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Tvilum M, Knap MM, Hoffmann L, Khalil AA, Appelt AL, Haraldsen A, Alber M, Grau C, Schmidt HH, Kandi M, Holt MI, Lutz CM, Møller DS. Early radiologic and metabolic tumour response assessment during combined chemo-radiotherapy for locally advanced NSCLC. Clin Transl Radiat Oncol 2024; 45:100737. [PMID: 38317680 PMCID: PMC10839576 DOI: 10.1016/j.ctro.2024.100737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/20/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Background The role of early treatment response for patients with locally advanced non-small cell lung cancer (LA-NSCLC) treated with concurrent chemo-radiotherapy (cCRT) is unclear. The study aims to investigate the predictive value of response to induction chemotherapy (iCX) and the correlation with pattern of failure (PoF). Materials and methods Patients with LA-NSCLC treated with cCRT were included for analyses (n = 276). Target delineations were registered from radiotherapy planning PET/CT to diagnostic PET/CT, in between which patients received iCX. Volume, sphericity, and SUVpeak were extracted from each scan. First site of failure was categorised as loco-regional (LR), distant (DM), or simultaneous LR+M (LR+M). Fine and Gray models for PoF were performed: a baseline model (including performance status (PS), stage, and histology), an image model for squamous cell carcinoma (SCC), and an image model for non-SCC. Parameters included PS, volume (VOL) of tumour, VOL of lymph nodes, ΔVOL, sphericity, SUVpeak, ΔSUVpeak, and oligometastatic disease. Results Median follow-up was 7.6 years. SCC had higher sub-distribution hazard ratio (sHR) for LRF (sHR = 2.771 [1.577:4.87], p < 0.01) and decreased sHR for DM (sHR = 0.247 [0.125:0.485], p < 0.01). For both image models, high diagnostic SUVpeak increased risk of LRF (sHR = 1.059 [1.05:1.106], p < 0.01 for SCC, sHR = 1.12 [1.03:1.21], p < 0.01 for non-SCC). Patients with SCC and less decrease in VOL had higher sHR for DM (sHR = 1.025[1.001:1.048] pr. % increase, p = 0.038). Conclusion Poor response in disease volume was correlated with higher sHR of DM for SCC, no other clear correlation of response and PoF was observed. Histology significantly correlated with PoF with SCC prone to LRF and non-SCC prone to DM as first site of failure. High SUVpeak at diagnosis increased the risk of LRF for both histologies.
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Affiliation(s)
- Marie Tvilum
- Department of Oncology, Aarhus University Hospital, Denmark
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | | | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
| | | | - Ane L. Appelt
- Leeds Institute of Medical Research at St James’s, University of Leeds, United Kingdom
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Ate Haraldsen
- Department of Nuclear Medicine and PET-centre, Aarhus University Hospital, Denmark
| | - Markus Alber
- Department of Radiation Oncology, Heidelberg University Hospital, Germany
- Heidelberg Institute for Radiation Oncology (HIRO), Heidelberg University Hospital, Germany
| | - Cai Grau
- Danish Center for Particle Therapy, Aarhus University Hospital, Denmark
| | | | - Maria Kandi
- Department of Oncology, Aarhus University Hospital, Denmark
| | | | | | - Ditte Sloth Møller
- Department of Oncology, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, Aarhus University, Denmark
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Hering S, Nieto A, Marschner S, Hofmaier J, Schmidt-Hegemann NS, da Silva Mendes V, Landry G, Niyazi M, Manapov F, Belka C, Corradini S, Eze C. The role of online MR-guided multi-fraction stereotactic ablative radiotherapy in lung tumours. Clin Transl Radiat Oncol 2024; 45:100736. [PMID: 38433949 PMCID: PMC10909605 DOI: 10.1016/j.ctro.2024.100736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 03/05/2024] Open
Abstract
Background The aim of this prospective observational study was to evaluate the dosimetry benefits, changes in pulmonary function, and clinical outcome of online adaptive MR-guided SBRT. Methods From 11/2020-07/2022, 45 consecutive patients with 59 lesions underwent multi-fraction SBRT (3-8 fractions) at our institution. Patients were eligible if they had biopsy-proven NSCLC or lung cancer/metastases diagnosed via clinical imaging. Endpoints were local control (LC) and overall survival (OS). We evaluated PTV/GTV dose coverage, organs at risk exposure, and changes in pulmonary function (PF). Acute toxicity was classified per the National Cancer Institute-Common Terminology Criteria for Adverse Events version 5.0. Results The median PTV was 14.4 cm3 (range: 3.4 - 96.5 cm3). In total 195/215 (91%) plans were reoptimised. In the reoptimised vs. predicted plans, PTV coverage by the prescribed dose increased in 94.6% of all fractions with a median increase in PTV VPD of 5.6% (range: -1.8 - 44.6%, p < 0.001), increasing the number of fractions with PTV VPD ≥ 95% from 33% to 98%. The PTV D95% and D98% (BED10) increased in 93% and 95% of all fractions with a median increase of 7.7% (p < 0.001) and 10.6% (p < 0.001). The PTV D95% (BED10) increased by a mean of 9.6 Gy (SD: 10.3 Gy, p < 0.001). At a median follow-up of 21.4 months (95% CI: 12.3-27.0 months), 1- and 2-year LC rates were 94.8% (95% CI: 87.6 - 100.0%) and 91.1% (95% CI: 81.3 - 100%); 1- and 2-year OS rates were 85.6% (95% CI: 75.0 - 96.3%) and 67.1 % (95% CI: 50.3 - 83.8%). One grade ≥ 3 toxicity and no significant reduction in short-term PF parameters were recorded. Conclusions Online adaptive MR-guided SBRT is an effective, safe and generally well tolerated treatment option for lung tumours achieving encouraging local control rates with significantly improved target volume coverage.
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Affiliation(s)
- Svenja Hering
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Alexander Nieto
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Marschner
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Jan Hofmaier
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | | | | | - Guillaume Landry
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Department of Radiation Oncology, University of Tübingen, Tübingen, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Claus Belka
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
- German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
- Bavarian Cancer Research Center (BZKF), Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, LMU University Hospital, LMU Munich, Munich, Germany
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3
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Iyengar P, All S, Berry MF, Boike TP, Bradfield L, Dingemans AMC, Feldman J, Gomez DR, Hesketh PJ, Jabbour SK, Jeter M, Josipovic M, Lievens Y, McDonald F, Perez BA, Ricardi U, Ruffini E, De Ruysscher D, Saeed H, Schneider BJ, Senan S, Widder J, Guckenberger M. Treatment of Oligometastatic Non-Small Cell Lung Cancer: An ASTRO/ESTRO Clinical Practice Guideline. Pract Radiat Oncol 2023; 13:393-412. [PMID: 37294262 DOI: 10.1016/j.prro.2023.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/07/2023] [Indexed: 06/10/2023]
Abstract
PURPOSE This joint guideline by American Society for Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) was initiated to review evidence and provide recommendations regarding the use of local therapy in the management of extracranial oligometastatic non-small cell lung cancer (NSCLC). Local therapy is defined as the comprehensive treatment of all known cancer-primary tumor, regional nodal metastases, and metastases-with definitive intent. METHODS ASTRO and ESTRO convened a task force to address 5 key questions focused on the use of local (radiation, surgery, other ablative methods) and systemic therapy in the management of oligometastatic NSCLC. The questions address clinical scenarios for using local therapy, sequencing and timing when integrating local with systemic therapies, radiation techniques critical for oligometastatic disease targeting and treatment delivery, and the role of local therapy for oligoprogression or recurrent disease. Recommendations were based on a systematic literature review and created using ASTRO guidelines methodology. RESULTS Based on the lack of significant randomized phase 3 trials, a patient-centered, multidisciplinary approach was strongly recommended for all decision-making regarding potential treatment. Integration of definitive local therapy was only relevant if technically feasible and clinically safe to all disease sites, defined as 5 or fewer distinct sites. Conditional recommendations were given for definitive local therapies in synchronous, metachronous, oligopersistent, and oligoprogressive conditions for extracranial disease. Radiation and surgery were the only primary definitive local therapy modalities recommended for use in the management of patients with oligometastatic disease, with indications provided for choosing one over the other. Sequencing recommendations were provided for systemic and local therapy integration. Finally, multiple recommendations were provided for the optimal technical use of hypofractionated radiation or stereotactic body radiation therapy as definitive local therapy, including dose and fractionation. CONCLUSIONS Presently, data regarding clinical benefits of local therapy on overall and other survival outcomes is still sparse for oligometastatic NSCLC. However, with rapidly evolving data being generated supporting local therapy in oligometastatic NSCLC, this guideline attempted to frame recommendations as a function of the quality of data available to make decisions in a multidisciplinary approach incorporating patient goals and tolerances.
