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Aurélie DB, Famke S, Suresh S. Evaluation of post-lung SABR imaging: A proposed pathway. Radiother Oncol 2024; 192:110083. [PMID: 38216087 DOI: 10.1016/j.radonc.2024.110083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/02/2024] [Indexed: 01/14/2024]
Affiliation(s)
- De Bruycker Aurélie
- Department of Radiation Oncology, AZ Groeninge, Kortrijk, Belgium; Department of Radiation Oncology, Amsterdam UMC, Location VUmc, The Netherlands.
| | - Schneiders Famke
- Department of Radiation Oncology, Amsterdam UMC, Location VUmc, The Netherlands
| | - Senan Suresh
- Department of Radiation Oncology, Amsterdam UMC, Location VUmc, The Netherlands
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Wang HH, Chen Y, Liu X, Zaorsky NG, Mani K, Niu ZM, Zheng BY, Zeng HY, Yan YY, Li YJ, He Y, Ji CZ, Sun BS, Meng MB. Reirradiation with stereotactic body radiotherapy for primary or secondary lung malignancies: Tumor control probability and safety analyses. Radiother Oncol 2023; 187:109817. [PMID: 37480993 DOI: 10.1016/j.radonc.2023.109817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 07/06/2023] [Accepted: 07/16/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Reirradiation with stereotactic body radiotherapy (SBRT) for patients with primary or secondary lung malignancies represents an appealing definitive approach, but its feasibility and safety are not well defined. The purpose of this study was to investigate the tumor control probability (TCP) and toxicity for patients receiving reirradiation with SBRT. PATIENTS AND METHODS Eligible patients with recurrence of primary or secondary lung malignancies from our hospital were subjected to reirradiation with SBRT, and PubMed- and Embase-indexed articles were reviewed. The patient characteristics, pertinent SBRT dosimetric details, local tumor control, and toxicities were extracted. The logistic dose-response models were compared for TCP and overall survival (OS) in terms of the physical dose and three-, four-, and five-fraction equivalent doses. RESULTS The data of 17 patients from our hospital and 195 patients extracted from 12 articles were summarized. Reirradiation with SBRT yielded 2-year estimates of 80% TCP for doses of 50.10 Gy, 55.85 Gy, and 60.54 Gy in three, four, and five fractions, respectively. The estimated TCP with common fractionation schemes were 50%, 60%, and 70% for 42.04 Gy, 47.44 Gy, and 53.32 Gy in five fractions, respectively. Similarly, the 2-year estimated OS was 50%, 60%, and 70% for 41.62 Gy, 46.88 Gy, and 52.55 Gy in five fractions, respectively. Central tumor localization may be associated with severe toxicity. CONCLUSIONS Reirradiation with SBRT doses of 50-60 Gy in 3-5 fractions is feasible for appropriately selected patients with recurrence of peripheral primary or secondary lung malignancies, but should be carefully considered for centrally-located tumors due to potentially severe toxicity. Further studies are warranted for optimal dose/fractionation schedules and more accurate selection of patients suitable for reirradiation with SBRT.
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Affiliation(s)
- Huan-Huan Wang
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Yuan Chen
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Xin Liu
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Kyle Mani
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zhi-Min Niu
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Bo-Yu Zheng
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Hong-Yu Zeng
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Yuan-Yuan Yan
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Yan-Jin Li
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Yuan He
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Chao-Zhi Ji
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Bing-Sheng Sun
- Department of Lung Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin 's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China
| | - Mao-Bin Meng
- Department of Radiation Oncology and CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center for Cancer, Tianjin 300060, PR China.
