Radiol Oncol 2019; 53:6-14. [PMID: 30840594 PMCID: PMC6411023 DOI: 10.2478/raon-2019-0006] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background The mainstay therapy for locally advanced non-small cell lung cancer is concurrent chemoradiotherapy. Loco-regional recurrence constitutes the predominant failure patterns. Previous studies confirmed the relationship between increased biological equivalent doses and improved overall survival. However, the large randomized phase III study, RTOG 0617, failed to demonstrate the benefit of dose-escalation to 74 Gy compared with 60 Gy by simply increasing fraction numbers. Conclusions Though effective dose-escalation methods have been explored, including altered fractionation, adapting individualized increments for different patients, and adopting new technologies and new equipment such as new radiation therapy, no consensus has been achieved yet.
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Affiliation(s)
- Li Ma
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Yu Men
- Department of VIP Medical Services, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Lingling Feng
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Jingjing Kang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Xin Sun
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Meng Yuan
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
| | - Wei Jiang
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China
| | - Zhouguang Hui
- Department of VIP Medical Services, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
- Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing100021, China
- Zhouguang Hui, M.D., Department of VIP Medical Services & Department of Radiation Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Panjiayuan Nanli 17, Chaoyang District, Beijing 100021, China. Phone: + 861087787656
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Chandra A, Park SS, Pignolo RJ. Potential role of senescence in radiation-induced damage of the aged skeleton. Bone 2019; 120:423-431. [PMID: 30543989 DOI: 10.1016/j.bone.2018.12.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/04/2018] [Accepted: 12/08/2018] [Indexed: 12/21/2022]
Abstract
Human aging-related changes are exacerbated in cases of disease and cancer, and conversely aging is a catalyst for the occurrence of disease and multimorbidity. For example, old age is the most significant risk factor for cancer and among people who suffer from cancer, >60% are above the age of 65. Oxidative stress and DNA damage, leading to genomic instability and telomere dysfunction, are prevalent in aging and radiation-induced damage and are major cellular events that lead to senescence. Human exposures from nuclear fallout, cosmic radiation and clinical radiotherapy (RT) are some common sources of irradiation that affect bone tissue. RT has been used to treat malignant tumors for over a century, but the effects of radiation damage on tumor-adjacent normal tissue has largely been overlooked. There is an increase in the percent survivorship among patients post-RT, and it is in older survivors where the deleterious synergy between aging and radiation exposure conspires to promote tissue deterioration and dysfunction which then negatively impacts their quality of life. Thus, an aging skeleton is already pre-disposed to architectural deterioration, which is further worsened by radiation-induced bone damage. Effects of senescence and the senescence associated secretory phenotype (SASP) have been implicated in age-associated bone loss, but their roles in radiation-associated bone damage are still elusive. RT is used in treatment for a variety of cancers and in different anatomical locations, the sequelae of which include long-term morbidity and lifelong discomfort. Therefore, consideration of the growing evidence that implicates the role of senescence in radiation-induced bone damage argues in favor of exploiting current senotherapeutic approaches as a possible prevention or treatment.
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Affiliation(s)
- Abhishek Chandra
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert J Pignolo
- Department of Medicine, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic School of Medicine, Mayo Clinic, Rochester, MN, USA.
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Modeling radiation pneumonitis of pulmonary stereotactic body radiotherapy: The impact of a local dose–effect relationship for lung perfusion loss. Radiother Oncol 2019; 132:142-147. [DOI: 10.1016/j.radonc.2018.12.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/06/2018] [Accepted: 12/16/2018] [Indexed: 12/25/2022]
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