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Cramer P, Pua BB. The Latest on Lung Ablation. Semin Intervent Radiol 2022; 39:285-291. [PMID: 36062233 PMCID: PMC9433157 DOI: 10.1055/s-0042-1753526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Lung cancer is the second most common cancer in both men and women. Despite smoking cessation efforts and advances in lung cancer detection and treatment, long-term survival remains low. For early-stage primary lung carcinoma, surgical resection offers the best chance of long-term survival; however, only about one-third of patients are surgical candidates. For nonsurgical candidates, minimally invasive percutaneous thermal ablation therapies have become recognized as safe and effective treatment alternatives, including radiofrequency ablation, microwave ablation, and cryoablation. Lung ablation is also an acceptable treatment for limited oligometastatic and oligorecurrent diseases. This article discusses the technologies and techniques available for tumor ablation of thoracic malignancies, as well as new treatments on the horizon.
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Affiliation(s)
- Peyton Cramer
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
| | - Bradley B. Pua
- Division of Interventional Radiology, Department of Radiology, New York Presbyterian Hospital/Weill Cornell Medicine, New York, New York
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Lee P, Loo BW, Biswas T, Ding GX, El Naqa IM, Jackson A, Kong FM, LaCouture T, Miften M, Solberg T, Tome WA, Tai A, Yorke E, Li XA. Local Control After Stereotactic Body Radiation Therapy for Stage I Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2021; 110:160-171. [PMID: 30954520 PMCID: PMC9446070 DOI: 10.1016/j.ijrobp.2019.03.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/06/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Numerous dose and fractionation schedules have been used to treat medically inoperable stage I non-small cell lung cancer (NSCLC) with stereotactic body radiation therapy (SBRT) or stereotactic ablative radiation therapy. We evaluated published experiences with SBRT to determine local control (LC) rates as a function of SBRT dose. METHODS AND MATERIALS One hundred sixty published articles reporting LC rates after SBRT for stage I NSCLC were identified. Quality of the series was assessed by evaluating the number of patients in the study, homogeneity of the dose regimen, length of follow-up time, and reporting of LC. Clinical data including 1, 2, 3, and 5-year tumor control probabilities for stages T1, T2, and combined T1 and T2 as a function of the biological effective dose were fitted to the linear quadratic, universal survival curve, and regrowth models. RESULTS Forty-six studies met inclusion criteria. As measured by the goodness of fit χ2/ndf, with ndf as the number of degrees of freedom, none of the models were ideal fits for the data. Of the 3 models, the regrowth model provides the best fit to the clinical data. For the regrowth model, the fitting yielded an α-to-β ratio of approximately 25 Gy for T1 tumors, 19 Gy for T2 tumors, and 21 Gy for T1 and T2 combined. To achieve the maximal LC rate, the predicted physical dose schemes when prescribed at the periphery of the planning target volume are 43 ± 1 Gy in 3 fractions, 47 ± 1 Gy in 4 fractions, and 50 ± 1 Gy in 5 fractions for combined T1 and T2 tumors. CONCLUSIONS Early-stage NSCLC is radioresponsive when treated with SBRT or stereotactic ablative radiation therapy. A steep dose-response relationship exists with high rates of durable LC when physical doses of 43-50 Gy are delivered in 3 to 5 fractions.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, California.