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Tekatli H, Palacios MA, Schneiders FL, Haasbeek CJA, Slotman BJ, Lagerwaard FJ, Senan S. Local control and toxicity after magnetic resonance imaging (MR)-guided single fraction lung stereotactic ablative radiotherapy. Radiother Oncol 2023; 187:109823. [PMID: 37516364 DOI: 10.1016/j.radonc.2023.109823] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Magnetic resonance imaging (MR)-guided radiotherapy permits continuous intrafraction visualization and use of automatic triggered beam delivery, with use of smaller planning target volumes (PTV). We report on long-term clinical outcomes following MR-guided single fraction (SF) lung SABR on a 0.35 T linac. MATERIALS AND METHODS Details of patients treated with SF-SABR for lung tumors were accessed from an ethics approved institutional database. A breath-hold 3D MR simulation scan was performed using a true FISP sequence, followed by a breath-hold 3D CT scan. The gross tumor volume (GTV) was first contoured on the breath-hold CT scan, which was then compared with contours on the 3D MR scan, before the GTV was finalized. SABR plans used step-and-shoot IMRT beams to a PTV derived by adding a 5 mm margin to the breath-hold GTV, and a 3 mm gating window was used. SABR was delivered during repeated breath-holds, using automatic beam gating with continuous visualization of the GTV in a sagittal MR plane. RESULTS Between 2018-2022, 50 consecutive patients were treated, and 69% had a primary non-small cell lung cancer. Median PTV was 11.2 cc (range 3.9-53.5); 80% of GTV's were located ≤2.5 cm from the chest wall. Prescribed doses were 34 Gy (in 58%), 30 Gy (32%), or between 20-28 Gy (10%). After a median follow-up of 18.1 months (95% CI 12.8-23.5), the 2-year survival was 82% (89% for primary NSCLC and 62% for metastases). After a median follow-up of 16.1 months (95% CI 11.2-21.1), local recurrences developed in 2 patients (4%). The 3-year local control rate was 97%, and just 1 patient developed grade ≥3 toxicity (chest wall pain). CONCLUSION MR-guided SF-SABR delivery to lung tumors on a 0.35 T linac, using repeated breath-holds with automatic beam gating, achieves good tumor control and low toxicity.
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Affiliation(s)
- Hilâl Tekatli
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands.
| | - Miguel A Palacios
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Famke L Schneiders
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Cornelis J A Haasbeek
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Ben J Slotman
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Frank J Lagerwaard
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
| | - Suresh Senan
- Amsterdam UMC, location VUmc, Department of Radiation Oncology, Amsterdam, the Netherlands
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Kirshenboim Z, Dan Lantsman C, Appel S, Klug M, Onn A, Truong MT, Marom EM. Magnetic resonance imaging for prospective assessment of local recurrence of non-small cell lung cancer after stereotactic body radiation therapy. Lung Cancer 2023; 182:107265. [PMID: 37327593 DOI: 10.1016/j.lungcan.2023.107265] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To evaluate multi-parametric MRI for distinguishing stereotactic body radiation therapy (SBRT) induced pulmonary fibrosis from local recurrence (LR). MATERIALS AND METHODS SBRT treated non-small cell lung cancer (NSCLC) patients suspected of LR by conventional imaging underwent MRI: T2 weighted, diffusion weighted imaging, dynamic contrast enhancement (DCE) with a 5-minute delayed sequence. MRI was reported as high or low suspicion of LR. Follow-up imaging ≥12 months or biopsy defined LR status as proven LR, no-LR or not-verified. RESULTS MRI was performed between 10/2017 and 12/2021, at a median interval of 22.5 (interquartile range 10.5-32.75) months after SBRT. Of the 20 lesions in 18 patients: 4 had proven LR, 10 did not have LR and 6 were not verified for LR due to subsequent additional local and/or systemic therapy. MRI correctly identified as high suspicion LR in all proven LR lesions and low suspicion LR in all confirmed no-LR lesions. All proven LR lesions (4/4) showed heterogeneous enhancement and heterogeneous T2 signal, as compared to the proven no-LR lesions in which 7/10 had homogeneous enhancement and homogeneous T2 signal. DCE kinetic curves could not predict LR status. Although lower apparent diffusion coefficient (ADC) values were seen in proven LR lesions, no absolute cut-off ADC value could determine LR status. CONCLUSION In this pilot study of NSCLC patients after SBRT, multi-parametric chest MRI was able to correctly determine LR status, with no single parameter being diagnostic by itself. Further studies are warranted.
