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Dong B, Chen R, Zhu X, Wu Q, Jin J, Wang W, Zhu Y, Jiang H, Bi N, Wang X, Xu X, Xu Y, Chen M. Comparison of stereotactic body radiation therapy versus surgery for multiple primary lung cancers after prior radical resection: A multicenter retrospective study. Clin Transl Radiat Oncol 2023; 40:100601. [PMID: 36936471 PMCID: PMC10020093 DOI: 10.1016/j.ctro.2023.100601] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/26/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Background Patients who previously underwent surgical resection of initial primary lung cancer are at a high risk of developing multiple primary lung cancers (MPLCs). The purpose of this study was to compare the efficacy and safety between stereotactic body radiation therapy (SBRT) and surgery for MPLCs patients after prior radical resection for the first lung cancers. Methods In this multicenter retrospective study, eligible MPLC patients with tumor diameter of 5.0 cm or less at N0M0 who underwent SBRT or reoperation between January 2013 and August 2020 were enrolled. The primary endpoint was the 3-year locoregional recurrence and treatment-related toxicity. Kaplan-Meier method was used to calculate survival rates. The χ2 test was adapted to assess the difference of categorical variables between the two subgroup patients. Results A total of 203 (73 in the SBRT group and 130 in the surgery group) patients from three academic cancer centers were evaluated with a median follow-up of 38.3 months. The cumulative 1-, 2-, and 3-year incidences of locoregional recurrence were 5.6 %, 7.0 % and 13.1 % in the SBRT group versus 3.2 %, 4.8 % and 7.4 % in the surgery group, respectively [hazard ratio (HR), 1.97; 95 % confidence interval (CI), 0.74-5.24; P = 0.14]. The cancer-specific survival rates were 95.9 %, 94.5 % and 88.1 % versus 96.9 %, 94.6 % and 93.8 % in the SBRT and surgery groups respectively (HR, 1.72; 95 % CI, 0.67-4.44; P = 0.23). In the SBRT group, two patients (2.7 %) suffered from grade 3 radiation pneumonitis, while in the surgery group, grade 3 complications occurred in four (3.1 %) patients, and four cases were expired due to pneumonia or pulmonary heart disease within 90 days after surgery. Conclusions SBRT is an effective therapeutic option with limited toxicity compared to surgery for patients with MPLCs after prior radical surgical resection, and it could be considered as an alternative treatment for those patients.
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Key Words
- BED, biological effective dose
- CCI, Charlson comorbidity index
- CSS, cancer-specific survival
- CT, computed tomography
- DM, distant metastasis
- FEV1, forced expiratory volume in the first second
- FVC, forced vital capacity
- ITV, internal target volume
- KPS, Karnofsky performance status
- LRR, locoregional recurrence
- Locoregional recurrence
- MPLC, multiple primary lung cancer
- Multiple primary lung cancers
- NSCLC, non-small cell lung cancer
- OS, overall survival
- PET/CT, positron emission tomography/computed tomography
- PTV, planning target volume
- Radical resection
- SBRT, stereotactic body radiation therapy
- Stereotactic body radiation therapy
- TTP, time to progression
- Toxicity
- VATS, video-assisted thoracoscopic surgery
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Affiliation(s)
- 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
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Runzhe 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
| | - Xuan Zhu
- Department of Radiation Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qing Wu
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
- The Second Clinical Medical College of Zhejiang Chinese Medicine University, Hangzhou, China
| | - Jia'nan Jin
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Wenqing Wang
- Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Yujia Zhu
- 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
| | - Hui Jiang
- 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
| | - Nan Bi
- Department of Radiation Oncology, Cancer Hospital Chinese Academy of Medical Sciences, Beijing, China
| | - Xu Wang
- Department of Radiology, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Xiaofang Xu
- Department of Thoracic Oncology Surgery, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
| | - Yujin Xu
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
- Corresponding authors at: The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1, East Banshan Road, Hangzhou 310022, China (Y. Zu) and Sun Yat-sen University Cancer Center, 651 East Dongfeng Road, Guangzhou 510060, China (M. Chen).
| | - 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
- Department of Thoracic Radiotherapy, The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Zhejiang Key Laboratory of Radiation Oncology, Hangzhou, China
- Corresponding authors at: The Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), No. 1, East Banshan Road, Hangzhou 310022, China (Y. Zu) and Sun Yat-sen University Cancer Center, 651 East Dongfeng Road, Guangzhou 510060, China (M. Chen).
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Gregoire J. Guiding Principles in the Management of Synchronous and Metachronous Primary Non-Small Cell Lung Cancer. Thorac Surg Clin 2021; 31:237-254. [PMID: 34304832 DOI: 10.1016/j.thorsurg.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Multiple lung cancers can be found simultaneously, with incidence ranging from 1% to 8%. Documentation of more than 1 pulmonary lesion can be challenging, because these solid, ground-glass, or mixed-density tumors may represent multicentric malignant disease or intrapulmonary metastases. If mediastinal nodal and distant deposits are excluded, surgery should be contemplated. After surgical treatment of lung cancer, patients should be followed closely for an undetermined period of time. Good clinical judgment is of outmost importance in deciding which individuals will benefit from those surgical interventions and which are candidates for alternate therapies. Every case should be discussed in a multidisciplinary meeting.
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Affiliation(s)
- Jocelyn Gregoire
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Quebec, Quebec G1V 4G5, Canada.
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Arifin AJ, Al-Shafa F, Chen H, Boldt RG, Warner A, Rodrigues GB, Palma DA, Louie AV. Is lung stereotactic ablative radiotherapy safe after pneumonectomy?-a systematic review. Transl Lung Cancer Res 2020; 9:348-353. [PMID: 32420074 PMCID: PMC7225144 DOI: 10.21037/tlcr.2020.01.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Patients treated with surgery for lung cancer are at risk of second primary lung cancers (SPLCs), which when localized, may be amenable to radical treatment. Treatment options, however, are limited due to reduced cardiopulmonary reserve and competing mortality risks. The aim of this study was to perform a systematic review of publications examining treatment planning considerations, clinical outcomes, and toxicity rates of stereotactic ablative radiotherapy (SABR) in patients who have previously undergone pneumonectomy. A systematic review of the literature was conducted in accordance with PRISMA guidelines using PubMed and EMBASE from inception to July 2018. Articles were limited to those published in the English language. Non-review articles with patients who received exclusively lung SABR post-pneumonectomy were included. Two reviewers independently performed abstract and full-text review, with discrepancies settled by a third reviewer. Of the 215 articles identified by the initial search, 6 articles comprising 53 patients who received lung SABR post-pneumonectomy met inclusion criteria. The mean age was 68, and most patients were male (73.7%). The mean time to pneumonectomy was 6.5 years. The mean biologically effective dose was 115 Gy, and the most common dose fractionation schemes were 54 Gy in 3 fractions, 48 Gy in 4 fractions, and 50 Gy in 5 fractions. The mean follow-up was 25.4 months. The mean 1-year overall survival and 2-year local control rates were 80.6% and 89.4%. Grade 3 or higher toxicity was reported in 13.2% of patients. SABR appears to be a safe and feasible option for SPLCs in patients with prior pneumonectomy. Multi-institutional and/or prospective studies would be helpful to determine the true risk and appropriateness of SABR in this high-risk patient population.