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Affiliation(s)
- Puneeth Iyengar
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas.
| | - Sean All
- Department of Radiation Oncology, UT Southwestern, Dallas, Texas
| | - Mark F Berry
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California
| | - Thomas P Boike
- Department of Radiation Oncology, GenesisCare/MHP Radiation Oncology, Troy, Michigan
| | - Lisa Bradfield
- American Society for Radiation Oncology, Arlington, Virginia
| | - Anne-Marie C Dingemans
- Department of Pulmonology, Erasmus Medical Center Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | | | - Daniel R Gomez
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paul J Hesketh
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Melenda Jeter
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | | | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Fiona McDonald
- Department of Radiation Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Bradford A Perez
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | | | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), Maastricht University Medical Centre, Maastricht and Erasmus Medical Center, University Medical Center, Rotterdam, The Netherlands
| | - Hina Saeed
- Department of Radiation Oncology, Baptist Health South Florida, Boca Raton, Florida
| | - Bryan J Schneider
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Mayinger M, Kotecha R, Sahgal A, Kim MS, Lo SS, Louie AV, Scorsetti M, Slotman B, Guckenberger M. Stereotactic Body Radiotherapy for Lung Oligo-metastases: Systematic Review and International Stereotactic Radiosurgery Society Practice Guidelines. Lung Cancer 2023; 182:107284. [PMID: 37390723 DOI: 10.1016/j.lungcan.2023.107284] [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: 04/11/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/02/2023]
Abstract
PURPOSE A systematic review of treatment characteristics, outcomes, and treatment-related toxicities of stereotactic body radiation therapy (SBRT) for pulmonary oligometastases served as the basis for development of this International Stereotactic Radiosurgery Society (ISRS) practice guideline. METHODS In accordance with PRISMA guidelines, a systematic review was performed of retrospective series with ≥50 patients/lung metastases, prospective trials with ≥25 patients/lung metastases, analyses of specific high-risk situations, and all randomized trials published between 2012 and July 2022 in the MEDLINE or Embase database using the key words "lung oligometastases", "lung metastases", "pulmonary metastases", "pulmonary oligometastases", "stereotactic body radiation therapy (SBRT)" and "stereotactic ablative body radiotherapy (SBRT)". Weighted random effects models were used to calculate pooled outcomes estimates. RESULTS Of the 1884 articles screened, 35 analyses (27 retrospective-, 5 prospective, and 3 randomized trials) reporting on treatment of >3600 patients and >4650 metastases were included. The median local control was 90 % (Range: 57-100 %) at 1 year and 79 % (R: 70-96 %) at 5 years. Acute toxicity ≥3 was reported for 0.5 % and late toxicity ≥3 for 1.8 % of patients. A total of 21 practice recommendations covering the areas of staging & patient selection (n = 10), SBRT treatment (n = 10), and follow-up (n = 1) were developed, with agreements rates of 100 %, except for recommendation 13 (83 %). CONCLUSION SBRT represents an effective definitive local treatment modality combining high local control rates with low risk of radiation-induced toxicities.
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Affiliation(s)
- Michael Mayinger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Rupesh Kotecha
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Arjun Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Nowon-gu, Seoul, South Korea
| | - Simon S Lo
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA, USA
| | - Alexander V Louie
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano 20089, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy
| | - Ben Slotman
- Department of Radiation Oncology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland.
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5
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Wu J, Song H, Li J, Tang B, Wu F. Evaluation of flattening-filter-free and flattening filter dosimetric and radiobiological criteria for lung SBRT: A volume-based analysis. Front Oncol 2023; 13:1108142. [PMID: 36761961 PMCID: PMC9903338 DOI: 10.3389/fonc.2023.1108142] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023] Open
Abstract
Introduction The use of volumetric modulated arc therapy (VMAT) with flattening-filter-free (FFF) beams is becoming more prevalent in lung cancer stereotactic body radiotherapy (SBRT). The aim in this study was to assess the impact of dosimetric and radiobiological differences between FFF and flattening filter (FF) beams for lung SBRT based on the target volume. Methods A total of 198 lung stereotactic body radiation therapy treatment plans with FFF beams and FF beams were retrospectively selected for this study. For all plans, the prescribed dose was 50 Gy/5 fractions, and the dose volume histogram (DVH) for the target and organs at risk (OAR) and the normal tissue complication probability (NTCP) of the lung were recorded and compared. Moreover, monitor units (MUs), the beam on-time and the treatment time were evaluated. Results The study was performed following the Radiation Therapy Oncology Group (RTOG) 0813 and 0915 protocols. No significant differences in D90, coverage rate (CR) or conformity index (CI) of the target were observed between FFF beams and FF beams (p>0.05). The D2, R50% and gradient index (GI) for the target improved with FFF beams compared with FF beams (p<0.05). FFF beams also significantly reduced the dose for the lung, heart, spinal cord, esophagus and NTCP of the lung (p<0.05), compared with FF beams. However, there was no significant difference in sparing of the trachea (p>0.05). The mean MUs, beam on-time and treatment time were 1871 ± 278 MUs, 3.2 ± 0.2 min and 3.9 ± 0.3 min for FFF beams, and 1890 ± 260 MUs, 4.2 ± 0.3 min and 4.8 ± 0.4 min for FF beams, respectively. Discussion The FFF beam technique for lung SBRT with VMAT results in a better dose fall-off, better dose-sparing of OAR, lower NTCP of the lung and a shorter beam on-time compared with the FF beam technique. Additionally, the improvement in target and OAR-sparing for FFF beams was increased with increasing target volume.
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Affiliation(s)
- Junxiang Wu
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongchang Song
- Department of Oncology, Xichang People’s Hospital, Xichang, China
| | - Jie Li
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Bin Tang
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Fan Wu
- Radiation Oncology Key Laboratory of Sichuan Province, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China,*Correspondence: Fan Wu,
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Stefanovic M, Calvet G, Pérez-Montero H, Esteve A, Bujalance MV, Navarro-Martín A, Fernández MDA, González FF, Borras SM, Borbalas AL, Fernandez MN, Garau MM, Calduch AL, Edo FG. Stereotactic body radiation therapy in the treatment of cancer patients with oligometastatic disease: a real world study. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2023; 25:199-206. [PMID: 36068449 DOI: 10.1007/s12094-022-02923-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/05/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is a treatment modality with curative intent for oligometastatic cancer patients, commonly defined by a low-burden metastatic disease with 1-5 systemic metastases. Better knowledge of the clinical profile and prognostic factors in oligometastatic cancer patients could help to improve the selection of candidates who may obtain most benefits from SBRT. The objective of this study was to describe the clinical data and outcome in term of overall survival (OS) of patients with oligometastatic disease treated with SBRT over a 6-year period. METHODS From 2013 to 2018, 284 solid tumor cancer patients with 1-5 oligometastases underwent SBRT at a large university-affiliated oncological center in Barcelona, Spain. Variables related to the patient profile, tumor, oligometastatic disease, and treatment were evaluated. RESULTS A total of 327 metastatic tumors were treated with SBRT. In 65.5% of cases, metachronous tumors were diagnosed at least 1 year after diagnosis of the primary tumor. The median age of the patients was 73.9 years and 66.5% were males. The median follow-up was 37.5 months. The most common primary tumors were lung and colorectal cancer, with lung and bone as the most commonly treated metastatic sites. Ninety-three percent of patients showed a Karnofsky score (KPS) between 80 and 100. Adenocarcinoma was the most common histological type. The median overall survival was 53.4 months, with 1-, 2- and 5-year survival rates of 90.5%, 73.9% and 43.4%, respectively. Overall survival rates of breast (67.6 months, 95% CI 56.4-78.9), urological (63.3 months, 95% CI 55.8-70.8), and colorectal (50.8 months, 95% CI 44.2-57.4) tumors were higher as compared with other malignancies (20 months, 95% CI 11.2-28.8 months) (p < 0.001). Patients with Karnofsky score (KPS) of 90 and 100 showed a significantly better survival than those with impaired performance status (p = 0.001). CONCLUSION SBRT appears to be well tolerated and safe approach in oligometastatic patients. Patients with good performance status and with primary breast, urological and colorectal cancer have higher OS compared with other malignancies. More studies are necessary to evaluate the prognostic factors in oligometastatic disease (OMD) in order to select patients who could benefit more from this therapeutic approach.
