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Ruan M, Chang C, Sun J, Liu L, Wang L, Lei B, Yan H, Zhang H, Xie W, Wang Y. Exploring the correlation between HER2 alterations and 18F-FDG PET/CT metabolic parameters and their prognostic value in EGFR-negative non-small-cell lung cancer patients. J Cancer Res Clin Oncol 2023; 149:14493-14507. [PMID: 37572120 DOI: 10.1007/s00432-023-05218-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Our study intended to explore the correlation between HER2 alterations and 18F-FDG PET/CT metabolic parameters and their prognostic value in EGFR-negative non-small-cell lung cancer (NSCLC) patients detected by next-generation sequencing (NGS). METHODS NGS assay was performed in 1737 NSCLC patients, a total of 88 HER2 alterations and 176 negative HER2 with EGFR-negative patients were randomly selected for this study. RESULTS When the HER2 status with EGFR-negative group was analyzed, multivariate analysis showed that smoking status, primary tumor SUVmax (pSUVmax) < 13.03 and stage were the independent deterministic factors of HER2 alterations. Multivariate cox regression analysis revealed that HER2 status, age, smoking status and stage were independent risk factors for overall survival (OS) in EGFR-negative NSCLC patients with different HER2 status. When the HER2 alterations group was separately analyzed, multivariate analysis demonstrated that low pSUVmax < 15.32 and histology were the independent deterministic factors of HER2 mutation. Multivariate cox regression analysis revealed that pSUVmax, smoking status, nodal involvement and treatment methods were independent risk factors for OS in EGFR-negative NSCLC patients with HER2 alterations. CONCLUSION The study revealed that low pSUVmax was associated with HER2 alterations in EGFR-negative NSCLC patients, moreover HER2 mutation and HER2 amplification exhibited distinct 18F-FDG metabolic and clinical characteristics. Furthermore, it explored the prognostic value of HER2 alterations and 18F-FDG PET/CT metabolic parameters of pSUVmax in EGFR-negative NSCLC patients.
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Affiliation(s)
- Maomei Ruan
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, People's Republic of China
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Cheng Chang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Jianwen Sun
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Liu Liu
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Lihua Wang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Bei Lei
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Hui Yan
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - He Zhang
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Wenhui Xie
- Department of Nuclear Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, People's Republic of China
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, No. 185, Juqian Street, Changzhou, 213003, Jiangsu, People's Republic of China.
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou, Jiangsu, People's Republic of China.
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Lee H, Choi YL, Kim HK, Choi YS, Kim H, Ahn MJ, Pyo HR, Choi JY. Prognostic Significance of Volumetric Parameters Based on FDG PET/CT in Patients with Lung Adenocarcinoma Undergoing Curative Surgery. Cancers (Basel) 2023; 15:4380. [PMID: 37686654 PMCID: PMC10486443 DOI: 10.3390/cancers15174380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION FDG PET/CT is a robust imaging modality to diagnose and stratify prognoses for non-small cell lung carcinoma. However, the role of FDG PET/CT in operable lung adenocarcinoma patients has not been previously investigated in a large cohort with varying pathological stages. The prognostic value of volumetric parameters based on FDG PET/CT was investigated in patients with stage I-III lung adenocarcinoma receiving curative surgery. METHODS This retrospective study included 432 patients with lung adenocarcinoma undergoing preoperative FDG PET/CT between January 2016 and December 2017. Clinicopathologic variables, conventional image parameters, such as the maximum standardized uptake value (SUVmax) and mean SUV (SUVmean) of the primary tumor, and volumetric parameters, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were included in Cox regression analysis. Subgroup analysis was conducted to compare hazard ratios (HRs) based on MTV in each pathological stage. A new staging system including volumetric parameters was suggested. RESULTS A total of 432 patients (median age: 62 years; interquartile range: 56-70 years; 225 males) were evaluated. Sex, age, presence of EGFR mutation, pathological stage, MTV, and TLG of the primary tumor were selected as statistically significant prognostic factors for overall survival irrespective of other variables (OS; p < 0.05 for all). Pathological stage, MTV, and TLG of the primary tumor were selected as statistically significant prognostic factors for disease-free survival irrespective of other variables (p < 0.05 for all). The suggested new staging system including MTV as an additional criterion showed better discrimination and prediction for OS than the conventional pathological staging system despite statistical insignificance (concordance index: 0.698 vs. 0.673). CONCLUSIONS The volumetric parameters of the primary tumor based on preoperative FDG PET/CT were independent prognostic factors in addition to pathological stage in patients with operable lung adenocarcinoma. The suggested new staging system considering MTV predicted the prognoses better than the conventional pathological staging system.