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Affiliation(s)
- Andrew J Arifin
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Faiez Al-Shafa
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Hanbo Chen
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - R Gabriel Boldt
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Andrew Warner
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - George B Rodrigues
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - David A Palma
- Division of Radiation Oncology, London Regional Cancer Program, London, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Jumeau R, Vilotte F, Durham AD, Ozsahin EM. Current landscape of palliative radiotherapy for non-small-cell lung cancer. Transl Lung Cancer Res 2019; 8:S192-S201. [PMID: 31673524 DOI: 10.21037/tlcr.2019.08.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Radiotherapy (RT) is a cornerstone in the management of advanced stage III and stage IV non-small-cell lung cancer (NSCLC) patients. Despite international guidelines, clinical practice remains heterogeneous. Additionally, the advent of stereotactic ablative RT (SABR) and new systemic treatments such as immunotherapy have shaken up dogmas in the approach of these patients. This review will focus on palliative thoracic RT for NSCLC but will also discuss the role of stereotactic radiotherapy, endobronchial brachytherapy (EBB), the interest of concomitant treatments (chemotherapy and immunotherapy), and the role of RT in lung cancer emergencies with palliative intent.
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Affiliation(s)
- Raphael Jumeau
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Florent Vilotte
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - André-Dante Durham
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Esat-Mahmut Ozsahin
- Department of Radiation-Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Clinical Outcomes After Lung Stereotactic Body Radiation Therapy in Patients With or Without a Prior Lung Resection. Am J Clin Oncol 2019; 41:695-701. [PMID: 27819875 DOI: 10.1097/coc.0000000000000344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Tumor control (TC), toxicity and survival, following stereotactic body radiation therapy (SBRT) were compared between patients with and without a prior lung resection (PLR). MATERIALS AND METHODS The study is comprised of 130 patients with 141 peripheral tumors treated with SBRT at our institution from 2009 to 2013. Primary TC and lobar control (LC) were defined per RTOG 0236. Toxicity was scored using Common Terminology Criteria for Adverse Events version 4.0. Survival/TC and toxicity were compared between patients with and without PLR using the Kaplan-Meier method and cumulative incidence, respectively. Fine and Gray regression was used for univariable/multivariable analysis for radiation pneumonitis (RP). RESULTS Of the 130 patients with median age 70 years (range, 42 to 93 y), 50 had undergone PLR (median time between PLR and SBRT: 33 mo; range, 1 to 206), including pneumonectomy (12%), lobectomy (46%), wedge resection (42%). With a median follow-up of 21 months in survivors, the PLR group had better TC (1-y 100% vs. 93%; P<0.01) and increased grade ≥2 (RP; 1-y 12% vs. 1%; P<0.01). OS was not significantly different between the 2 groups (1-y 91% vs. 85%; P=0.24). On univariable/multivariable analyses, biologically effective dose was associated with TC (hazard ratios, 0.97; 95% confidence interval, 0.94-0.999; P=0.04). Chemotherapy use was associated with grade ≥2 RP for all patients (hazard ratios, 14.92; 95% confidence interval, 5.68-39.21; P<0.0001) in multivariable analysis. PLR was not associated with increased RP in multivariable analysis. CONCLUSIONS Patients with PLR who receive lung SBRT for lung tumors have high local control and relatively low toxicity. SBRT is an excellent option to treat second lung tumors or pulmonary metastases in patients with PLR.
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Abstract
PURPOSE OF REVIEW Significant advances have been made in the field of stereotactic ablative radiotherapy (SABR) for the treatment of pulmonary neoplasms in recent years. This review aims to summarize recent salient evidence on SABR for early-stage nonsmall cell lung cancer (ES-NSCLC). RECENT FINDINGS In medically inoperable patients, SABR remains the standard of care. The optimal SABR dosing regimen is being studied. Comparisons with non-SABR radiotherapy regimens with lower doses per fraction revealed benefit of SABR. In operable patients, no prospective clinical trial comparing SABR and surgery has been completed, although multiple trials are currently underway to address this question. SABR is generally cost-effective and safe in most patients, with preserved patient-reported quality of life. However, increased toxicity with SABR is noted in patients with disease close to, or invading the proximal tracheobronchial tree. Significant SABR-related toxicity and mortality is also reported in patients with coexisting interstitial lung disease. Considerations on pathologic confirmation, surveillance and multiple primaries are also addressed. SUMMARY SABR is an effective and safe treatment for inoperable ES-NSCLC. Ongoing trials and comparative effectiveness research will help to clarify SABR's role in various lung cancer indications going forward.
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Ono T, Nakamura T, Azami Y, Suzuki M, Wada H, Kikuchi Y, Murakami M, Nemoto K. Proton beam therapy is a safe and feasible treatment for patients with second primary lung cancer after lung resection. Thorac Cancer 2018; 10:289-295. [PMID: 30585704 PMCID: PMC6360225 DOI: 10.1111/1759-7714.12949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The purpose of the present study was to retrospectively evaluate the safety and efficacy of proton beam therapy (PBT) in patients with second primary lung cancer after lung resection. METHODS Patients who were diagnosed with second primary lung cancer after lung resection and underwent PBT between January 2009 and February 2015 were retrospectively recruited. Toxicities were evaluated using Common Terminology Criteria for Adverse Events version 4.0. RESULTS Nineteen patients were eligible for inclusion in this study. All of the patients completed the treatment. The median age was 75 (range: 63-82) years, and the median follow-up time of living patients was 60 months. The median dose of PBT was 76.8 Gy relative biological effectiveness (range: 66.0-80.0 Gy). The three-year overall survival rate was 63.2% and the three-year local control rate was 84.2%. No grade 4 or 5 toxicities were observed after PBT. CONCLUSIONS Our results suggest that PBT is a safe and feasible treatment for second primary lung cancer compared to surgery or X-ray radiotherapy. PBT may become a treatment choice for patients with second primary lung cancer after lung resection.