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Affiliation(s)
- Milica Stefanovic
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain. .,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.
| | - Gemma Calvet
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Héctor Pérez-Montero
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Anna Esteve
- Badalona Applied Research Group in Oncology (B·ARGO), Oncology Data Analytics Program (ODAP), Institut Català d'Oncologia (ICO), Institut Català d'Oncologia (ICO Badalona), Hospital Universitari Germans Trias i Pujol, Carretera de Canyet s/n, Badalona, 08916, Barcelona, Spain
| | - Montse Ventura Bujalance
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Arturo Navarro-Martín
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Maria Dolores Arnaiz Fernández
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Ferran Ferrer González
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Susanna Marin Borras
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Alicia Lozano Borbalas
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Miriam Nuñez Fernandez
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Miquel Macia Garau
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Anna Lucas Calduch
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
| | - Ferran Guedea Edo
- Radiation Oncology Department, Hospital Duran i Reynals, Institut Català d'Oncologia (ICO), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Radiobiology and Cancer Group, ONCOBELL Program, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain.,Department of Clinical Sciences, University of Barcelona, Bellvitge Campus, Avinguda de la Gran Via de l'Hospitalet 199-203, L'Hospitalet de Llobregat, 08098, Barcelona, Spain
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7
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Inagaki T, Doi H, Inada M, Ishida N, Ri A, Tatsuno S, Wada Y, Uehara T, Nakamatsu K, Hosono M, Nishimura Y. Difference in failure patterns after stereotactic body radiotherapy for lung cancer according to clinical T stage based on 4D computed tomography. Strahlenther Onkol 2022; 199:465-476. [PMID: 36477250 DOI: 10.1007/s00066-022-02030-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Stereotactic body radiotherapy (SBRT) is a treatment option for early-stage lung cancer. We aimed to examine the differences in failure patterns after SBRT according to the clinical T stage. METHODS A total of 120 patients with early-stage lung cancer (T1-3N0M0) who underwent SBRT were analysed. The clinical stage in patients whose tumours were in contact with the chest wall was confirmed using four-dimensional computed tomography (4D-CT). Local failure, regional node metastasis, and distant metastasis were confirmed from clinical charts. RESULTS Median follow-up time was 27.5 months (range 7-122) after SBRT. Thirteen patients were restaged from clinical T2 with visceral pleural invasion to T3 with chest wall invasion using 4D-CT analysis. Thirty-seven patients developed recurrences. The median progression-free survival (PFS) and overall survival (OS) were 38.1 and 53.8 months, respectively. The 3‑year PFS and OS rates were 50.7% and 60.3%, respectively. A significant difference was observed in PFS according to the clinical T stage (p = 0.001). No significant differences were observed in OS according to the clinical T stage (p = 0.213). The proportion of locoregional failures relative to distant metastasis decreased with progression from T1 to T3. The pleural dissemination rate was significantly higher in T3 tumours than in T1 and T2 tumours (p = 0.010). CONCLUSION Clinical T stage is associated with PFS after SBRT for lung cancer. There were differences in the failure patterns according to T stage. 4D-CT might provide significant information for assessing chest wall invasion associated with unfavourable PFS.
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Affiliation(s)
- Takaya Inagaki
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Hiroshi Doi
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan.
| | - Masahiro Inada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Naoko Ishida
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Aritoshi Ri
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Saori Tatsuno
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Yutaro Wada
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Takuya Uehara
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Kiyoshi Nakamatsu
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Makoto Hosono
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
| | - Yasumasa Nishimura
- Department of Radiation Oncology, Kindai University Faculty of Medicine, 377-2, Ohno-higashi, Osaka-Sayama, Osaka, Japan
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8
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Chen H, Ma X, Liu J, Yang Y, Fang Y, Wang L, Fang J, Zhao J, Zhuo M. Clinical outcomes of atezolizumab in combination with etoposide/platinum for treatment of extensive-stage small-cell lung cancer: A real-world, multicenter, retrospective, controlled study in China. Chin J Cancer Res 2022; 34:353-364. [PMID: 36199537 PMCID: PMC9468015 DOI: 10.21147/j.issn.1000-9604.2022.04.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/13/2022] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Atezolizumab along with chemotherapy has prolonged the survival of patients with extensive-stage small-cell lung cancer (ES-SCLC) worldwide, although real-world (RW) data are lacking in China. This study was designed to evaluate the efficacy and clinical outcomes of atezolizumab plus etoposide/platinum (EP). METHODS Data obtained in this retrospective study were captured from six oncology units of five medical facilities from January 2019 to April 2022. For first-line treatments, atezolizumab combined with EP vs. EP alone, we primarily evaluated progression-free survival (PFS); other efficacy indicators, including overall survival (OS), objective response rate (ORR), and patterns of SCLC progression and adverse events (AEs) were assessed. RESULTS The primary analysis included data from 225 patients, of whom 133 received EP along with atezolizumab (atezolizumab group) and 92 received EP alone (EP group). The PFS duration of the atezolizumab group [7.10 months; 95% confidence interval (95% CI), 6.53-9.00] exceeded that of the EP group (6.50 months; 95% CI, 4.83-7.53). Overall, the hazard ratio (HR) was 0.69 (95% CI, 0.49-0.97) (P=0.029); particularly, the HR was 0.54 (95% CI, 0.36-0.80) among patients undergoing ≥4 chemotherapy cycles and 0.33 (95% CI, 0.20-0.56) among individuals with atezolizumab maintenance. The ORR and disease-control rate (DCR) were similar between the two groups. Because of incomplete OS data, the median OS was not determined for either group. Bone marrow suppression was the most common AE detected (58.6%) in the atezolizumab group. Immune-related AEs occurred in 19 patients in the atezolizumab group (14.3%), with only one case of grade 3 encephalitis. CONCLUSIONS This RW study in China demonstrated improved clinical outcomes of atezolizumab along with EP for ES-SCLC, particularly in the chemosensitive population. These results align with the results of the IMpower133 study, although the impact of this treatment modality on OS warrants additional follow-up studies.