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Affiliation(s)
- Zehavit Kirshenboim
- Division of Diagnostic Radiology, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Christine Dan Lantsman
- Division of Diagnostic Radiology, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sarit Appel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Radiotherapy, Sheba Medical Center, Ramat Gan, Israel
| | - Maximiliano Klug
- Division of Diagnostic Radiology, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amir Onn
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Pulmonary Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Mylene T Truong
- Department of Thoracic Imaging, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Edith Michelle Marom
- Division of Diagnostic Radiology, Sheba Medical Center, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Pougnet I, Habert P, Delcourt S, Boucekine M, Wong S, Zacchariotto A, Muracciole X, Gaubert JY, Padovani L. Local Recurrence Risk Score to Predict Relapse after Stereotactic Body Radiation Therapy for Lung Tumors. J Clin Med 2022; 11. [PMID: 36362674 DOI: 10.3390/jcm11216445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/13/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Background: After stereotactic body radiation therapy (SBRT) for lung tumors, follow-up CT scans remain a pitfall. The early detection of local relapse is essential to propose a new treatment. We aim to create a local recurrence predictive score using pre- and post-therapeutic imaging criteria and test it on a validation cohort. Methods: Between February 2011 and July 2016, lung tumors treated by SBRT with available pretreatment fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) and follow-up CT scans were retrospectively analyzed. The risk factors associated with relapse were identified by univariate logistic regression on a train cohort. The score was created using these factors, merging clinical and imaging criteria associated with local relapse, and then tested on an independent validation cohort. Overall and local relapse-free survival at 1 and 3 years were recorded. Results: Twenty-eight patients were included in the train cohort and ten in the derivation cohort (male 74%, median age 70 ± 12 years). Five variables significantly associated with local recurrence (female gender; sequential enlargement; craniocaudal growing; bulging margins; standardized uptake value (SUVmax > 5.5)) were combined to create the score on five points. With the threshold >2.5/5, the sensitivity and specificity of the score on the validation cohort were 100% and 88%, respectively. Overall survival and local relapse-free survival at 1 and 3 years were 89% and 42%, and 89% and 63%, respectively. Conclusion: The local recurrence risk score created has high sensitivity (100%) and specificity (88%), upon independent validation cohort, to detect local relapse. This score is easy to use in daily clinical practice.
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Hutten RJ, Nelson G, Sarkar V, Johnson SB, Tao R, Hitchcock Y, Chan J, Schroeder J, Kokeny K. Feasibility and clinical utility of a workflow interfacing radiation oncology lung stereotactic body radiotherapy treatment planning and diagnostic radiology. Pract Radiat Oncol 2022:S1879-8500(22)00202-8. [PMID: 35752410 DOI: 10.1016/j.prro.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022]
Abstract
Stereotactic body radiotherapy (SBRT) is commonly used to treat early stage non-small cell lung cancer (NSCLC). SBRT beam arrangements include multiple entry/exit pathways resulting in irregular low dose distributions within normal lung parenchyma. An improved understanding of post-treatment radiographic changes may improve the ability to predict clinical complications including radiation pneumonitis as well as assist in early detection of local failures. Radiation treatment planning is conducted using software systems separate from diagnostic radiology, often not accessible to the diagnostic radiologist. We developed a workflow for interfacing radiation dose information from lung SBRT treatments with diagnostic radiology picture archiving and communication system (PACS). In an anonymized PACS study folder, SBRT dose maps depicting high dose, low dose, and non-irradiated lung volumes were viewable side-by-side with pretreatment and follow up diagnostic CT scans. Clinical utility was evaluated by two thoracic diagnostic radiologists reviewing post-treatment diagnostic follow up scans in PACS both with and without radiation dose maps available. The addition of the biologically effective dose (BED) map did not significantly change identification rates of radiation induced lung injury (RILI) (92% vs. 95%, p=0.32) but did significantly decrease radiologic suspicion for LR (22% vs. 8%, p=0.003). The addition of BED maps significantly increased confidence in calling RILI (7.75 vs. 8.82, p=0.004) and LR (5.5 vs 6.6, p=0.005). Recommendation for additional workup was not significantly different (10% vs 7%, p=0.41). We demonstrated the feasibility and clinical utility of a workflow generating simplified radiation dose maps that are viewable within PACS for diagnostic radiology review.