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Affiliation(s)
- Takashi Ono
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan.,Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tatsuya Nakamura
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Yusuke Azami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Fukushima, Japan
| | - Kenji Nemoto
- Department of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata, Japan
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Ayub A, Rehmani S, Al-Ayoubi AM, Lewis E, Santana-Rodríguez N, Clavo B, Raad W, Bhora FY. Radiation therapy improves survival for unresectable postpneumonectomy lung tumors. J Surg Res 2018; 227:60-66. [DOI: 10.1016/j.jss.2018.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 01/09/2018] [Accepted: 02/13/2018] [Indexed: 11/25/2022]
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Shinde A, Li R, Kim J, Salgia R, Hurria A, Amini A. Stereotactic body radiation therapy (SBRT) for early-stage lung cancer in the elderly. Semin Oncol 2018; 45:210-219. [PMID: 30286944 DOI: 10.1053/j.seminoncol.2018.06.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/08/2018] [Accepted: 06/26/2018] [Indexed: 01/05/2023]
Abstract
Early-stage non-small cell lung cancer (NSCLC) is on the rise due to the implementation of screening guidelines for patients at risk for developing lung cancer. It is anticipated that as the US population continues to age, there will be a higher percentage of medically inoperable early-stage lung cancer patients. For this reason, noninvasive ablative therapies are necessary. Stereotactic body radiation therapy (SBRT) is an effective modality in addressing early-stage NSCLC. SBRT consists of high-dose radiation delivered over 3-5 treatments. Several randomized trials comparing surgery to SBRT in early-stage operable patients have unfortunately closed early due to poor accrual. However, a recent pooled analysis from 2 randomized trials (StereoTActic Radiotherapy and Radiosurgery Or Surgery for operable Early-stage non-small cell Lung cancer) comparing surgery to SBRT did show comparable local control and overall survival rates between surgery and SBRT, offering a very effective, noninvasive modality for older adult patients with early-stage NSCLC. In this review, we summarize the role of SBRT in early-stage NSCLC, in particularly applied to the older adult population.
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Affiliation(s)
- Ashwin Shinde
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Richard Li
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Jae Kim
- Department of Thoracic Surgery, City of Hope National Medical Center, Duarte, CA, USA
| | - Ravi Salgia
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arti Hurria
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.
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Ueyama T, Arimura T, Takumi K, Nakamura F, Higashi R, Ito S, Fukukura Y, Umanodan T, Nakajo M, Koriyama C, Yoshiura T. Risk factors for radiation pneumonitis after stereotactic radiation therapy for lung tumours: clinical usefulness of the planning target volume to total lung volume ratio. Br J Radiol 2018; 91:20170453. [PMID: 29565649 DOI: 10.1259/bjr.20170453] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To identify risk factors for symptomatic radiation pneumonitis (RP) after stereotactic radiation therapy (SRT) for lung tumours. METHODS We retrospectively evaluated 68 lung tumours in 63 patients treated with SRT between 2011 and 2015. RP was graded according to the National Cancer Institute-Common Terminology Criteria for Adverse Events version 4.0. SRT was delivered at 7.0-12.0 Gy per each fraction, once daily, to a total of 48-64 Gy (median, 50 Gy). Univariate analysis was performed to assess patient- and treatment-related factors, including age, sex, smoking index (SI), pulmonary function, tumour location, serum Krebs von den Lungen-6 value (KL-6), dose-volume metrics (V5, V10, V20, V30, V40 and VS5), homogeneity index of the planning target volume (PTV), PTV dose, mean lung dose (MLD), contralateral MLD and V2, PTV volume, lung volume and the PTV/lung volume ratio (PTV/Lung). Performance of PTV/Lung in predicting symptomatic RP was also analysed using receiver operating characteristic (ROC) analysis. RESULTS The median follow-up period was 21 months. 10 of 63 patients (15.9%) developed symptomatic RP after SRT. On univariate analysis, V10, V20, PTV volume and PTV/Lung were significantly associated with occurrence of RP ≥Grade 2. ROC curves indicated that symptomatic RP could be predicted using PTV/Lung [area under curve (AUC): 0.88, confidence interval (CI: 0.78-0.95), cut-off value: 1.09, sensitivity: 90.0% and specificity: 72.4%]. CONCLUSION PTV/Lung is a good predictor of symptomatic RP after SRT. Advances in knowledge: The cases with high PTV/Lung should be carefully monitored with caution for the occurrence of RP after SRT.
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Affiliation(s)
- Tomoko Ueyama
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Takeshi Arimura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Koji Takumi
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Fumihiko Nakamura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Ryutaro Higashi
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Soichiro Ito
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Yoshihiko Fukukura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Tomokazu Umanodan
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Masanori Nakajo
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Chihaya Koriyama
- 2 Department of Epidemiology and Preventive Medicine, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
| | - Takashi Yoshiura
- 1 Department of Radiology, Graduate School of Medical and Dental Sciences, Kagoshima University , Kagoshima , Japan
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Dosimetric effect of uncorrected rotations in lung SBRT with stereotactic imaging guidance. Phys Med 2017; 42:197-202. [DOI: 10.1016/j.ejmp.2017.09.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/20/2017] [Accepted: 09/23/2017] [Indexed: 12/25/2022] Open
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12
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Pulmonary Resection for Second Lung Cancer After Pneumonectomy: A Population-Based Study. Ann Thorac Surg 2017; 104:1131-1137. [DOI: 10.1016/j.athoracsur.2017.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/13/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
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Petrella F, Spaggiari L. Therapeutic options following pneumonectomy in non-small cell lung cancer. Expert Rev Respir Med 2016; 10:919-25. [PMID: 27176616 DOI: 10.1080/17476348.2016.1188694] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Pneumonectomy can be considered the most appropriate treatment for lung cancer that cannot be removed by lesser resection on. AREAS COVERED Therapeutic options following pneumonectomy may be required at least in 3 different scenarios: 1) an early approach due to acute surgical complications 2) a late approach due to chronic surgical complications 3) an integrated radio-chemotherapeutic adjuvant approach for advanced stages. In this review we focused on these three settings with particular emphasis to surgical approach as well as to alternative options. Expert commentary: Pneumonectomy itself does not preclude postoperative additional treatments, if needed, to maximize oncological results and to manage potential short or long term complications. However, as pneumonectomy puts a significant physiological stress on the respiratory and circulatory systems, the benefits and risks of pneumonectomy should be compared with those of alternative, non-resectional treatment modalities.
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Affiliation(s)
| | - Lorenzo Spaggiari
- a Department of Thoracic Surgery , University of Milan , Milan , Italy.,b Department of Oncology and Hematology/Oncology - DIPO , University of Milan , Milan , Italy
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Wei Z, Wang J, Ye X, Yang X, Huang G. Computed tomography-guided percutaneous microwave ablation of early stage non-small cell lung cancer in a pneumonectomy patient. Thorac Cancer 2016; 7:151-3. [PMID: 26816550 PMCID: PMC4718118 DOI: 10.1111/1759-7714.12244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/07/2015] [Indexed: 11/26/2022] Open
Abstract
A squamous cell lung cancer patient was treated with pneumonectomy. A recurrent lung cancer (adenocarcinoma) was found 45 months later and successfully biopsied and treated with microwave ablation. After 18 months of follow up, no evidence of tumor recurrence was observed.