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Affiliation(s)
- Hanxiao Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Xiangjuan Ma
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department II of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jie Liu
- Department of Pneumology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Yu Yang
- Department of Oncology, the 2nd Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Yong Fang
- Department of Oncology, Sir Run Run Shaw Hospital Zhejiang University School of Medicine, Hangzhou 310020, China
| | - Liping Wang
- Department of Oncology, Baotou Cancer Hospital, Baotou 014030, China
| | - Jian Fang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department II of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Jun Zhao
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Minglei Zhuo
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department I of Thoracic Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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9
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Wei Z, Peng X, He L, Wang J, Liu Z, Xiao J. Treatment plan comparison of volumetric-modulated arc therapy to intensity-modulated radiotherapy in lung stereotactic body radiotherapy using either 6- or 10-MV photon energies. J Appl Clin Med Phys 2022; 23:e13714. [PMID: 35808973 PMCID: PMC9359046 DOI: 10.1002/acm2.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 05/05/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose The aim of this study was to dosimetrically compare volumetric‐modulated arc therapy (VMAT) with intensity‐modulated radiotherapy (IMRT) techniques using either 6‐ or 10‐MV photon beam energies in lung stereotactic body radiation therapy (SBRT) plans. Methods Thirty patients with primary or metastatic lung tumors eligible for SBRT were randomly selected. VMAT and IMRT treatment plans using either 6‐ or 10‐MV photon energies were generated through automatic SBRT planning software in the RayStation treatment planning system. Results For planning target volume, there was no difference in D95% for all plans, whereas D2% and D50% were significantly increased by 5.22%–5.98% and 2.47%–2.59%, respectively, using VMAT6/10‐MV plans compared to IMRT6/10‐MV plans. When comparing the Dmax of organs at risk (OARs), VMAT6/10‐MV was 18.32%–47.95% lower than IMRT6/10‐MV for almost all OARs. VMAT6/10‐MV obviously decreased Dmean, V5Gy, V10Gy, and V20Gy of whole lung by 9.68%–20.92% than IMRT6/10‐MV. Similar results were found when comparing VMAT6‐MV with IMRT10‐MV or VMAT10‐MV with IMRT6‐MV. The differences in the D2%, heterogeneity index, and conformity index between 6‐ and 10‐MV plans are not statistically significant. Plans using 6‐MV performed 4.68%–8.91% lower levels of Dmax of spinal cord, esophagus, great vessels, and trachea and proximal bronchial tree than those using 10‐MV plans. Similarly, Dmean, V5Gy, V10Gy, and V20Gy of whole lung were also reduced by 2.79%–5.25% using 6‐MV. For dose fall‐off analysis, the D2cm and R50% of VMAT6/10‐MV were lower than those of IMRT6/10‐MV. Dose fall‐off curve based on 10 rings was steeper for VMAT plans than IMRT plans regardless of the energy used. Conclusions For lung SBRT plans, VMAT‐based plans significantly reduced OARs dose and steepened dose fall‐off curves compared to IMRT‐based plans. A 6‐MV energy level was a better choice than 10‐MV for lung SBRT. In addition, the dose differences between different techniques were more obvious than those between different energy levels.
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Affiliation(s)
- Zhigong Wei
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingchen Peng
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ling He
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jingjing Wang
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zheran Liu
- Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jianghong Xiao
- Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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10
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Katz LM, Ng V, Wu SP, Yan S, Grew D, Shin S, Colangelo NW, McCarthy A, Pass HI, Chachoua A, Schiff PB. Stereotactic Body Radiation Therapy for the Treatment of Locally Recurrent and Oligoprogressive Non-Small Cell Lung Cancer: A Single Institution Experience. Front Oncol 2022; 12:870143. [PMID: 35686111 PMCID: PMC9170989 DOI: 10.3389/fonc.2022.870143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the efficacy and safety of lung stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC) including oligorecurrent and oligoprogressive disease. Methods Single-institution retrospective analysis of 60 NSCLC patients with 62 discrete lesions treated with SBRT between 2008 and 2017. Patients were stratified into three groups, including early stage, locally recurrent, and oligoprogressive disease. Group 1 included early stage local disease with no prior local therapy. Group 2 included locally recurrent disease after local treatment of a primary lesion, and group 3 included regional or well-controlled distant metastatic disease receiving SBRT for a treatment naive lung lesion (oligoprogressive disease). Patient/tumor characteristics and adverse effects were recorded. Local failure free survival (LFFS), progression free survival (PFS), and overall survival (OS) were estimated using the Kaplan Meier method. Results At median follow-up of 34 months, 67% of the study population remained alive. The estimated 3-year LFFS for group 1, group 2, and group 3 patients was 95% (95% CI: 86%-100%), 82%(62% - 100%), and 83% (58-100%), respectively. The estimated 3-year PFS was 59% (42-83%), 40% (21%-78%), and 33% (12%-95%), and the estimated 3-year OS was 58% (41-82%), 60% (37-96%), and 58% (31-100%)), respectively for each group. When adjusted for age and size of lesion, no significant difference in OS, LFFS, and PFS emerged between groups (p > 0.05). No patients experienced grade 3 to 5 toxicity. Eighteen patients (29%) experienced grade 1 to 2 toxicity. The most common toxicities reported were cough and fatigue. Conclusions Our data demonstrates control rates in group 1 patients comparable to historical controls. Our study also reveals comparable clinical results for SBRT in the treatment of NSCLC by demonstrating similar rates of LFFS and OS in group 2 and group 3 patients with locally recurrent and treatment naïve lung lesion with well-controlled distant metastatic disease.
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Affiliation(s)
- Leah M Katz
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Victor Ng
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - S Peter Wu
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Sherry Yan
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - David Grew
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Samuel Shin
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Nicholas W Colangelo
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Allison McCarthy
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Harvey I Pass
- Department of Cardiothoracic Surgery, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Abraham Chachoua
- Department of Medicine, Division of Medical Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
| | - Peter B Schiff
- Department of Radiation Oncology, New York University (NYU) Langone Health, Perlmutter Cancer Center, New York, NY, United States
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11
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Frost N, Griesinger F, Hoffmann H, Länger F, Nestle U, Schütte W, Wolf J, Reck M. Lung Cancer in Germany. J Thorac Oncol 2022; 17:742-750. [PMID: 35623674 DOI: 10.1016/j.jtho.2022.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Nikolaj Frost
- Department of Infectious Diseases and Pulmonary Medicine, Charité - Universitätsmedizin Berlin (Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Berlin, Germany
| | - Frank Griesinger
- Department of Hematology and Oncology, University Medicine Oldenburg, Pius-Hospital, Oldenburg, Germany
| | - Hans Hoffmann
- Division of Thoracic Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; German Cancer Society, Zertifizierungskommission Lungenkrebszentrum, Berlin, Germany
| | - Florian Länger
- Institute of Pathology, Hanover Medical School, Hanover, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Moenchengladbach, Germany; Department of Radiation Oncology, Medical Center Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Wolfgang Schütte
- Klinik für Innere Medizin II, Krankenhaus Martha-Maria Halle-Dölau, Halle (Saale), Germany
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I of Internal Medicine, Center for Integrated Oncology, University Hospital of Cologne, Cologne, Germany
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungenClinic, Grosshansdorf, Germany.