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Lee K, Le T, Hau E, Hanna GG, Gee H, Vinod S, Dammak S, Palma D, Ong A, Yeghiaian-Alvandi R, Buck J, Lim R. A systematic review into the radiological features predicting local recurrence after stereotactic ablative body radiotherapy (SABR) in patients with non-small cell lung cancer (NSCLC): Local recurrence features of NSCLC post-SABR. Int J Radiat Oncol Biol Phys 2021; 113:40-59. [PMID: 34879247 DOI: 10.1016/j.ijrobp.2021.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Post-treatment surveillance for local recurrence (LR) following SABR can include both fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT). Radiation-induced lung injury (RILI) shares a similar appearance to LR after treatment making the detection of LR on imaging difficult for clinicians. We aimed to summarise radiological features of CT and FDG-PET predicting LR, and to evaluate radiomics as another tool for detecting LR. METHODS AND MATERIALS We searched MEDLINE, EMBASE and PubMed databases for published studies and Web of Science, Wiley Online and Science Direct databases for conference abstracts that had patient populations with NSCLC and reported post-SABR radiological features of FDG-PET or CT and radiomics from either FDG-PET or CT. Studies for inclusion were independently reviewed by two authors. RESULTS Across 32 relevant studies, the incidence of LR was 13% (222/1726). On CT, certain gross radiological appearances, and kinetic features of changes in size, diameter, volume or 3 consecutive rises in volume of mass-like consolidation are suggestive of LR. Particular regard should be made for the presence of any ≥3 high-risk features (HRF) on CT or the individual HRF of enlarging opacity at ≥12 month's post-SABR as being highly suspicious of LR. On FDG-PET a relative reduction of <5% of SUVmax from baseline in the first 12 months or cut-offs of SUVmax >5 and SUVmean >3.44 after 12 months can indicate LR. There is limited evidence available to corroborate radiomic features suggestive of LR. CONCLUSION This research has identified common features of LR compared to RILI which may aid in early and accurate detection of LR post-SABR; further research is required to validate these findings.
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Affiliation(s)
- Katherine Lee
- Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Tue Le
- Radiation Oncology - Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Eric Hau
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Westmead Institute of Medical Research, Sydney, New South Wales, Australia
| | - Gerard G Hanna
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Harriet Gee
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia; Children's Medical Research Institute, Sydney, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Salma Dammak
- The School of Biomedical Engineering, Western University, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Anselm Ong
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, New South Wales, Australia
| | | | - Jacqueline Buck
- Department of Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Rebecca Lim
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
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Chassagnon G, Martini K, Giraud P, Revel MP. Radiological assessment after stereotactic body radiation of lung tumours. Cancer Radiother 2020; 24:379-387. [PMID: 32534799 DOI: 10.1016/j.canrad.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
The increasing use of stereotactic body radiation therapy for lung tumours comes along with new post-therapeutic imaging findings that should be known by physicians involved in patient follow-up. Radiation-induced lung injury is much more frequent than after conventional radiation therapy, it can also be delayed and has a different radiological presentation. Radiation-induced lung injury after stereotactic body radiation therapy involves the lung parenchyma surrounding the target tumour and appears as a dynamic process continuing for years after completion of the treatment. Thus, the radiological pattern and the severity of radiation-induced lung injury are prone to changes during follow-up, which can make it difficult to differentiate from local recurrence. Contrary to radiation-induced lung injury, local recurrence after stereotactic body radiation therapy is rare. Other complications mainly depend on tumour location and include airway complications, rib fractures and organizing pneumonia. The aim of this article is to provide a wide overview of radiological changes occurring after SBRT for lung tumours. Awareness of changes following stereotactic body radiation therapy should help avoiding unnecessary interventions for pseudo tumoral presentations.