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Affiliation(s)
- Zhigang Wei
- Department of Oncology Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong Province China
| | - Jiao Wang
- Department of Oncology Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong Province China
| | - Xin Ye
- Department of Oncology Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong Province China
| | - Xia Yang
- Department of Oncology Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong Province China
| | - Guanghui Huang
- Department of Oncology Shandong Provincial Hospital affiliated to Shandong University Jinan Shandong Province China
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Efficacy and Safety of Stereotactic Ablative Radiotherapy in Patients with Previous Pneumonectomy. TUMORI JOURNAL 2015; 101:148-53. [DOI: 10.5301/tj.5000227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2014] [Indexed: 12/26/2022]
Abstract
Background Thoracic surgery for a newly diagnosed primary lung tumor following a previous pneumonectomy is rarely indicated. Stereotactic ablative radiotherapy (SABR) might represent a curative option. This report focuses on outcomes, toxicity and quality of life (QoL) after SABR. Methods Nine patients were treated with SABR between 2004 and 2011; median time since surgery was 8.4 years. In 4 cases, a histological confirmation was possible with bronchoscopy. In 5 cases, the clinical proof of malignancy was based on radiological criteria. Forced expiratory volume in 1 second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) were tested in all patients. A SABR biologically equivalent dose of >100 Gy was prescribed in all cases. QoL questionnaire forms were administered before SABR and during follow-up. Results Median follow-up was 41.8 months. We did not observe grade >3 acute toxicity, and concerning late toxicity, we registered 2 cases. QoL was decreased during the first 12 months of follow-up, followed by a progressive improvement after this time. One patient had a local relapse at 7.4 years; 1 developed a new nodule at 5.5 years, associated with metastases; and 1 developed a new nodule without any systemic disease at 3 years. There were 2 cancer-related deaths (18.2%) at 3 and 12 months after progression. Conclusions Data support efficacy and safety of SABR in patients with a new primary lung cancer following previous pneumonectomy, with acceptable acute, late toxicity profile and without significant impairment of QoL. Our results were comparable to those in the literature.
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Testolin A, Favretto MS, Cora S, Cavedon C. Stereotactic body radiation therapy for a new lung cancer arising after pneumonectomy: dosimetric evaluation and pulmonary toxicity. Br J Radiol 2015; 88:20150228. [PMID: 26290398 DOI: 10.1259/bjr.20150228] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To evaluate the tolerance of stereotactic body radiation therapy (SBRT) for the treatment of secondary lung tumours in patients who underwent previous pneumonectomy. METHODS 12 patients were retrospectively analysed. The median maximum tumour diameter was 2.1 cm (1-4.5 cm). The median planning target volume was 20.7 cm(3) (2.4-101.2 cm(3)). Five patients were treated with a single fraction of 26 Gy and seven patients with fractionated schemes (3 × 10 Gy, 4 × 10 Gy, 4 × 12 Gy). Lung toxicity, correlated with volume (V) of lung receiving >5, >10 and >20 Gy, local control and survival rate were assessed. Median follow-up was 28 months. RESULTS None of the patients experienced pulmonary toxicity > grade 2 at the median dosimetric lung parameters of V5, V10 and V20 of 23.1% (range 10.7-56.7%), 7.3% (2.2-27.2%) and 2.7% (0.7-10.9%), respectively. No patients required oxygen or had deterioration of the performance status during follow-up if not as a result of clinical progression of disease. The local control probability at 2 years was 64.5%, and the overall survival at 2 years was 80%. CONCLUSION SBRT appears to be a safe and effective modality for treating patients with a second lung tumour after pneumonectomy. ADVANCES IN KNOWLEDGE Our results and similar literature results show that when keeping V5, V10 V20 <50%, <20% and <7%, respectively, the risk of significant lung toxicity is acceptable. Our experience also shows that biologically effective dose 10 >100 Gy, necessary for high local control rate, can be reached while complying with the dose constraints for most patients.
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Affiliation(s)
| | | | - Stefania Cora
- 3 Department of Medical Physics, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Cavedon
- 4 Department of Medical Physics, University of Verona, Borgo Trento Hospital, Verona, Italy
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Pöttgen C, Abu Jawad J, Gkika E, Freitag L, Lübcke W, Welter S, Gauler T, Schuler M, Eberhardt WEE, Stamatis G, Stuschke M. Accelerated radiotherapy and concurrent chemotherapy for patients with contralateral central or mediastinal lung cancer relapse after pneumonectomy. J Thorac Dis 2015; 7:264-72. [PMID: 25922702 DOI: 10.3978/j.issn.2072-1439.2015.01.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/13/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Treatment options are very limited for patients with lung cancer who experience contralateral central or mediastinal relapse following pneumonectomy. We present results of an accelerated salvage chemoradiotherapy regimen. METHODS Patients with localized contralateral central intrapulmonary or mediastinal relapse after pneumonectomy were offered combined chemoradiotherapy including concurrent weekly cisplatin (25 mg/m(2)) and accelerated radiotherapy [accelerated fractionated (AF), 60 Gy, 8×2 Gy per week] to reduce time for repopulation. Based on 4D-CT-planning, patients were irradiated using multifield intensity-modulated radiotherapy (IMRT) or helical tomotherapy. RESULTS Between 10/2011 and 12/2012, seven patients were treated. Initial stages were IIB/IIIA/IIIB: 3/1/3; histopathological subtypes scc/adeno/large cell: 4/1/2. Tumour relapses were located in mediastinal nodal stations in five patients with endobronchial tumour in three patients. The remaining patients had contralateral central tumour relapses. All patients received 60 Gy (AF), six patients received concurrent chemotherapy. Median dose to the remaining contralateral lung, esophagus, and spinal cord was 6.8 (3.3-11.4), 8.0 (5.1-15.5), and 7.6 (2.8-31.2) Gy, respectively. With a median follow-up of 29 [17-32] months, no esophageal or pulmonary toxicity exceeding grade 2 [Common terminology criteria for adverse events (CTC-AE) v. 3] was observed. Median survival was 17.2 months, local in-field control at 12 months 80%. Only two local recurrences were observed, both in combination with out-field metastases. CONCLUSIONS This intensified accelerated chemoradiotherapy schedule was safely applicable and offers a curative chance in these pretreated frail lung cancer patients.