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12
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Regnery S, Buchele C, Weykamp F, Pohl M, Hoegen P, Eichkorn T, Held T, Ristau J, Rippke C, König L, Thomas M, Winter H, Adeberg S, Debus J, Klüter S, Hörner-Rieber J. Adaptive MR-Guided Stereotactic Radiotherapy is Beneficial for Ablative Treatment of Lung Tumors in High-Risk Locations. Front Oncol 2022; 11:757031. [PMID: 35087746 PMCID: PMC8789303 DOI: 10.3389/fonc.2021.757031] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/02/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE To explore the benefit of adaptive magnetic resonance-guided stereotactic body radiotherapy (MRgSBRT) for treatment of lung tumors in different locations with a focus on ultracentral lung tumors (ULT). PATIENTS & METHODS A prospective cohort of 21 patients with 23 primary and secondary lung tumors was analyzed. Tumors were located peripherally (N = 10), centrally (N = 2) and ultracentrally (N = 11, planning target volume (PTV) overlap with proximal bronchi, esophagus and/or pulmonary artery). All patients received MRgSBRT with gated dose delivery and risk-adapted fractionation. Before each fraction, the baseline plan was recalculated on the anatomy of the day (predicted plan). Plan adaptation was performed in 154/165 fractions (93.3%). Comparison of dose characteristics between predicted and adapted plans employed descriptive statistics and Bayesian linear multilevel models. The posterior distributions resulting from the Bayesian models are presented by the mean together with the corresponding 95% compatibility interval (CI). RESULTS Plan adaptation decreased the proportion of fractions with violated planning objectives from 94% (predicted plans) to 17% (adapted plans). In most cases, inadequate PTV coverage was remedied (predicted: 86%, adapted: 13%), corresponding to a moderate increase of PTV coverage (mean +6.3%, 95% CI: [5.3-7.4%]) and biologically effective PTV doses (BED10) (BEDmin: +9.0 Gy [6.7-11.3 Gy], BEDmean: +1.4 Gy [0.8-2.1 Gy]). This benefit was smaller in larger tumors (-0.1%/10 cm³ PTV [-0.2 to -0.02%/10 cm³ PTV]) and ULT (-2.0% [-3.1 to -0.9%]). Occurrence of exceeded maximum doses inside the PTV (predicted: 21%, adapted: 4%) and violations of OAR constraints (predicted: 12%, adapted: 1%, OR: 0.14 [0.04-0.44]) was effectively reduced. OAR constraint violations almost exclusively occurred if the PTV had touched the corresponding OAR in the baseline plan (18/19, 95%). CONCLUSION Adaptive MRgSBRT is highly recommendable for ablative treatment of lung tumors whose PTV initially contacts a sensitive OAR, such as ULT. Here, plan adaptation protects the OAR while maintaining best-possible PTV coverage.
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Affiliation(s)
- Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Carolin Buchele
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Moritz Pohl
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Philipp Hoegen
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Ristau
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany
| | - Carolin Rippke
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Thomas
- National Center for Tumor diseases, Heidelberg, Germany.,Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Hauke Winter
- National Center for Tumor diseases, Heidelberg, Germany.,Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, Heidelberg, Germany.,Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Sebastian Klüter
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,National Center for Radiation Oncology, Heidelberg Institute for Radiation Oncology, Heidelberg, Germany.,National Center for Tumor diseases, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
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13
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Chen Y, Wang Y, Yang Z, Hu M, Lu J, Zhang Y, Qian F, Zhang B, Wang S, Wang K, Zhang W, Han B. Local consolidative therapy for synchronous oligometastatic non‐small cell lung cancer treated with first‐line pembrolizumab: A retrospective observational study. Thorac Cancer 2022; 13:732-741. [PMID: 35060346 PMCID: PMC8888157 DOI: 10.1111/1759-7714.14312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/22/2021] [Accepted: 12/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background Local consolidative therapy (LCT) has emerged as a treatment option in patients with oligometastatic non‐small cell lung cancer (NSCLC) undergoing chemotherapy or targeted therapy. However, the current literature lacks evidence as to whether LCT improves survival in NSCLC patients receiving immunotherapy. Our study aimed to assess whether LCT combined with pembrolizumab ± chemotherapy could improve the survival of patients with synchronous oligometastatic NSCLC. Methods Patients with NSCLC, without EGFR or ALK genetic aberrations, who were treated with first‐line pembrolizumab ± chemotherapy, were included in the study. Survival analysis of the LCT and non‐LCT groups was compared. Results A total of 231 patients were included in the study. The median follow‐up time was 15.24 months. Median progression‐free survival (PFS) and overall survival (OS) of the entire cohort were 12.00 and 23.43 months, respectively. Of the 231 patients included, 76 patients received LCT combined with pembrolizumab ± chemotherapy (LCT group) while 155 patients received pembrolizumab ± chemotherapy alone (non‐LCT group). Of note, the PFS of the LCT and non‐LCT groups was 13.97 and 10.08 months (p = 0.016), respectively. The OS were 30.67 and 21.97 months (p = 0.011), respectively. The PFS and OS were significantly improved with LCT for patients with brain or lung metastases but not bone metastases. No significant increase in treatment‐related toxicity was observed in the LCT group. Conclusions The present study shows that LCT to metastatic sites is an option for consideration in patients with synchronous oligometastatic NSCLC during first‐line pembrolizumab treatment, with significantly improved PFS and OS compared with systemic treatment alone.
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Affiliation(s)
- Ya Chen
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Yanan Wang
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Zhengyu Yang
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Minjuan Hu
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Jun Lu
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Yanwei Zhang
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Fangfei Qian
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Bo Zhang
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Shuyuan Wang
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Kai Wang
- Central Laboratory Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Wei Zhang
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
| | - Baohui Han
- Department of Pulmonary Shanghai Chest Hospital, Shanghai Jiao Tong University Shanghai China
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14
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Planning benchmark study for SBRT of liver metastases: Results of the DEGRO/DGMP working group stereotactic radiotherapy and radiosurgery. Int J Radiat Oncol Biol Phys 2022; 113:214-227. [PMID: 35074434 DOI: 10.1016/j.ijrobp.2022.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 12/19/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To investigate, if liver SBRT treatment planning can be harmonized across different treatment planning systems, delivery techniques and institutions by using a specific prescription method and to minimize the knowledge gap concerning inter-system and inter-user differences. To provide best practice guidelines for all used techniques. METHODS A multiparametric specification of target dose (GTVD50%, GTVD0.1cc, GTVV90%, PTVV70%) with a prescription dose of GTVD50% = 3 × 20 Gy and OAR limits were distributed with CTs and structure sets from three liver metastases patients. Thirty-five institutions provided 132 treatment plans using different irradiation techniques. These plans were first analyzed for target and OAR doses. Four different renormalization methods were performed (PTVDmin, PTVD98%, PTVD2%, PTVDmax). The resulting 660 treatments plans were evaluated regarding target doses in order to study the effect of dose renormalization to different prescription methods. A relative scoring system was used for comparisons. RESULTS GTVD50% prescription can be performed in all systems. Treatment plan harmonization was overall successful with standard deviations for Dmax, PTVD98%, GTVD98% and PTVDmean of 1.6 Gy, 3.3 Gy, 1.9 Gy and 1.5 Gy, respectively. Primary analysis showed 55 major deviations from clinical goals in 132 plans, while in only <20% of deviations GTV/PTV dose was traded for meeting OAR limits. GTVD50% prescription produced the smallest deviation from target planning objectives and between techniques, followed by the PTVDmax, PTVD98%, PTVD2% and PTVDmin prescription. Deviations were significant for all combinations but for the PTVDmax prescription compared with GTVD50% and PTVD98%. Based on the various dose prescription methods, all systems significantly differed from each other, while GTVD50% and PTVD98% prescription showed the least differences between the systems. CONCLUSIONS This study showed the feasibility of harmonizing liver SBRT treatment plans across different treatment planning systems and delivery techniques when a sufficient set of clinical goals is given.
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15
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Zhao X, Zhang Y, Gao Z, Han Y. Prognostic value of peripheral naive CD8 + T cells in oligometastatic non-small-cell lung cancer. Future Oncol 2021; 18:55-65. [PMID: 34608815 DOI: 10.2217/fon-2021-0728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim: This study aimed to investigate the prognostic value of peripheral naive and memory CD8+ and CD4+ T cells and other immune cells in patients with oligometastatic non-small-cell lung cancer (NSCLC) undergoing radiotherapy (RT). Methods: A total of 142 patients with oligometastatic NSCLC treated with RT were enrolled, and their blood samples were collected within 3 days before RT. Immune cells were identified by flow cytometry. Results: Patients with high levels of naive CD8+ T cells had longer overall survival (p = 0.004) and progression-free survival (p = 0.001) than those with low levels of naive CD8+ T cells. Multivariate analyses revealed that naive CD8+ T cells were independently correlated with overall survival (p = 0.019) and progression-free survival (p = 0.024). Conclusion: The results suggest that peripheral naive CD8+ T cells may be an independent prognostic indicator for patients with oligometastatic NSCLC undergoing RT.