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Tithi Biswas
- Department of Radiation Oncology, University Hospitals Case Medical Center, Cleveland, Ohio
| | - George X Ding
- Department of Radiation Oncology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Issam M El Naqa
- Department of Radiation Oncology, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Andrew Jackson
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Feng-Ming Kong
- Department of Radiation Oncology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Tamara LaCouture
- Department of Radiation Oncology, Jefferson Health New Jersey, Sewell, New Jersey
| | - Moyed Miften
- Department of Radiation Oncology, Colorado University School of Medicine, Aurora, Colorado
| | - Timothy Solberg
- Department of Radiation Oncology, University of California at San Francisco, San Francisco, California
| | - Wolfgang A Tome
- Department of Radiation Oncology, Albert Einstein College of Medicine, New York, New York
| | - An Tai
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ellen Yorke
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - X Allen Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
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Christensen NL, Kejs AMT, Jakobsen E, Dalton SO, Rasmussen TR. Early death in Danish stage I lung cancer patients: a population-based case study. Acta Oncol 2018; 57:1561-1566. [PMID: 30169986 DOI: 10.1080/0284186x.2018.1497298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Clinical stage (c-stage) at diagnosis is the most significant prognostic marker for patients with cancer, where 1- and 5-year survival rates as main landmarks when assessing outcomes. This is a population-based case study of Danish c-stage I lung cancer patients who were considered candidates for curative therapy and then died within 1 year after diagnosis (cases). Cases were identified in the Danish Lung Cancer Register (DLCR), and medical records were used to retrieve treatment details and cause of death (CoD). Our aims were, if possible, to identify and describe clusters of patients, in terms of CoD and treatment modality at risk for an adverse short-term outcome. RESULTS Patients who died early were more frequently male, older, had squamous-cell histology, were less frequently surgically treated and generally had a higher burden of comorbidity. In terms of CoD, 29% died of lung cancer with distant recurrence (DR) as the most common type of recurrence (55%). Death from co-morbidity occurred for 23%, where the largest proportion (36%) died from another cancer. Nineteen percentage died from treatment complications, with the majority being male (p < .001). The remainder died of unknown or other causes. CONCLUSIONS Lung cancer with DR remains the most common CoD. Identifying and accordingly treating patients at risk for DR could potentially improve outcomes. Further studies of the predominantly male subgroup of patients who die of treatment complications are needed. Death from co-morbidity especially in patients with another cancer is a significant CoD and when assessing the quality of lung cancer care a competing event.
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Affiliation(s)
- Niels Lyhne Christensen
- Department of Documentation and Quality, Danish Cancer Society, Copenhagen Ø, Denmark
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Erik Jakobsen
- The Danish Lung Cancer Registry, Department of Thoracic Surgery, Odense University Hospital, Odense, Denmark
| | | | - Torben Riis Rasmussen
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
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Franco I, Chen YH, Chipidza F, Agrawal V, Romano J, Baldini E, Chen A, Colson Y, Hou Y, Kozono D, Wee J, Mak R. Use of frailty to predict survival in elderly patients with early stage non-small-cell lung cancer treated with stereotactic body radiation therapy. J Geriatr Oncol 2017; 9:130-137. [PMID: 28941581 DOI: 10.1016/j.jgo.2017.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/31/2017] [Accepted: 09/01/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Frailty has been shown to increase morbidity and mortality independent of age, but studies are lacking in radiation oncology. This study evaluates a modified frailty index (mFI) in predicting overall survival (OS) and non-cancer death for Stage I/II [N0M0] Non-Small-Cell Lung Cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT). MATERIALS AND METHODS Medical records for all patients with Stage I/II NSCLC treated at our institution with SBRT from 2009 to 2014 were reviewed. A validated mFI score, consisting of 11 variables was calculated, classifying patients as non-frail (0-1) or frail (≥2). Primary endpoint (OS) was analyzed using Kaplan-Meier method and log-rank. Secondary endpoint, non-cancer death, was analyzed using Fine-Gray's method, with death from lung cancer as a competing risk. RESULTS Patient cohort consisted of 38 (27.3%) non-frail and 101 (72.7%) frail [median total mFI score 3.0 (range 0-7)]. Median age and pack-year history was 74 and 46years, respectively. Median follow-up among survivors was 38.5months (range 4.0-74.1months). Frailty was associated with a lower 3-year OS (37.3% vs. 74.7%; p=0.003) and 3-year cumulative incidence of non-cancer death (36.7% vs. 12.5%; p=0.02). Frailty remained significant in the multivariate model [OS HR for mFI ≥2: 2.25 (1.14-4.44); p=0.02]. CONCLUSION Frailty is associated with lower OS in older patients with early stage NSCLC treated with SBRT, yet frail patients survived a median 2.5years, and were more likely to die of causes unrelated to the primary lung cancer, suggesting SBRT should be considered even in older patients deemed unfit for surgery.