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Affiliation(s)
- Christoph Pöttgen
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Jehad Abu Jawad
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Eleni Gkika
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Lutz Freitag
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wolfgang Lübcke
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Stefan Welter
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Thomas Gauler
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Schuler
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Wilfried Ernst Erich Eberhardt
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Georgios Stamatis
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Martin Stuschke
- 1 Department of Radiotherapy; West German Cancer Center, University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 2 Division of Interventional Pneumology, 3 Division of Thoracic Surgery, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 4 Department of Medical Oncology, West German Cancer Center; University of Duisburg-Essen, Hufelandstr, 55, D-45122 Essen, Germany ; 5 Division of Thoracic Oncology, Ruhrlandklinik, West German Lung Center, University of Duisburg-Essen, Tüschener Weg 40, D-45239 Essen, Germany ; 6 German Cancer Consortium (DKTK), Heidelberg, Germany
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Casutt A, Bouchaab H, Beigelman-Aubry C, Bourhis J, Lovis A, Matzinger O. Stereotactic body radiotherapy with helical TomoTherapy for medically inoperable early stage primary and second-primary non-small-cell lung neoplasm: 1-year outcome and toxicity analysis. Br J Radiol 2015; 88:20140687. [PMID: 25735428 DOI: 10.1259/bjr.20140687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE This study investigated the effectiveness of stereotactic body radiotherapy with helical TomoTherapy (T-SBRT) for treating medically inoperable primary and second-primary early stage non-small-cell lung neoplasm (SPLN) and evaluated whether the movement of organizing pneumonia (OP) within the irradiation field (IF) can be detected via analysis of radiological changes. METHODS Patients (n = 16) treated for 1 year (2011-12) at our hospital by T-SBRT at a total dose of 60 Gy in five fractions were examined retrospectively. Outcome and toxicity were recorded and were separately described for SPLN. CT scans were reviewed by a single radiologist. RESULTS Of the 16 patients, 5 (31.3%) had primary lung malignancies, 10 (62.5%) had SPLN, and 1 case (6.3%) had isolated mediastinal metastasis of lung neoplasm. Pathological evidence was obtained for 72.2% of all lesions. The median radiological follow-up was 11 months (10.5 months for SPLN). For all cases, the 6- and 12-month survival rates were 100% and 77.7% (100% and 71.4%, respectively, for SPLN), and the 6- and 12-month locoregional control rates were 100% in all cases. 2 (12.5%) of 16 patients developed grade 3 late transient radiation pneumonitis following steroid therapy and 1 (6.3%) presented asymptomatic infiltrates comparable to OP opacities. CONCLUSION T-SBRT seems to be safe and effective. ADVANCES IN KNOWLEDGE Mild OP is likely associated with radiation-induced anomalies in the IF, identification of migrating opacities can help discern relapse of radiation-induced opacities.
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Affiliation(s)
- A Casutt
- 1 Department of Pneumology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Hayes JT, David EA, Qi L, Chen AM, Daly ME. Risk of Pneumonitis After Stereotactic Body Radiation Therapy in Patients With Previous Anatomic Lung Resection. Clin Lung Cancer 2015; 16:379-84. [PMID: 25737143 DOI: 10.1016/j.cllc.2015.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 01/16/2015] [Accepted: 01/23/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) has emerged as a standard treatment of early-stage, medically inoperable lung cancer. Limited data have evaluated the radiation pneumonitis (RP) risk with SBRT after previous anatomic lung resection (ALR). We assessed the incidence of RP and all pulmonary toxicity (PT) in patients who underwent lung SBRT after ALR and compared them with those of patients without previous ALR. MATERIALS AND METHODS We reviewed the medical records of 84 consecutively treated patients with stage T1-T2b non-small-cell lung cancer (NSCLC) treated with 88 courses of SBRT for 94 lung tumors from January 2007 to December 2014, including 17 patients with previous ALR. The rates of RP and all PT were compared between the patients with and without previous ALR. RESULTS At a median follow-up duration of 18.3 months (range, 1.8-85.6 months), the crude grade 2+ RP rate was 5.9% and 2.8% for patients with and without previous ALR, respectively (P = .51). The corresponding 2-year estimates of freedom from RP were 89% and 97% (P = .51). The crude rate of all grade 2+ PT was 11.8% and 2.8% for those with and without previous ALR (P = .11), with 2-year estimates of freedom from PT of 97% and 84% (P = .11), respectively. The 2 cohorts were well matched by the mean lung dose, percentage of lung volume receiving 20 Gy (P = .86), and prescribed dose (P = .75). The 2-year estimates of local control, cause-specific survival, and overall survival were similar between the 2 cohorts. CONCLUSION The observed rates of PT were low among all patients, with a trend toward increased grade 2 and 3 lung toxicity among patients with previous ALR. Previous ALR did not increase the risk of grade 4 and 5 RP, and SBRT appears safe and effective in this population.
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Affiliation(s)
- Jason T Hayes
- Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA
| | - Elizabeth A David
- Section of Thoracic Surgery, Department of Surgery, University of California, Davis, School of Medicine, Sacramento, CA
| | - LiHong Qi
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Sacramento, CA
| | - Allen M Chen
- Department of Radiation Oncology, University of California, Los Angeles, School of Medicine, Los Angeles, CA
| | - Megan E Daly
- Department of Radiation Oncology, University of California, Davis, Comprehensive Cancer Center, Sacramento, CA.
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21
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Maciejczyk A, Skrzypczyńska I, Janiszewska M. Lung cancer. Radiotherapy in lung cancer: Actual methods and future trends. Rep Pract Oncol Radiother 2014; 19:353-60. [PMID: 25337407 PMCID: PMC4201776 DOI: 10.1016/j.rpor.2014.04.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 04/16/2014] [Indexed: 12/25/2022] Open
Abstract
This survey is performed to update knowledge about methods and trends in lung cancer radiotherapy. A significant development has been noticed in radiotherapeutic techniques, but also in the identification of clinical prognostic factors. The improvement in the therapeutic line includes: application of the four-dimensional computer tomography (4DCT), taking advantage of positron emission tomography (PET-CT), designing of new computational algorithms, allowing more precise irradiation planning, development of treatment precision verification systems and introducing IMRT techniques in chest radiotherapy. The treatment outcomes have improved with high dose radiotherapy, but other fractionation alternations have been investigated as well.
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Affiliation(s)
- Adam Maciejczyk
- Radiotherapy Department, Lower Silesian Centre of Oncology, Wrocław, Poland
| | - Iga Skrzypczyńska
- Radiotherapy Department, Lower Silesian Centre of Oncology, Wrocław, Poland
| | - Marzena Janiszewska
- Medical Physics Department, Lower Silesian Centre of Oncology, Wrocław, Poland
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22
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Xiong W, Xu Q, Xu Y, Sun C, Li N, Zhou L, Liu Y, Zhou X, Wang Y, Wang J, Bai S, Lu Y, Gong Y. Stereotactic body radiation therapy for post-pulmonary lobectomy isolated lung metastasis of thoracic tumor: survival and side effects. BMC Cancer 2014; 14:719. [PMID: 25260301 PMCID: PMC4189164 DOI: 10.1186/1471-2407-14-719] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/24/2014] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Stereotactic body radiation therapy (SBRT) has emerged as an alternative treatment for patients with early stage non-small cell lung cancer (NSCLC) or metastatic pulmonary tumors. However, for isolated lung metastasis (ILM) of thoracic malignances after pulmonary lobectomy, reported outcomes of SBRT have been limited. This study evaluates the role of SBRT in the treatment of such patients. METHODS A retrospective search of the SBRT database was conducted in three hospitals. The parameters analyzed in the treated patients were local control, progression-free survival (PFS), overall survival (OS), and the treatment-related side-effects. RESULTS In total, 23 patients with single ILM after pulmonary lobectomy treated with SBRT were identified and the median follow-up time was 14 months (range: 6.0-47.0 months). Local recurrences were observed in two patients during follow-up and the 1-year local control rate was 91.3%. Median PFS and OS for the studied cohort were 10.0 months [95% confidence interval (CI) 5.1-14.9 months] and 21.0 months (95% CI 11.4-30.6 months), respectively. Acute radiation pneumonitis (RP) of grade 2 or worse was observed in five (21.7%) and three (13.0%) patients, respectively. Other treatment-related toxicities included chest wall pain in one patient (4.3%) and acute esophagitis in two patients (8.7%). By Pearson correlation analysis, the planning target volume (PTV) volume and the volume of the ipsilateral lung exposed to a minimum dose of 5 Gy (IpV5) were significantly related to the acute RP of grade 2 or worse in present study (p < 0.05). The optimal thresholds of the PTV and IpV5 to predict RP of acute grade 2 or worse RP were 59 cm3 and 51% respectively, according to the receiver-operating characteristics curve analysis, with sensitivity/specificity of 75.0%/80.0% and 62.5%/80.0%. CONCLUSIONS SBRT for post-lobectomy ILM was effective and well tolerated. The major reason for disease progression was distant failure but not local recurrence. The PTV and IpV5 are potential predictors of acute RP of grade 2 or higher and should be considered in treatment planning for such patients.