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Affiliation(s)
- Hyunjong Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoon-La Choi
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (H.K.K.); (Y.S.C.)
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea; (H.K.K.); (Y.S.C.)
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Hong Ryul Pyo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
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Buti G, Shusharina N, Ajdari A, Sterpin E, Bortfeld T. Exploring trade-offs in treatment planning for brain tumor cases with a probabilistic definition of the clinical target volume. Med Phys 2023; 50:410-423. [PMID: 36354283 DOI: 10.1002/mp.16097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 10/20/2022] [Accepted: 10/26/2022] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study demonstrates how a novel probabilistic clinical target volume (CTV) concept-the clinical target distribution (CTD)-can be used to navigate the trade-off between target coverage and organ sparing with a semi-interactive treatment planning approach. METHODS Two probabilistic treatment planning methods are presented that use tumor probabilities to balance tumor control with organ-at-risk (OAR) sparing. The first method explores OAR dose reduction by systematically discarding x % $x\%$ of CTD voxels with an unfavorable dose-to-probability ratio from the minimum dose coverage objective. The second method sequentially expands the target volume from the GTV edge, calculating the CTD coverage versus OAR sparing trade-off after dosing each expansion. Each planning method leads to estimated levels of tumor control under specific statistical models of tumor infiltration: an independent tumor islets model and contiguous circumferential tumor growth model. The methods are illustrated by creating proton therapy treatment plans for two glioblastoma patients with the clinical goal of sparing the hippocampus and brainstem. For probabilistic plan evaluation, the concept of a dose-expected-volume histogram is introduced, which plots the dose to the expected tumor volume ⟨ v ⟩ $\langle v \rangle$ considering tumor probabilities. RESULTS Both probabilistic planning approaches generate a library of treatment plans to interactively navigate the planning trade-offs. In the first probabilistic approach, a significant reduction of hippocampus dose could be achieved by excluding merely 1% of CTD voxels without compromising expected tumor control probability (TCP) or CTD coverage: the hippocampus D 2 % $D_{2\%}$ dose reduces with 9.5 and 5.3 Gy for Patient 1 and 2, while the TCP loss remains below 1%. Moreover, discarding up to 10% of the CTD voxels does not significantly diminish the expected CTD dose, even though evaluation with a binary volume suggests poor CTD coverage. In the second probabilistic approach, the expected CTD D ⟨ 98 % ⟩ $D_{\langle 98\%\rangle }$ and TCP depend more strongly on the extent of the high-dose region: the target volume margin cannot be reduced by more than 2 mm if one aims at keeping the expected CTD D ⟨ 98 % ⟩ $D_{\langle 98\%\rangle }$ loss and TCP loss under 1 Gy and 2%, respectively. Therefore, there is less potential for improved OAR sparing without compromising TCP or expected CTD coverage. CONCLUSIONS This study proposes and implements treatment planning strategies to explore trade-offs using tumor probabilities.
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Affiliation(s)
- Gregory Buti
- Institute of Experimental and Clinical Research, Center of Molecular Imaging, Radiotherapy and Oncology, Brussels, Belgium.,Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation Biophysics, Boston, Massachusetts, USA
| | - Nadya Shusharina
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation Biophysics, Boston, Massachusetts, USA
| | - Ali Ajdari
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation Biophysics, Boston, Massachusetts, USA
| | - Edmond Sterpin
- Institute of Experimental and Clinical Research, Center of Molecular Imaging, Radiotherapy and Oncology, Brussels, Belgium.,KU Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, Leuven, Belgium
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation Biophysics, Boston, Massachusetts, USA
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Wang S, Shiau Y, Hsu C. Comments on "dynamic 18 F-FDG PET/CT can predict the major pathological response to neoadjuvant immunotherapy in non-small cell lung cancer". Thorac Cancer 2022; 13:3513-3514. [PMID: 36288468 PMCID: PMC9750810 DOI: 10.1111/1759-7714.14710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/14/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Shan‐Ying Wang
- Department of Nuclear MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan,Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
| | - Yu‐Chien Shiau
- Department of Nuclear MedicineFar Eastern Memorial HospitalNew Taipei CityTaiwan
| | - Chen‐Xiong Hsu
- Department of Biomedical Imaging and Radiological SciencesNational Yang Ming Chiao Tung UniversityTaipeiTaiwan,Division of Radiation Oncology, Department of RadiologyFar Eastern Memorial HospitalNew Taipei CityTaiwan
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Optimal Clinical Target Volume of Radiotherapy Based on Microscopic Extension around the Primary Gross Tumor in Non-Small-Cell Lung Cancer: A Systematic Review. Cancers (Basel) 2022; 14:cancers14092318. [PMID: 35565447 PMCID: PMC9103011 DOI: 10.3390/cancers14092318] [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: 04/19/2022] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 12/10/2022] Open
Abstract
A crucial issue in radical radiation therapy for non-small-cell lung cancer is how to define the clinical target volume (CTV). Although the scope of microscopic extension (ME) and microscopic proximal bronchial extension (PBE) from a primary tumor should be considered when defining the CTV, there has been limited research on ME and PBE. Therefore, we conducted this systematic review. The PubMed, ICHUSHI (Japanese database), and Cochrane Library databases were searched, and 816 articles were initially retrieved. After primary and secondary screenings, eight articles were ultimately selected. The results of this systematic review suggest the importance of a 0 mm margin in stereotactic radiotherapy for early-stage cancer and a 5–8 mm margin in curative irradiation for locally advanced cancer. Regarding PBE, this review yielded the conclusion that it is appropriate to consider the addition of an approximately 15 mm margin from the bronchial vasculature. Although there were few articles with a high level of evidence, this systematic review enabled us to collate results from previous studies and to provide recommendations, to some extent, regarding the CTV margin in the current clinical environment, where high-precision radiation therapy, such as image-guided radiotherapy and intensity-modulated radiotherapy, is predominant.