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Affiliation(s)
- G Chassagnon
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - K Martini
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Giraud
- Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, centre université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-P Revel
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France
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Kim TH, Woo S, Halpenny DF, Kim YJ, Yoon SH, Suh CH. Can high-risk CT features suggest local recurrence after stereotactic body radiation therapy for lung cancer? A systematic review and meta-analysis. Eur J Radiol 2020; 127:108978. [PMID: 32298960 DOI: 10.1016/j.ejrad.2020.108978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/05/2020] [Accepted: 03/29/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis evaluating usefulness of high-risk CT features (HRFs) on follow-up CT in detecting local recurrence after stereotactic body radiation therapy (SBRT) in lung cancer patients. METHODS Pubmed and EMBASE were searched up to January 11th, 2019. We included studies that differentiated local recurrence from post-SBRT changes after SBRT on follow-up CT in lung cancer patients. Methodological quality was assessed using QUADAS-2. The association between HRFs and local recurrence were pooled in the form of odds ratio (OR) using the random effects model. Heterogeneity was examined by the Inconsistency index (I2). RESULTS Eight studies were included, consisting of 356 lung cancer patients. The overall prevalence of patients with local recurrence was 18.8 % (67/356). Compared with post-SBRT changes, local recurrence after SBRT more frequently demonstrated air-bronchogram disappearance (OR = 7.15), bulging margin (OR = 24.12), craniocaudal growth (OR = 26.07), enlargement after 12 months (OR = 28.11), enlarging opacity (OR = 7.92), linear margin disappearance (OR = 29.24), and sequential enlargement (OR = 83.23) (p ≤ 0.02). Pleural effusion appearance was not related with local recurrence (p = 0.82). Heterogeneity varied among HRFs (I2 = 0-91 %). The quality of the studies was considered moderate. CONCLUSIONS Several HRFs on follow-up CT after SBRT were useful in suggesting local recurrence. These HRFs may help raise clinical suspicion of local recurrence, initiate prompt additional test for confirmation and perform subsequent proper personalized salvage treatment.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Radiology, Naval Pohang Hospital, Pohang, Republic of Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Darragh F Halpenny
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Yeon Joo Kim
- Department of Radiation Oncology, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea
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Yossi S, Nguyen D, Krhili S, Lizée T, Khodri M. [Prognosis factors after lung stereotactic body radiotherapy for non-small cell lung carcinoma]. Cancer Radiother 2020; 24:267-74. [PMID: 32192839 DOI: 10.1016/j.canrad.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/27/2019] [Accepted: 11/05/2019] [Indexed: 10/24/2022]
Abstract
Lung cancer is the fourth most common cancer in France with a prevalence of 30,000 new cases per year. Lobectomy surgery with dissection is the gold standard treatment for T1-T2 localized non-small cell lung carcinoma. A segmentectomy may be proposed to operable patients but fragile from a respiratory point of view. For inoperable patients or patients with unsatisfactory pulmonary function tests, local treatment with stereotactic radiotherapy may be proposed to achieve local control rates ranging from 85 to 95% at 3-5 years. Several studies have examined prognostic factors after stereotaxic pulmonary radiotherapy. We conducted a general review of the literature to identify factors affecting local control.
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Halpenny D, O'Dwyer E, Camacho Vasquez J, Shaverdian N, Girshman J, Ginsberg MS. Imaging of Novel Oncologic Treatments in Lung Cancer Part 2: Local Ablative Therapies. J Thorac Imaging 2020; 35:37-48. [PMID: 31592831 DOI: 10.1097/RTI.0000000000000452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Conventional approaches to the treatment of early-stage lung cancer have focused on the use of surgical methods to remove the tumor. Recent progress in radiation therapy techniques and in the field of interventional oncology has seen the development of several novel ablative therapies that have gained widespread acceptance as alternatives to conventional surgical options in appropriately selected patients. Local control rates with stereotactic body radiation therapy for early-stage lung cancer now approach those of surgical resection, while percutaneous ablation is in widespread use for the treatment of lung cancer and oligometastatic disease for selected other malignancies. Tumors treated with targeted medical and ablative therapies can respond to treatment differently when compared with conventional therapies. For example, after stereotactic body radiation therapy, radiologic patterns of posttreatment change can mimic disease progression, and, following percutaneous ablation, the expected initial increase in the size of a treated lesion limits the utility of conventional size-based response assessment criteria. In addition, numerous treatment-related side effects have been described that are important to recognize, both to ensure appropriate treatment and to avoid misclassification as worsening tumor. Imaging plays a vital role in the assessment of patients receiving targeted ablative therapy, and it is essential that thoracic radiologists become familiar with these findings.