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Affiliation(s)
- Xin Zhao
- Department of Oncology, Hebei Medical University, Shijiazhuang 050017, PR China
| | - Yan Zhang
- Department of Oncology, Hebei Medical University, Shijiazhuang 050017, PR China.,Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang 050030, PR China
| | - Zhenlin Gao
- Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang 050030, PR China
| | - Yaguang Han
- Department of Oncology, Shijiazhuang People's Hospital, Shijiazhuang 050030, PR China
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16
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Chai R, Yin Y, Cai X, Fu X, Zhang Q. Patterns of Failure in Patients With Advanced Non-Small Cell Lung Cancer Treated With Immune Checkpoint Inhibitors. Front Oncol 2021; 11:724722. [PMID: 34557412 PMCID: PMC8454403 DOI: 10.3389/fonc.2021.724722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/13/2021] [Indexed: 11/13/2022] Open
Abstract
Objective The advent of immune checkpoint inhibitors (ICIs) has rapidly transformed the treatment paradigm of non-small cell lung cancer (NSCLC). Despite the durability of response to ICIs, the vast majority of patients will later develop progression. However, the failure patterns of ICI treatment are unknown. Here, our study explored the failure patterns in advanced NSCLC patients treated with ICIs. Methods A cohort of 156 IIIB or IV NSCLC patients treated with first-/second-line ICIs were retrospectively analyzed. Patients who experienced clinical benefit and then developed progression were identified. The disease progression patterns were divided into three categories: progression in new sites, progression in existing sites, and combined progression. The number of progression sites was also recorded. Results Before the cutoff date, 91 (77.1%) patients had experienced disease progression; 34% of patients had progressed in the last 9 months of the first year. Fifty-three (58.2%) patients had developed progression at existing lesions, and 56 (61.5%) patients had shown ≤2 progression sites (oligo-progression). In patients with oligo-progression, the median time of disease progression was 8.23 months and the counterpart (systemic progression) was 5.97 months. The oligo-progression patients showed prolonged median overall survival (27.23 months) compared with patients with systemic progression (18.87 months). Conclusions Failure patterns of ICI therapy were predominantly “existing” sites, and the most common lesions of progression were the lung and lymph nodes. Most patients experienced oligo-progression which occurred later than systemic progression and showed prolonged overall survival. The control of the local lesions might be beneficial to improve ICI treatment efficacy.
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Affiliation(s)
- Rong Chai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yipengchen Yin
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xuwei Cai
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaolong Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qin Zhang
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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17
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Franceschini D, Teriaca MA, Dominici L, Franzese C, Scorsetti M. Knowing When to Use Stereotactic Ablative Radiation Therapy in Oligometastatic Cancer. Cancer Manag Res 2021; 13:7009-7031. [PMID: 34522143 PMCID: PMC8434826 DOI: 10.2147/cmar.s294116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/28/2021] [Indexed: 11/23/2022] Open
Abstract
Oligometastatic patients are a heterogeneous and yet not well-defined population. The actual definition identifies as oligometastatic, patients with 1-5 metastases in 1-3 different organs. However, only a proportion of these patients are "true" oligometastatic and therefore derive some kinds of benefit from local ablative approaches like stereotactic ablative radiation therapy (SABR). Since SABR is an easily accessible, effective and well-tolerated treatment, it is widely employed in the oligometastatic scenarios, without a particular focus on selection criteria. However, it should be crucial to identify predictive and prognostic features that could be clinically implemented. Therefore, we conducted this narrative review of the available literature to summarize all clinical, radiomic, genetic and epigenetic features found to be predictive of overall survival, progression-free survival or local control of oligometastatic patients treated with SABR.
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Affiliation(s)
- Davide Franceschini
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Maria Ausilia Teriaca
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Dominici
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Ciro Franzese
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Scorsetti
- Department of Radiotherapy and Radiosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
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18
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Turchan WT, Pitroda SP, Weichselbaum RR. Radiotherapy and Immunotherapy Combinations in the Treatment of Patients with Metastatic Disease: Current Status and Future Focus. Clin Cancer Res 2021; 27:5188-5194. [PMID: 34140404 DOI: 10.1158/1078-0432.ccr-21-0145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/09/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
Radiotherapy and immunotherapy benefit subsets of patients with metastatic cancer. Here, we review selected laboratory and clinical studies investigating the utility of combining radiotherapy and immunotherapy in metastatic patients. We examine potential approaches to increase the therapeutic ratio of radioimmunotherapy in the treatment of metastatic cancers moving forward.
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Affiliation(s)
- William Tyler Turchan
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago, Illinois
| | - Sean P Pitroda
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago, Illinois
| | - Ralph R Weichselbaum
- University of Chicago, Department of Radiation and Cellular Oncology, Chicago, Illinois.
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19
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Abstract
Metastatic lesions are largely responsible for cancer-related deaths and are synonymous with a poor prognosis. However, this is not always true for patients with oligometastases whose disease may be amenable to curative-intent local therapies. It has been proposed that an "intermediate state" (oligometastasis) exists in between locoregional and advanced disease states; however, the clinical definition of oligometastasis varies, and there is limited understanding of how tumor biology differs between oligometastases and polymetastases. There is evidence that local therapies can extend survival in patients with oligometastases, yet patient selection for local intervention and/or systemic therapy remains a challenge. Prognostic and predictive biomarkers of oligometastatic disease are strongly needed to identify patient candidates most likely to gain survival benefit from local therapies and to aid in the incorporation of ablative treatments in the context of existing systemic therapies.
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20
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Wu L, Zhu J, Rudqvist NP, Welsh J, Lee P, Liao Z, Xu T, Jiang M, Zhu X, Pan X, Li P, Zhou Z, He X, Yin R, Feng J. T-Cell Receptor Profiling and Prognosis After Stereotactic Body Radiation Therapy For Stage I Non-Small-Cell Lung Cancer. Front Immunol 2021; 12:719285. [PMID: 34733273 PMCID: PMC8559517 DOI: 10.3389/fimmu.2021.719285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/30/2021] [Indexed: 12/21/2022] Open
Abstract
Radiotherapy is known to influence immune function, including T cell receptor (TCR) repertoire. We evaluated the TCR repertoire before and after stereotactic body radiotherapy (SBRT) for stage I non-small-cell lung cancer (NSCLC) and explored correlations between TCR indexes and distant failure after SBRT. TCR repertoires were analyzed in peripheral blood mononuclear cells (PBMCs) collected before and after SBRT from 19 patients. TCR combinational diversity in V and J genes was assessed with multiplex PCR of genomic DNA from PBMCs and tested for associations with clinical response. All patients received definitive SBRT to a biologically effective dose of >=100 Gy. The number of unique TCR clones was decreased after SBRT versus before, but clonality and the Shannon Entropy did not change. Four patients (21%) developed distant metastases after SBRT (median 7 months); those patients had lower Shannon Entropy in post-SBRT samples than patients without metastasis. Patients with a low change in Shannon Entropy from before to after SBRT [(post-SBRT Shannon Entropy minus baseline Shannon)/(baseline Shannon) * 100] had poorer metastasis-free survival than those with high change in Shannon Entropy (P<0.001). Frequencies in V/J gene fragment expression in the TCR β chain were also different for patients with or without metastases (two V fragments in baseline samples and 2 J and 9 V fragments in post-treatment samples). This comprehensive analysis of immune status before and after SBRT showed that quantitative assessments of TCRs can help evaluate prognosis in early-stage NSCLC.