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Affiliation(s)
- Weijie Xiong
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
- />Chengdu Fifth People’s Hospital and Chengdu Third People’s Hospital, Chengdu, China
| | - Qingfeng Xu
- />Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yong Xu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Changjin Sun
- />Department of Radiation Oncology, The Second People’s Hospital of Sichuan Province, Chengdu, 610031 PR China
- />Chengdu Fifth People’s Hospital and Chengdu Third People’s Hospital, Chengdu, China
| | - Na Li
- />Department of Oncology, Second Affiliated Hospital of Anhui Medical University, Hefei, 230601 PR China
| | - Lin Zhou
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yongmei Liu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Xiaojuan Zhou
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Yongsheng Wang
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Jin Wang
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Sen Bai
- />Radiation Physics Center, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - You Lu
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
| | - Youling Gong
- />Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041 PR China
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Stereotactic Body Radiotherapy in Patients with Previous Pneumonectomy: Safety and Efficacy. J Thorac Oncol 2014; 9:843-7. [DOI: 10.1097/jto.0000000000000159] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Verstegen NE, Lagerwaard FJ, Senan S. Developments in early-stage NSCLC: advances in radiotherapy. Ann Oncol 2013; 23 Suppl 10:x46-51. [PMID: 22987992 DOI: 10.1093/annonc/mds301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
An increase in the number of predominantly elderly patients with early-stage non-small-cell lung cancer is anticipated in many Western populations. Patients often have major co-morbidities and are at increased risk for surgical morbidity and mortality. In the past decade, the use of stereotactic ablative radiotherapy (SABR) has achieved excellent results, with only mild toxicity in such vulnerable patient groups, leading to SABR becoming accepted as a standard of care for unfit patients in several countries. The planning and delivery of SABR has rapidly improved in recent years, particularly with the use of 'on-board' imaging at treatment units, and shortened treatment delivery times. Increasingly, more central tumors are being treated using lower doses per fraction (so-called risk-adapted schemes). It is also becoming clear that long-term follow-up should take place at specialist centers in order to distinguish the evolving fibrosis that is frequently observed from the relatively infrequent local recurrences. Given the high local control rates and limited toxicity, increasing attention is being paid to the use of SABR in the subgroup of so-called borderline operable patients, and clinical trials comparing surgery and SABR in these patients are ongoing.
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Affiliation(s)
- N E Verstegen
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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25
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Chen KC, Chen JS. Radiotherapy for lung tumors arising after a prior pneumonectomy. J Thorac Dis 2013; 5:112-3. [PMID: 23585933 DOI: 10.3978/j.issn.2072-1439.2013.03.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 03/25/2013] [Indexed: 11/14/2022]
Affiliation(s)
- Ke-Cheng Chen
- The Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan; ; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Senthi S, Haasbeek CJA, Lagerwaard FJ, Verbakel WF, de Haan PF, Slotman BJ, Senan S. Radiotherapy for a second primary lung cancer arising post-pneumonectomy: planning considerations and clinical outcomes. J Thorac Dis 2013; 5:116-22. [PMID: 23585935 DOI: 10.3978/j.issn.2072-1439.2013.02.07] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 02/27/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Second primary non-small cell lung cancer (SPLC) is a significant cause of death amongst lung cancer survivors. As subsequent surgery is seldom feasible post-pneumonectomy, we studied the long-term clinical outcomes achieved with curative radiotherapy using modern delivery techniques. METHODS Retrospective review of an institutional database between 2003-2011 identified 27 patients who had received curative radiotherapy for SPLC arising post-pneumonectomy. Treatments included; stereotactic ablative radiotherapy (SABR, n=20, dose 54-60 Gy in 3-8 fractions), hypofractionated radiotherapy (HFR, n=6, dose 39-60 Gy in 12-23 fractions) and conventional radiotherapy (RT, n=1, 60 Gy in 30 fractions). Clinical follow-up with a CT scan at 3, 6 and 12 months, then yearly was performed. Toxicities were scored using the common toxicity criteria for adverse events (version 4.0). RESULTS The median overall survival was 39 months (95% CI, 33-44 months). After a median follow-up of 52 months (95% CI, 37-67 months), any recurrence was observed in four (15%) patients. Actuarial 3-year rates of local, regional and distant recurrences were 8% (95% CI, 0-21 months), 10% (95% CI, 0-23%) and 9% (95% CI, 0-20%), respectively. Patients receiving HFR or RT all had centrally located tumors. Of the patients treated with HFR delivered 12 fractions, 75% (3/4) developed grade 3 or higher radiation pneumonitis (RP), including one probable grade 5 toxicity. Of those receiving RT or HFR in 13 or more fractions no (0/3) grade 3 or worse RP was observed, despite such treatment being used for larger tumors and resulting in worse lung dose-volume histogram metrics. All the patients who developed RP had radiotherapy plans, which prioritized the sparing of central structures over lung sparing. No non-RP grade 3 or higher toxicities were observed. CONCLUSIONS Curative radiotherapy is an effective treatment for SPLC arising post-pneumonectomy. For larger central tumors, our data suggests that plans should prioritize reducing lung doses above the sparing of central structures.