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Munoz-schuffenegger P, Kandel S, Alibhai Z, Hope A, Bezjak A, Sun A, Simeonov A, Cho B, Giuliani M. A Prospective Study of Magnetic Resonance Imaging Assessment of Post-radiation Changes Following Stereotactic Body Radiation Therapy for Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2019; 31:720-7. [DOI: 10.1016/j.clon.2019.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 12/25/2022]
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Meng MB, Wang HH, Zaorsky NG, Sun BS, Zhu L, Song YC, Li FT, Dong Y, Wang JS, Chen HM, Yu XY, Yuan ZY. Risk-adapted stereotactic body radiation therapy for central and ultra-central early-stage inoperable non-small cell lung cancer. Cancer Sci 2019; 110:3553-3564. [PMID: 31464032 PMCID: PMC6825012 DOI: 10.1111/cas.14185] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/29/2019] [Accepted: 08/24/2019] [Indexed: 12/23/2022] Open
Abstract
To determine the therapeutic efficacy and safety of risk‐adapted stereotactic body radiation therapy (SBRT) schedules for patients with early‐stage central and ultra‐central inoperable non‐small cell lung cancer. From 2006 to 2015, 80 inoperable T1‐2N0M0 NSCLC patients were treated with two median dose levels: 60 Gy in six fractions (range, 48‐60 Gy in 4‐8 fractions) prescribed to the 74% isodose line (range, 58%‐79%) for central lesions (ie within 2 cm of, but not abutting, the proximal bronchial tree; n = 43), and 56 Gy in seven fractions (range, 48‐60 Gy in 5‐10 fractions) prescribed to the 74% isodose line (range, 60%‐80%) for ultra‐central lesions (ie abutting the proximal bronchial tree; n = 37) on consecutive days. Primary endpoint was overall survival (OS); secondary endpoints included progression‐free survival (PFS), tumor local control rate (LC), and toxicity. Median OS and PFS were 64.47 and 32.10 months (respectively) for ultra‐central patients, and not reached for central patients. Median time to local failure, regional failure, and any distant failures for central versus ultra‐central lesions were: 27.37 versus 26.07 months, 20.90 versus 12.53 months, and 20.85 versus 15.53 months, respectively, all P < .05. Multivariate analyses showed that tumor categorization (ultra‐central) and planning target volume ≥52.76 mL were poor prognostic factors of OS, PFS, and LC, respectively (all P < .05). There was one grade 5 toxicity; all other toxicities were grade 1‐2. Our results showed that ultra‐central tumors have a poor OS, PFS, and LC compared with central patients because of the use of risk‐adapted SBRT schedules that allow for equal and favorable toxicity profiles.
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Affiliation(s)
- Mao-Bin Meng
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Huan-Huan Wang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
| | - Bing-Shen Sun
- Department of Lung Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Lei Zhu
- Department of Molecular Imaging and Nuclear Medicine and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Yong-Chun Song
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Feng-Tong Li
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Yang Dong
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Jing-Sheng Wang
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Hua-Ming Chen
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Xu-Yao Yu
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
| | - Zhi-Yong Yuan
- Department of Radiation Oncology, CyberKnife Center, and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China
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Hanania AN, Mainwaring W, Ghebre YT, Hanania NA, Ludwig M. Radiation-Induced Lung Injury: Assessment and Management. Chest 2019; 156:150-162. [PMID: 30998908 PMCID: PMC8097634 DOI: 10.1016/j.chest.2019.03.033] [Citation(s) in RCA: 270] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 12/22/2022] Open
Abstract
Radiation-induced lung injury (RILI) encompasses any lung toxicity induced by radiation therapy (RT) and manifests acutely as radiation pneumonitis and chronically as radiation pulmonary fibrosis. Because most patients with thoracic and breast malignancies are expected to undergo RT in their lifetime, many with curative intent, the population at risk is significant. Furthermore, indications for thoracic RT are expanding given the advent of stereotactic body radiation therapy (SBRT) or stereotactic ablative radiotherapy (SABR) for early-stage lung cancer in nonsurgical candidates as well as oligometastatic pulmonary disease from any solid tumor. Fortunately, the incidence of serious pulmonary complications from RT has decreased secondary to advances in radiation delivery techniques. Understanding the temporal relationship between RT and injury as well as the patient, disease, and radiation factors that help distinguish RILI from other etiologies is necessary to prevent misdiagnosis. Although treatment of acute pneumonitis is dependent on clinical severity and typically responds completely to corticosteroids, accurately diagnosing and identifying patients who may progress to fibrosis is challenging. Current research advances include high-precision radiation techniques, an improved understanding of the molecular basis of RILI, the development of small and large animal models, and the identification of candidate drugs for prevention and treatment.