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MESH Headings
- Aged
- Aged, 80 and over
- Biomarkers
- Carcinoma, Non-Small-Cell Lung/diagnosis
- Carcinoma, Non-Small-Cell Lung/genetics
- Carcinoma, Non-Small-Cell Lung/mortality
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Female
- Gene Expression Profiling
- High-Throughput Nucleotide Sequencing
- Humans
- Lung Neoplasms/diagnosis
- Lung Neoplasms/genetics
- Lung Neoplasms/mortality
- Lung Neoplasms/radiotherapy
- Male
- Middle Aged
- Neoplasm Staging
- Positron Emission Tomography Computed Tomography
- Prognosis
- ROC Curve
- Radiosurgery
- Receptors, Antigen, T-Cell/genetics
- Receptors, Antigen, T-Cell/metabolism
- Tomography, X-Ray Computed
- V(D)J Recombination
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Affiliation(s)
- Lirong Wu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jun Zhu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Nils-Petter Rudqvist
- Department of Thoracic/Head & Neck Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
- Department of Immunology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - James Welsh
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Percy Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Zhongxing Liao
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ting Xu
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ming Jiang
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangzhi Zhu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Pan
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Pansong Li
- Department of Scientific Research, Geneplus-Beijing Institute, Beijing, China
| | - Zhipeng Zhou
- Department of Scientific Research, Geneplus-Beijing Institute, Beijing, China
| | - Xia He
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xia He, ; Rong Yin, ; Jifeng Feng,
| | - Rong Yin
- Department of Thoracic Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- Jiangsu Biobank of Clinical Resources, Nanjing, China
- *Correspondence: Xia He, ; Rong Yin, ; Jifeng Feng,
| | - Jifeng Feng
- Department of Medical Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xia He, ; Rong Yin, ; Jifeng Feng,
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21
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Franzese C, Ingargiola R, Tomatis S, Iacovelli NA, Beltramo G, Franco P, Bonomo P, Zanetti IB, Argenone A, Cante D, Romanello DA, Musio D, De Felice F, Furlan C, Scorsetti M, Orlandi E. Metastatic salivary gland carcinoma: A role for stereotactic body radiation therapy? A study of AIRO-Head and Neck working group. Oral Dis 2020; 28:345-351. [PMID: 33320410 DOI: 10.1111/odi.13755] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The role of radiotherapy (RT) for oligometastases is currently established in different oncological settings but data on salivary gland cancer (SGC) are lacking. We evaluated the role of RT in oligometastatic SGC patients, focusing on stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS We performed a retrospective, multicentric study of oligometastatic SGC treated with palliative RT or SBRT. Endpoints included response evaluation and local control (LC). RESULTS Between 2006 and 2016, 64 patients were collected from 9 Italian Cancer Centers, on behalf of the Italian Association of Radiotherapy and Clinical Oncology (AIRO) Head and Neck Working Group. 37 patients (57.8%) were suffering from adenoid cystic carcinoma (ACC) and 27 patients (42.2%) had non-ACC. Thirty-four patients underwent palliative RT (53,1%), and 30 received SBRT (46,9%). Most common metastatic sites were bone for palliative RT and lung for SBRT. Among patients treated with SBRT, an objective response or a stability was observed in all treated lesions. After a median follow-up of 29.2 months (range 2.3-117.1), LC at 12 months was 57.5% for patients treated with SBRT and was higher in ACC subgroup. CONCLUSION We confirmed the potential role of SBRT in the management of oligometastatic SGC patients to control limited burden of disease considering the absence of effective systemic therapies.
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Affiliation(s)
- Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Rossana Ingargiola
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy
| | | | - Giancarlo Beltramo
- Radiation Oncology, Cyberknife Center, Centro Diagnostico Italiano, Milan, Italy
| | - Pierfrancesco Franco
- Department of Oncology, Radiation Oncology, School of Medicine, University of Turin, Turin, Italy
| | - Pierluigi Bonomo
- Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Isa Bossi Zanetti
- Radiation Oncology, Cyberknife Center, Centro Diagnostico Italiano, Milan, Italy
| | - Angela Argenone
- Radiation Oncology Unit, Istituto Nazionale per la cura e lo studio dei tumori, Fondazione G. Pascale, Napoli, Italy
| | - Domenico Cante
- Radiotherapy Department, Ivrea Community Hospital, Ivrea (Turin), Italy
| | | | - Daniela Musio
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Francesca De Felice
- Department of Radiotherapy, Policlinico Umberto I "Sapienza" University of Rome, Rome, Italy
| | - Carlo Furlan
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCSS, Aviano, Italy
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ester Orlandi
- Radiation Oncology Unit 2, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.,Radiation Oncology Unit 1, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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22
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Safety and Efficacy of Stereotactic Body Radiotherapy in Ultracentral Lung Tumors Using a Risk-optimized Fractionation Scheme. Clin Lung Cancer 2020; 22:332-340.e3. [PMID: 33281061 DOI: 10.1016/j.cllc.2020.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/28/2020] [Accepted: 11/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delivery of stereotactic body radiotherapy (SBRT) to ultracentral lung tumors remains a major challenge, with potentially excessive SBRT-related toxicity. This study investigates a risk-optimized approach to ultracentral SBRT in an elderly and comorbid patient cohort. PATIENTS AND METHODS Analysis encompassed 129 patients (mean age: 70 ± 11 years, median Charlson comorbidity index: 4 [range, 3-5]) following risk-adapted SBRT to central or ultracentral primary and secondary lung tumors between 2012 and 2019 (78 central, 51 ultracentral). Ultracentral tumors were defined by planning target volume overlap with the proximal bronchial tree. Whereas ultracentral tumors were treated with a risk-optimized fractionation scheme of 50 Gy in 10 fractions, central tumors received higher-fractionated 60 Gy in 8 fractions. Outcome parameters and toxicity for ultracentral and central tumors were assessed using Kaplan-Meier and competing risk analyses. RESULTS Local failure rate was not significantly increased in ultracentral tumors compared with central tumors (2-year local failure rate ultracentral, 26.9%; 95% confidence interval [CI], 12.2%-44.2%; central, 14.6%; 95% CI, 6.6%-25.5%; P = .17). Overall survival was similar in both groups (2-year overall survival central, 55.4%; 95% CI, 44.5%-68.9%; ultracentral, 54.9%; 95% CI, 40.8%-73.9%; P = .6). Toxicity was moderate, with toxicity ≥ grade 3 rates of 15.3% (95% CI, 5.9%-28.9%) for ultracentral and 7.3% (95% CI, 2.7%-15.0%) for central tumors after 2 years (P = .27). No grade 4 toxicity and only 1 potential grade 5 toxicity were observed in the ultracentral cohort. CONCLUSION Risk-optimized SBRT to ultracentral lung tumors is a reasonably effective and safe treatment alternative in frail patients.
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23
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Regnery S, Eichkorn T, Weykamp F, Held T, Dinges LA, Schunn F, Winter H, Thomas M, Debus J, El Shafie RA, Adeberg S, Hörner-Rieber J. Progression of Pulmonary Function and Correlation with Survival Following Stereotactic Body Radiotherapy of Central and Ultracentral Lung Tumors. Cancers (Basel) 2020; 12:cancers12102862. [PMID: 33027940 PMCID: PMC7600477 DOI: 10.3390/cancers12102862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 12/25/2022] Open
Abstract
Simple Summary Stereotactic body radiotherapy (SBRT) enables highly focused irradiation of lung tumors and has become a standard treatment. However, SBRT of lung tumors with close proximity to the central airways or mediastinum (central and ultracentral tumors) is associated with an increased risk for severe complications (bronchial bleeding, blockage of bronchi with loss of lung function). This retrospective study analyzed lung function and survival after risk-adapted approaches of SBRT in 107 central and ultracentral lung tumors. Lung function (vital capacity, forced expiratory volume in the first second) showed a statistically significant but in absolute numbers modest decrease that correlated moderately with the maximum radiation dose to the central airways. Stronger decrease in pulmonary function was found to be associated with limited survival. Consequently, lung function tests should be an integral element of follow-up after SBRT of lung tumors with proximity to the central airways or mediastinum. Abstract Stereotactic body radiotherapy (SBRT) to central and ultracentral lung tumors carries a risk of excessive toxicity. This study analyzed changes in pulmonary function tests (PFT) and their correlation with overall survival (OS) in 107 patients following central (n = 62) or ultracentral (n = 45) lung SBRT. Ultracentral location was defined as planning target volume overlap with the proximal bronchial tree (PBT). Vital capacity (VC) (−0.3 l, absolute −9.4% of predicted, both p < 0.001) and forced expiratory volume in the first second (FEV1s) (−0.2 l, absolute −7.7% of predicted, both p < 0.001) significantly decreased following SBRT. Higher maximum dose to the PBT significantly correlated with a steeper decline in VC (p = 0.005) and FEV1s (p = 0.03) over time. Pronounced decline in FEV1s between 6 and 12 months (HR = 0.90, p = 0.006) and pronounced decline in VC between baseline and 12 months (HR = 0.95, p = 0.004) independently correlated with worse OS. Consequently, PFT presented a statistically significant albeit clinically mild decrease in lung volumes following central and ultracentral SBRT that correlated moderately with maximum dose to the PBT. Stronger decline in pulmonary function was associated with constrained survival, advocating consequent performance of PFT during follow-up.