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Affiliation(s)
- Idalid Franco
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.
| | - Yu-Hui Chen
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02115, United States
| | - Fallon Chipidza
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Vishesh Agrawal
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - John Romano
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Elizabeth Baldini
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Aileen Chen
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Yolonda Colson
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA 02115, United States
| | - Ying Hou
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - David Kozono
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Jon Wee
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA 02115, United States
| | - Raymond Mak
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States
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Bi N, Shedden K, Zheng X, Kong FMS. Comparison of the Effectiveness of Radiofrequency Ablation With Stereotactic Body Radiation Therapy in Inoperable Stage I Non-Small Cell Lung Cancer: A Systemic Review and Pooled Analysis. Int J Radiat Oncol Biol Phys 2017; 95:1378-1390. [PMID: 27479723 DOI: 10.1016/j.ijrobp.2016.04.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/05/2016] [Accepted: 04/13/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To performed a systematic review and pooled analysis to compare clinical outcomes of stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) for the treatment of medically inoperable stage I non-small cell lung cancer. METHODS AND MATERIALS A comprehensive literature search for published trials from 2001 to 2012 was undertaken. Pooled analyses were performed to obtain overall survival (OS) and local tumor control rates (LCRs) and adverse events. Regression analysis was conducted considering each study's proportions of stage IA and age. RESULTS Thirty-one studies on SBRT (2767 patients) and 13 studies on RFA (328 patients) were eligible. The LCR (95% confidence interval) at 1, 2, 3, and 5 years for RFA was 77% (70%-85%), 48% (37%-58%), 55% (47%-62%), and 42% (30%-54%) respectively, which was significantly lower than that for SBRT: 97% (96%-98%), 92% (91%-94%), 88% (86%-90%), and 86% (85%-88%) (P<.001). These differences remained significant after correcting for stage IA and age (P<.001 at 1 year, 2 years, and 3 years; P=.04 at 5 years). The effect of RFA was not different from that of SBRT on OS (P>.05). The most frequent complication of RFA was pneumothorax, occurring in 31% of patients, whereas that for SBRT (grade ≥3) was radiation pneumonitis, occurring in 2% of patients. CONCLUSIONS Compared with RFA, SBRT seems to have a higher LCR but similar OS. More studies with larger sample sizes are warranted to validate such findings.
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Affiliation(s)
- Nan Bi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Cancer Hospital and Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Kerby Shedden
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Xiangpeng Zheng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Feng-Ming Spring Kong
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Indiana University, Indianapolis.
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Venuta F, Diso D, Onorati I, Anile M, Mantovani S, Rendina EA. Lung cancer in elderly patients. J Thorac Dis 2016; 8:S908-S914. [PMID: 27942414 DOI: 10.21037/jtd.2016.05.20] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
There is a worldwide-accepted evidence of a population shift toward older ages. This shift favors an increased risk of developing lung cancer that is primarily a disease of older populations. Decision making is extremely difficult in elderly patients, since this group is under-represented in clinical trials with only 25% of them historically opening to patients older than 65 years. For all these reasons, a "customized" preoperative assessment to identify physiological or pathological frailty should be encouraged since standard tools may be less reliable. The work already done to improve patient selection for lung surgery in the elderly population clearly shows that surgical resection seems the treatment of choice for early stage lung cancer. Further studies are required to improve outcome by reducing postoperative morbidity and mortality.