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Affiliation(s)
- Alexander N Hanania
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Walker Mainwaring
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Yohannes T Ghebre
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Nicola A Hanania
- Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX.
| | - Michelle Ludwig
- Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
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Napel S, Mu W, Jardim‐Perassi BV, Aerts HJWL, Gillies RJ. Quantitative imaging of cancer in the postgenomic era: Radio(geno)mics, deep learning, and habitats. Cancer 2018; 124:4633-4649. [PMID: 30383900 PMCID: PMC6482447 DOI: 10.1002/cncr.31630] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/11/2018] [Accepted: 07/17/2018] [Indexed: 11/07/2022]
Abstract
Although cancer often is referred to as "a disease of the genes," it is indisputable that the (epi)genetic properties of individual cancer cells are highly variable, even within the same tumor. Hence, preexisting resistant clones will emerge and proliferate after therapeutic selection that targets sensitive clones. Herein, the authors propose that quantitative image analytics, known as "radiomics," can be used to quantify and characterize this heterogeneity. Virtually every patient with cancer is imaged radiologically. Radiomics is predicated on the beliefs that these images reflect underlying pathophysiologies, and that they can be converted into mineable data for improved diagnosis, prognosis, prediction, and therapy monitoring. In the last decade, the radiomics of cancer has grown from a few laboratories to a worldwide enterprise. During this growth, radiomics has established a convention, wherein a large set of annotated image features (1-2000 features) are extracted from segmented regions of interest and used to build classifier models to separate individual patients into their appropriate class (eg, indolent vs aggressive disease). An extension of this conventional radiomics is the application of "deep learning," wherein convolutional neural networks can be used to detect the most informative regions and features without human intervention. A further extension of radiomics involves automatically segmenting informative subregions ("habitats") within tumors, which can be linked to underlying tumor pathophysiology. The goal of the radiomics enterprise is to provide informed decision support for the practice of precision oncology.
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Affiliation(s)
- Sandy Napel
- Department of RadiologyStanford UniversityStanfordCalifornia
| | - Wei Mu
- Department of Cancer PhysiologyH. Lee Moffitt Cancer CenterTampaFlorida
| | | | - Hugo J. W. L. Aerts
- Dana‐Farber Cancer Institute, Department of Radiology, Brigham and Women’s HospitalHarvard Medical SchoolBostonMassachusetts
| | - Robert J. Gillies
- Department of Cancer PhysiologyH. Lee Moffitt Cancer CenterTampaFlorida
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Kalman NS, Hugo GD, Kahn JM, Zhao SS, Jan N, Mahon RN, Weiss E. Interobserver reliability in describing radiographic lung changes after stereotactic body radiation therapy. Adv Radiat Oncol 2018; 3:655-661. [PMID: 30370367 PMCID: PMC6200874 DOI: 10.1016/j.adro.2018.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/03/2018] [Accepted: 05/09/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Radiographic lung changes after stereotactic body radiation therapy (SBRT) vary widely between patients. Standardized descriptions of acute (≤6 months after treatment) and late (>6 months after treatment) benign lung changes have been proposed but the reliable application of these classification systems has not been demonstrated. Herein, we examine the interobserver reliability of classifying acute and late lung changes after SBRT. METHODS AND MATERIALS A total of 280 follow-up computed tomography scans at 3, 6, and 12 months post-treatment were analyzed in 100 patients undergoing thoracic SBRT. Standardized descriptions of acute lung changes (3- and 6-month scans) include diffuse consolidation, patchy consolidation and ground glass opacity (GGO), diffuse GGO, patchy GGO, and no change. Late lung change classifications (12-month scans) include modified conventional pattern, mass-like pattern, scar-like pattern, and no change. Five physicians scored the images independently in a blinded fashion. Fleiss' kappa scores quantified the interobserver agreement. RESULTS The Kappa scores were 0.30 at 3 months, 0.20 at 6 months, and 0.25 at 12 months. The proportion of patients in each category at 3 and 6 months was as follows: Diffuse consolidation 11% and 21%; patchy consolidation and GGO 15% and 28%; diffuse GGO 10% and 11%; patchy GGO 15% and 15%; and no change 49% and 25%, respectively. The percentage of patients in each category at 12 months was as follows: Modified conventional 46%; mass-like 16%; scar-like 26%; and no change 12%. Uniform scoring between the observers occurred in 26, 8, and 14 cases at 3, 6, and 12 months, respectively. CONCLUSIONS Interobserver reliability scores indicate a fair agreement to classify radiographic lung changes after SBRT. Qualitative descriptions are insufficient to categorize these findings because most patient scans do not fit clearly into a single classification. Categorization at 6 months may be the most difficult because late and acute lung changes can arise at that time.