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Affiliation(s)
- Sebastian Regnery
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Tanja Eichkorn
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Fabian Weykamp
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Thomas Held
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Lisa-Antonia Dinges
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Fabian Schunn
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Hauke Winter
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), 69120 Heidelberg, Germany
| | - Michael Thomas
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), 69120 Heidelberg, Germany
- Department of Thoracic Oncology, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126 Heidelberg, Germany
| | - Jürgen Debus
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
- Heidelberg Ion-Beam Therapy Center (HIT), Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Rami A. El Shafie
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Sebastian Adeberg
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
| | - Juliane Hörner-Rieber
- Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; (S.R.); (T.E.); (F.W.); (T.H.); (L.-A.D.); (F.S.); (J.D.); (R.A.E.S.); (S.A.)
- National Center for Radiation Oncology (NCRO), Heidelberg Institute for Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
- National Center for Tumor diseases (NCT), 69120 Heidelberg, Germany; (H.W.); (M.T.)
- Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
- Correspondence:
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Franzese C, Badalamenti M, Comito T, Franceschini D, Clerici E, Navarria P, Loi M, D'agostino G, Baldaccini D, Chiola I, Reggiori G, Mancosu P, Tomatis S, Scorsetti M. Assessing the role of Stereotactic Body Radiation Therapy in a large cohort of patients with lymph node oligometastases: Does it affect systemic treatment’s intensification? Radiother Oncol 2020; 150:184-190. [DOI: 10.1016/j.radonc.2020.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 02/07/2023]
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Desai DD, Cordrey IL, Johnson EL. A physically meaningful relationship between R50% and PTV surface area in lung SBRT. J Appl Clin Med Phys 2020; 21:47-56. [PMID: 32725674 PMCID: PMC7497922 DOI: 10.1002/acm2.12964] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose We propose a novel understanding of two characteristics of the planning target volume (PTV) that affect the intermediate‐dose spill in lung stereotactic body radiation therapy (SBRT) as measured by R50%. This phantom model research investigates two characteristics of the PTV that have a marked effect on the value of R50%: the mean dose deposited within the PTV (Dav) and the surface area of the PTV (SAPTV). Methods Using a phantom model provided by a CT of the IROC Thorax‐Lung Phantom® (IROC Houston QA Center, Houston, TX) and Eclipse® Treatment Planning System (Varian Medical Systems, Palo Alto, CA), we investigate the two characteristics for spherical and cylindrical PTVs. A total of 135 plans with tightly controlled PTV characteristics are employed. A lower bound for R50% (R50%min∆r) is derived and clearly establishes a relationship between R50% and SAPTV that has not been fully appreciated previously. Results The study of PTV Dav revealed a local minimum for R50% as a function of the PTV Dav at Dav ≈ 110% of Rx dose. As PTV Dav increases above this local minimum, R50% increases; while for PTV Dav less than this local minimum, the R50% value also increases. The study of PTV surface area (SAPTV) demonstrated that as the SAPTV increases, the R50% increases if the PTV volume stays the same. The SAPTV result is predicted by the theoretical investigation that yields the R50% lower bound, R50%min∆r. Conclusions This research has identified two characteristics of the PTV that have a marked influence on R50%: PTV Dav and SAPTV. These characteristics have not been clearly articulated in the vast body of previous research in SBRT. These results could help explain plans that cannot meet the RTOG criteria for R50%. With further development, these concepts could be extended to provide additional guidance for creating acceptable SBRT plans.
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Affiliation(s)
- Dharmin D Desai
- Radiation Oncology, CHI Memorial Hospital, Chattanooga, TN, USA
| | - Ivan L Cordrey
- Radiation Oncology, CHI Memorial Hospital, Chattanooga, TN, USA
| | - E L Johnson
- Department of Radiation Medicine, University of Kentucky Chandler Medical Center, Lexington, KY, USA
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Defining oligometastatic disease from a radiation oncology perspective: An ESTRO-ASTRO consensus document. Radiother Oncol 2020; 148:157-166. [DOI: 10.1016/j.radonc.2020.04.003] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 12/15/2022]
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27
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Tsao MN, Ven LI', Cheung P, Poon I, Ung Y, Louie AV. Stereotactic Body Radiation Therapy for Extracranial Oligometastatic Non-small-cell Lung Cancer: A Systematic Review. Clin Lung Cancer 2019; 21:95-105.e1. [PMID: 31959533 DOI: 10.1016/j.cllc.2019.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/26/2019] [Accepted: 11/12/2019] [Indexed: 12/13/2022]
Abstract
Stereotactic body radiation therapy (SBRT) has emerged as a treatment modality for selected patients with oligometastatic non-small-cell lung cancer (NSCLC). The objectives of this systematic review were to explore the benefits and risks of SBRT for extracranial oligometastatic NSCLC. The MEDLINE, Embase, PubMed, and CENTRAL databases were searched for relevant articles from January 1, 2000 to July 23, 2019. Fully published phase III or phase II trials of any sample size were included. Retrospective series published in manuscript form with at least 50 patients were also included. Four prospective phase II randomized trials (total, 188 participants), 4 prospective non-randomized studies (total, 140 participants), and eleven retrospective studies (total, 1288 participants) were included in this systematic review. A variety of dose fractionation schemes were used. The median overall survival (OS) ranged from 13.5 to 55 months. Progression-free survival (PFS) ranged from 4.4 to 14.7 months. Quality of life outcomes were reported in 2 studies. None of the studies reported symptom control outcomes. There are no fully completed phase III randomized trials that clarify the risks and benefits of SBRT for oligometastatic NSCLC. Higher PFS and OS with SBRT were reported in 4 phase II randomized studies. The results from mature phase III randomized data regarding whether SBRT for oligometastatic NSCLC benefits patients in terms of OS, PFS, quality of life, and symptom control are needed.
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Affiliation(s)
- May N Tsao
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
| | - Lieke In 't Ven
- Department of Radiation Oncology, School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Yee Ung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
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28
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Real-time control of respiratory motion: Beyond radiation therapy. Phys Med 2019; 66:104-112. [PMID: 31586767 DOI: 10.1016/j.ejmp.2019.09.241] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/23/2019] [Accepted: 09/26/2019] [Indexed: 12/16/2022] Open
Abstract
Motion management in radiation oncology is an important aspect of modern treatment planning and delivery. Special attention has been paid to control respiratory motion in recent years. However, other medical procedures related to both diagnosis and treatment are likely to benefit from the explicit control of breathing motion. Quantitative imaging - including increasingly important tools in radiology and nuclear medicine - is among the fields where a rapid development of motion control is most likely, due to the need for quantification accuracy. Emerging treatment modalities like focussed-ultrasound tumor ablation are also likely to benefit from a significant evolution of motion control in the near future. In the present article an overview of available respiratory motion systems along with ongoing research in this area is provided. Furthermore, an attempt is made to envision some of the most expected developments in this field in the near future.
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