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Affiliation(s)
- Federico Venuta
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Ilaria Onorati
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Sara Mantovani
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
| | - Erino A Rendina
- Department of Thoracic Surgery, University of Rome Sapienza, Rome, Italy
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Vest MT, Herrin J, Soulos PR, Decker RH, Tanoue L, Michaud G, Kim AW, Detterbeck F, Morgensztern D, Gross CP. Use of new treatment modalities for non-small cell lung cancer care in the Medicare population. Chest 2013. [PMID: 23187634 DOI: 10.1378/chest.12-1149] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many older patients with early stage non-small cell lung cancer (NSCLC) do not receive curative therapy. New surgical techniques and radiation therapy modalities, such as video-assisted thoracoscopic surgery (VATS), potentially allow more patients to receive treatment. The adoption of these techniques and their impact on access to cancer care among Medicare beneficiaries with stage I NSCLC are unknown. METHODS We used the Surveillance, Epidemiology and End Results-Medicare database to identify patients with stage I NSCLC diagnosed between 1998 and 2007. We assessed temporal trends and created hierarchical generalized linear models of the relationship between patient, clinical, and regional factors and type of treatment. RESULTS The sample comprised 13,458 patients with a mean age of 75.7 years. The proportion of patients not receiving any local treatment increased from 14.6% in 1998 to 18.3% in 2007. The overall use of surgical resection declined from 75.2% to 67.3% ( P , .001), although the proportion of patients undergoing VATS increased from 11.3% to 32.0%. Similarly, although the use of new radiation modalities increased from 0% to 5.2%, the overall use of radiation remained stable. The oldest patients were less likely to receive surgical vs no treatment (OR, 0.12; 95% CI, 0.09-0.16) and more likely to receive radiation vs surgery (OR, 13.61; 95% CI, 9.75-19.0). CONCLUSION From 1998 to 2007, the overall proportion of older patients with stage I NSCLC receiving curative local therapy decreased, despite the dissemination of newer, less-invasive forms of surgery and radiation.
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Affiliation(s)
- Michael T Vest
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT
| | - Jeph Herrin
- Department of Internal Medicine, Section of Cardiology, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Health Research and Educational Trust, Chicago, IL
| | - Pamela R Soulos
- Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT
| | - Roy H Decker
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Therapeutic Radiology, New Haven, CT
| | - Lynn Tanoue
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT
| | - Gaetane Michaud
- Department of Internal Medicine, Section of Pulmonary and Critical Care Medicine, New Haven, CT
| | - Anthony W Kim
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT; Department of Surgery, Section of Thoracic Surgery, New Haven, CT
| | - Frank Detterbeck
- Department of Surgery, Section of Thoracic Surgery, New Haven, CT
| | - Daniel Morgensztern
- Department of Internal Medicine, Section of Medical Oncology, New Haven, CT; Yale Cancer Center, Yale School of Medicine, New Haven, CT
| | - Cary P Gross
- Department of Internal Medicine, Section of General Internal Medicine, New Haven, CT; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, New Haven, CT.
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Stereotactic body radiotherapy in patients with stage I non-small-cell lung cancer aged 75 years and older: retrospective results from a multicenter consortium. Clin Lung Cancer 2013; 14:446-51. [PMID: 23660522 DOI: 10.1016/j.cllc.2013.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 02/13/2013] [Accepted: 03/26/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study was a retrospective analysis of elderly patients treated with stereotactic body radiotherapy (SBRT) in the setting of a multi-institutional consortium. PATIENTS AND METHODS Three institutions pooled data on patients aged ≥ 75 years who received SBRT for stage I non-small-cell lung cancer (NSCLC). Forty-seven tumors in 46 patients were analyzed in patients aged 75 to 92 years (median, 82 years). Treatment was delivered during 2007 to 2009, with a median follow-up of 12.4 months. All patients underwent staging positron emission tomography-computed tomography (PET-CT), and 87% of tumors were confirmed by biopsy results. Total doses were 35 to 60 Gy, mainly in 3 to 5 fractions. All tumors were treated using a linear accelerator, with 96% of patients receiving 3-dimensional (3D) conformal RT and 4% undergoing intensity modulated RT (IMRT). RESULTS At the time of analysis, the local failure rate was 2% (1 of 47). The regional failure rate was 9% (4 of 47). The distant failure rate was 6% (3 of 47). The combined failure rate was 15% (7 of 47) because 1 patient experienced both regional and distant failure. Among 20 tumors with any acute toxicity, there were no ≥ grade 3 toxicities. Pneumonitis (n = 10) grades 1 (n = 3) and 2 (n = 2) was seen in 15% and 10% of patients, respectively; these data were missing for 25% of patients. CONCLUSION SBRT in patients aged ≥ 75 years with stage I NSCLC proved tolerable, with toxicity rates comparable to those in younger patients. Excellent rates of local, regional, and distant control were achieved at a median follow-up of 12.4 months. This patient population represents a rapidly growing segment of the early lung cancer population, and SBRT appears to be a safe and effective treatment option for patients who are not optimal candidates for surgery.
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