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Affiliation(s)
- Noah S. Kalman
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Geoffrey D. Hugo
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Jenna M. Kahn
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Sherry S. Zhao
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Nuzhat Jan
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Rebecca N. Mahon
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia
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Febbo JA, Gaddikeri RS, Shah PN. Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists. Radiographics 2018; 38:1312-1336. [DOI: 10.1148/rg.2018170155] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jennifer A. Febbo
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 181, Chicago, IL 60612
| | - Ramya S. Gaddikeri
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 181, Chicago, IL 60612
| | - Palmi N. Shah
- From the Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, 1653 W Congress Pkwy, Jelke 181, Chicago, IL 60612
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Dickhoff C, Rodriguez Schaap PM, Otten RHJ, Heymans MW, Heineman DJ, Dahele M. Salvage surgery for local recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: a systematic review. Ther Adv Med Oncol 2018; 10:1758835918787989. [PMID: 30023008 PMCID: PMC6047243 DOI: 10.1177/1758835918787989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction: Stereotactic body (or ablative) radiotherapy (SBRT/SABR) is now a
guideline-recommended treatment for medically inoperable patients with
peripherally-located, stage I non-small cell lung cancer (NSCLC), and for
medically operable patients who decline surgery. The 5-year local failure
rate after SBRT is about 10% and in highly selected patients, surgery has
been used as a salvage therapy. We performed a systematic review to address
the feasibility, safety, and outcome of salvage surgery for locally
recurrent early stage NSCLC after SBRT. Methods: A systematic literature search was performed according to Preferred Reporting
Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
PubMed, Embase and Cochrane databases
were searched and two authors independently assessed the articles. A total
of seven eligible articles were identified. Results: All seven articles were retrospective case series, representing a total of 47
patients. Surgery was completed in all patients. Where reported in
sufficient detail, morbidity (four studies) was between 29 and 50% (series
of two patients) and 90-day mortality (six studies) was between 0% (four
studies) and 11% (n = 1, disease progression). Median
(n = 5)/mean (n = 1) reported or
calculated follow ups were 7–54.5/17.3 months. Median overall survival was
reported in three studies and ranged between 13.6–82.7 months. Crude
survival in three others was 2–35 months. Conclusion: Limited, low-level evidence prevents firm conclusions, but based on the
existing data, salvage surgery after local recurrence of NSCLC following
SBRT appears technically feasible, with acceptable morbidity and mortality
in appropriately selected and counselled patients who are fit enough and who
accept the risks (level of evidence 4, strength of recommendation C).
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Affiliation(s)
- Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands
| | | | - Rene H J Otten
- Medical Library, VU University Medical Center, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Max Dahele
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Ronden MI, Palma D, Slotman BJ, Senan S. Brief Report on Radiological Changes following Stereotactic Ablative Radiotherapy (SABR) for Early-Stage Lung Tumors: A Pictorial Essay. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.02.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Senan S, Rusthoven CG, Slotman BJ, Siva S. Progress in Radiotherapy for Regional and Oligometastatic Disease in 2017. J Thorac Oncol 2018; 13:488-96. [PMID: 29452269 DOI: 10.1016/j.jtho.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 12/25/2022]
Abstract
This review highlights key publications and abstracts in the field of radiation oncology for lung cancer in 2017 and attempts to place these in the context of developments for the broader thoracic oncology community.
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