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Affiliation(s)
- Sashendra Senthi
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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27
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Nambu A, Onishi H, Aoki S, Tominaga L, Kuriyama K, Araya M, Saito R, Maehata Y, Komiyama T, Marino K, Koshiishi T, Sawada E, Araki T. Rib fracture after stereotactic radiotherapy for primary lung cancer: prevalence, degree of clinical symptoms, and risk factors. BMC Cancer 2013; 13:68. [PMID: 23391264 PMCID: PMC3573931 DOI: 10.1186/1471-2407-13-68] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 02/04/2013] [Indexed: 12/25/2022] Open
Abstract
Background As stereotactic body radiotherapy (SBRT) is a highly dose-dense radiotherapy, adverse events of neighboring normal tissues are a major concern. This study thus aimed to clarify the frequency and degree of clinical symptoms in patients with rib fractures after SBRT for primary lung cancer and to reveal risk factors for rib fracture. Appropriate α/β ratios for discriminating between fracture and non-fracture groups were also investigated. Methods Between November 2001 and April 2009, 177 patients who had undergone SBRT were evaluated for clinical symptoms and underwent follow-up thin-section computed tomography (CT). The time of rib fracture appearance was also assessed. Cox proportional hazard modeling was performed to identify risk factors for rib fracture, using independent variables of age, sex, maximum tumor diameter, radiotherapeutic method and tumor-chest wall distance. Dosimetric details were analyzed for 26 patients with and 22 randomly-sampled patients without rib fracture. Biologically effective dose (BED) was calculated with a range of α/β ratios (1–10 Gy). Receiver operating characteristics analysis was used to define the most appropriate α/β ratio. Results Rib fracture was found on follow-up thin-section CT in 41 patients. The frequency of chest wall pain in patients with rib fracture was 34.1% (14/41), and was classified as Grade 1 or 2. Significant risk factors for rib fracture were smaller tumor-chest wall distance and female sex. Area under the curve was maximal for BED at an α/β ratio of 8 Gy. Conclusions Rib fracture is frequently seen on CT after SBRT for lung cancer. Small tumor-chest wall distance and female sex are risk factors for rib fracture. However, clinical symptoms are infrequent and generally mild. When using BED analysis, an α/β ratio of 8 Gy appears most effective for discriminating between fracture and non-fracture patients.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan.
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28
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Senthi S, Verstegen NE, Senan S. Treatment of peripheral lung tumors arising after a prior pneumonectomy. Chest 2012; 142:263. [PMID: 22796856 DOI: 10.1378/chest.12-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Sashendra Senthi
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Naomi E Verstegen
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands
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29
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Izumi Y, Yamauchi Y, Kawaguchi O, Nomori H. Treatment of Peripheral Lung Tumors Arising After a Prior Pneumonectomy: Response. Chest 2012. [DOI: 10.1378/chest.12-0719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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30
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A prospective study of quality of life including fatigue and pulmonary function after stereotactic body radiotherapy for medically inoperable early-stage lung cancer. Support Care Cancer 2012; 21:211-8. [DOI: 10.1007/s00520-012-1513-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 05/21/2012] [Indexed: 12/26/2022]
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31
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Louie AV, Rodrigues G, Cheung P, Palma DA, Movsas B. A review of palliative radiotherapy for lung cancer and lung metastases. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13566-012-0042-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Varlotto JM, Recht A, Flickinger JC, Medford-Davis LN, Dyer AM, DeCamp MM. Lobectomy leads to optimal survival in early-stage small cell lung cancer: a retrospective analysis. J Thorac Cardiovasc Surg 2011; 142:538-46. [PMID: 21684554 DOI: 10.1016/j.jtcvs.2010.11.062] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 10/15/2010] [Accepted: 11/02/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Stage I or II small cell lung cancer is rare. We evaluated the contemporary incidence of early-stage small cell lung cancer and defined its optimal local therapy. METHODS We analyzed the incidence, treatment patterns, and outcomes of 2214 patients with early-stage small cell lung cancer (1690 with stage I and 524 with stage II) identified from the Surveillance, Epidemiology, and End Results database from 1988 to 2005. RESULTS Early-stage small cell lung cancer constituted a stable proportion of all small cell lung cancers (3%-5%), lung cancers (0.10%-0.17%), and stage I lung cancers (1%-1.5%) until 2003 but, by 2005, increased significantly to 7%, 0.29%, and 2.2%, respectively (P < .0001). Surgery for early-stage small cell lung cancer peaked at 47% in 1990 but declined to 16% by 2005. Patients treated with lobectomy or greater resections (lobe) without radiotherapy had longer median survival (50 months) than those treated with sublobar resections (sublobe) without radiotherapy (30 months, P = .006) or those treated with radiotherapy alone (20 months, P < .0001). Patients undergoing sublobe without radiotherapy also demonstrated superior survival than patients receiving radiotherapy alone (P = .002). The use or omission of radiotherapy made no difference after limited resection (30 vs 28 months, P = .6). Multivariable analysis found survival independently related to age, year of diagnosis, tumor size, stage, and treatment (lobe vs sublobe vs radiotherapy alone). CONCLUSIONS Surgery is an underused modality in the management of early-stage small cell lung cancer. Lobectomy provides optimal local control and leads to superior survival. Although sublobar resection proved inferior to lobectomy, it conferred a survival advantage superior to radiotherapy alone. The addition of radiotherapy to resection provided no additional benefit.
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Affiliation(s)
- John M Varlotto
- Division of Radiation Oncology, Pennsylvania State University, Hershey, PA, USA
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33
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Nambu A, Onishi H, Aoki S, Koshiishi T, Kuriyama K, Komiyama T, Marino K, Araya M, Saito R, Tominaga L, Maehata Y, Sawada E, Araki T. Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients. Radiat Oncol 2011; 6:137. [PMID: 21995807 PMCID: PMC3213137 DOI: 10.1186/1748-717x-6-137] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 10/13/2011] [Indexed: 12/25/2022] Open
Abstract
Background Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer Materials and methods A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Results Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Conclusion Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present.
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Affiliation(s)
- Atsushi Nambu
- Department of Radiology, University of Yamanashi, Chuo City, Japan.
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34
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Ong CL, Palma D, Verbakel WFAR, Slotman BJ, Senan S. Treatment of large stage I-II lung tumors using stereotactic body radiotherapy (SBRT): planning considerations and early toxicity. Radiother Oncol 2011; 97:431-6. [PMID: 20971523 DOI: 10.1016/j.radonc.2010.10.003] [Citation(s) in RCA: 113] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Revised: 10/01/2010] [Accepted: 10/03/2010] [Indexed: 12/25/2022]
Abstract
PURPOSE To study the dosimetric predictors of early clinical toxicity following SBRT in patients with lung tumors and planning target volumes (PTV) exceeding 80 cm(3). METHODS Eighteen consecutive patients who were treated using volumetric modulated arc therapy (RapidArc™) were assessed. All were either unfit or refused to undergo surgery or chemoradiotherapy. PTV planning objectives were as used in the ROSEL study protocol. Clinical toxicity was scored using Common Toxicity Criteria AE4.0. Lung volumes receiving 5, 10, 15, and 20 Gy (V(5), V(10), V(15) and V(20)) and mean lung dose were assessed and correlated to symptomatic radiation pneumonitis (RP). RESULTS Median age, age-adjusted Charlson-comorbidity score and PTV size were 74, 7.5 and 137 cm(3), respectively. At a median follow-up of 12.8 months, 8 deaths were recorded: 5 arising from comorbidity, 2 were potentially treatment-related and 1 had local recurrence. RP was reported in 5 patients (grade 2 in 3 and grade 3 in 2). All RP occurred in plans without a high priority optimization objective on contralateral lung. Acute RP was best predicted by contralateral lung V(5) (p<0.0001). CONCLUSION After SBRT using RapidArc in lung tumors >80 cm(3), the contralateral lung V(5) best predicts RP. Limiting contralateral lung V(5) to <26% may reduce acute toxicity.
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Affiliation(s)
- Chin Loon Ong
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
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35
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Stereotactic radiation therapy: changing treatment paradigms for stage I nonsmall cell lung cancer. Curr Opin Oncol 2011; 23:133-9. [DOI: 10.1097/cco.0b013e328341ee11] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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36
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Kim W, Kim HJ, Park JH, Huh HD, Choi SH. Treatment Results of CyberKnife Radiosurgery for Patients with Primary or Recurrent Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.3857/jkstro.2011.29.1.28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Woochul Kim
- Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea
| | - Hun-Jung Kim
- Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea
| | - Jeong Hoon Park
- Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea
| | - Hyun Do Huh
- Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea
| | - Sang Huoun Choi
- Department of Radiation Oncology, Inha University School of Medicine, Incheon, Korea
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37
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De Ruysscher D, Faivre-Finn C, Nestle U, Hurkmans CW, Le Péchoux C, Price A, Senan S. European Organisation for Research and Treatment of Cancer Recommendations for Planning and Delivery of High-Dose, High-Precision Radiotherapy for Lung Cancer. J Clin Oncol 2010; 28:5301-10. [DOI: 10.1200/jco.2010.30.3271] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To derive recommendations for routine practice and clinical trials for techniques used in high-dose, high-precision thoracic radiotherapy for lung cancer. Methods A literature search was performed to identify published articles considered both clinically relevant and practical to use. Recommendations were categorized under the following headings: patient selection, patient positioning and immobilization, tumor motion, computed tomography and [18F]fluorodeoxyglucose–positron emission technology scanning, generating target volumes, radiotherapy treatment planning, treatment delivery, and scoring of response and toxicity. The American College of Chest Physicians grading of recommendations was used. Results Recommendations were identified for each of the recommendation categories. Although most of the recommended techniques have not been evaluated in multicenter clinical trials, their use in high-precision thoracic radiotherapy and stereotactic body radiotherapy (SBRT) appears to be justified on the basis of available evidence. Conclusion Recommendations to facilitate the clinical implementation of high-precision conformal radiotherapy and SBRT for lung tumors were identified from the literature. Some techniques that are considered investigational at present were also highlighted.
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Affiliation(s)
- Dirk De Ruysscher
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Corinne Faivre-Finn
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Ursula Nestle
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Coen W. Hurkmans
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Cécile Le Péchoux
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Allan Price
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
| | - Suresh Senan
- From the Maastricht University Medical Center, GROW Research Institute, Maastricht; Free University Medical Center, Amsterdam; and Catharina Hospital, Eindhoven, the Netherlands; the Christie, Manchester; and Edinburgh Cancer Centre, Western General Hospital, Edinburgh, United Kingdom; Freiburg University Medical Center, Freiburg, Germany; and Gustave Roussy Institute, Villejuif, France
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38
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Videtic GMM, Stephans KL. The role of stereotactic body radiotherapy in the management of non-small cell lung cancer: an emerging standard for the medically inoperable patient? Curr Oncol Rep 2010; 12:235-41. [PMID: 20446066 DOI: 10.1007/s11912-010-0108-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The standard of care for early-stage lung cancer is surgical resection. Many patients with this diagnosis have comorbidities that preclude oncologic resection. Randomized data show that limited resection is inadequate for local disease control and may negatively impact on survival. Stereotactic body radiotherapy (SBRT) has emerged as a novel radiation modality with significant applications in the inoperable, early-stage lung cancer population. Retrospective and prospective studies published in the past decade have established the feasibility, safety, and efficacy of SBRT in these patients using a variety of dose regimens and technologies. To date, lung SBRT results demonstrate excellent local control with very little acute toxicity, and suggest improved overall survival compared to historical controls of fractionated radiotherapy. Ongoing prospective trials are exploring dose and fractionation schedules in the inoperable population, and are starting to explore the role of SBRT for the operable patient.
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Affiliation(s)
- Gregory M M Videtic
- Cleveland Clinic Lerner College of Medicine, The Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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39
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Sculier JP, Berghmans T, Meert AP. Update in lung cancer and mesothelioma 2009. Am J Respir Crit Care Med 2010; 181:773-81. [PMID: 20382800 DOI: 10.1164/rccm.201001-0045up] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jean-Paul Sculier
- Department of Critical Care & Thoracic Oncology, Institut Jules Bordet, Université Libre Bruxelles (ULB), B - 1000 Brussels, Belgium.
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40
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Iwata H, Murakami M, Demizu Y, Miyawaki D, Terashima K, Niwa Y, Mima M, Akagi T, Hishikawa Y, Shibamoto Y. High-dose proton therapy and carbon-ion therapy for stage I nonsmall cell lung cancer. Cancer 2010; 116:2476-85. [PMID: 20225229 DOI: 10.1002/cncr.24998] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A study was undertaken to evaluate the clinical outcome of particle therapy for stage I nonsmall cell lung cancer (NSCLC). METHODS From April 2003 to April 2007, 80 patients with stage I NSCLC were treated with proton therapy or carbon-ion therapy (57 with proton therapy and 23 with carbon-ion therapy) using 3 treatment protocols. In the first protocol, 80 gray equivalents (GyE) of proton therapy was given in 20 fractions, and the second proton therapy protocol used 60 GyE in 10 fractions. For carbon-ion therapy, 52.8 GyE was given in 4 fractions. After achieving promising preliminary results for the first protocol, the authors started to use the second proton therapy protocol to shorten the overall treatment time. Carbon-ion therapy was started in 2005, and thereafter, both proton and carbon-ion therapy plans were made for each patient, and the 1 that appeared superior was adopted. Patient age ranged from 48 to 89 years (median, 76 years). Thirty-seven patients were medically inoperable, and 43 refused surgery. Forty-two patients had T1 tumors, and 38 had T2 tumors. RESULTS The median follow-up period for living patients was 35.5 months. For all 80 patients, the 3-year overall survival, cause-specific survival, and local control rates were 75% (IA: 74%; IB: 76%), 86% (IA: 84%; IB: 88%), and 82% (IA: 87%; IB: 77%), respectively. There were no significant differences in treatment results among the 3 protocols. Grade 3 pulmonary toxicity was observed in only 1 patient. CONCLUSIONS Proton therapy and carbon-ion therapy are safe and effective for stage I NSCLC. Further investigation of particle therapy for stage I NSCLC is warranted.
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Affiliation(s)
- Hiromitsu Iwata
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
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41
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Stereotactic radiotherapy for stage I lung cancer: Current results and new developments. Cancer Radiother 2010; 14:115-8. [DOI: 10.1016/j.canrad.2009.11.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Revised: 11/04/2009] [Accepted: 11/19/2009] [Indexed: 12/25/2022]
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