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Buti G, Souris K, Maria Barragán Montero A, Aldo Lee J, Sterpin E. Introducing a probabilistic definition of the target in a robust treatment planning framework. Phys Med Biol 2021; 66. [PMID: 34236043 DOI: 10.1088/1361-6560/ac1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/01/2021] [Indexed: 11/11/2022]
Abstract
The 'clinical target distribution' (CTD) has recently been introduced as a promising alternative to the binary clinical target volume (CTV). However, a comprehensive study that considers the CTD, together with geometric treatment uncertainties, was lacking. Because the CTD is inherently a probabilistic concept, this study proposes a fully probabilistic approach that integrates the CTD directly in a robust treatment planning framework. First, the CTD is derived from a reported microscopic tumor infiltration model such that it explicitly features the probability of tumor cell presence in its target definition. Second, two probabilistic robust optimization methods are proposed that evaluate CTD coverage under uncertainty. The first method minimizes the expected-value (EV) over the uncertainty scenarios and the second method minimizes the sum of the expected value and standard deviation (EV-SD), thereby penalizing the spread of the objectives from the mean. Both EV and EV-SD methods introduce the CTD in the objective function by using weighting factors that represent the probability of tumor presence. The probabilistic methods are compared to a conventional worst-case approach that uses the CTV in a worst-case optimization algorithm. To evaluate the treatment plans, a scenario-based evaluation strategy is implemented that combines the effects of microscopic tumor infiltrations with the other geometric uncertainties. The methods are tested for five lung tumor patients, treated with intensity-modulated proton therapy. The results indicate that for the studied patient cases, the probabilistic methods favor the reduction of the esophagus dose but compensate by increasing the high-dose region in a low conflicting organ such as the lung. These results show that a fully probabilistic approach has the potential to obtain clinical benefits when tumor infiltration uncertainties are taken into account directly in the treatment planning process.
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Affiliation(s)
- Gregory Buti
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Avenue Hippocrate 54-Box B1.54.07, B-1200 Brussels, Belgium
| | - Kevin Souris
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Avenue Hippocrate 54-Box B1.54.07, B-1200 Brussels, Belgium
| | - Ana Maria Barragán Montero
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Avenue Hippocrate 54-Box B1.54.07, B-1200 Brussels, Belgium
| | - John Aldo Lee
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Avenue Hippocrate 54-Box B1.54.07, B-1200 Brussels, Belgium
| | - Edmond Sterpin
- Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique (IREC), Center of Molecular Imaging, Radiotherapy and Oncology (MIRO), Avenue Hippocrate 54-Box B1.54.07, B-1200 Brussels, Belgium.,Katholieke Universiteit Leuven, Department of Oncology, Laboratory of Experimental Radiotherapy, UZ Herestraat 49-Box 7003, B-3000 Leuven, Belgium
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Meynard C, Mansuet-Lupo A, Giraud N, Boulle G, Imbault P, Guénégou-Arnoux A, Bobbio A, Durdux C, Damotte D, Giraud P. Size and Predictive Factors of Microscopic Tumor Extension in Locally Advanced Non-Small Cell Lung Cancer. Pract Radiat Oncol 2021; 11:491-501. [PMID: 34126295 DOI: 10.1016/j.prro.2021.05.006] [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] [Received: 12/28/2020] [Revised: 05/21/2021] [Accepted: 05/27/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation therapy for locally advanced non-small cell lung cancer (NSCLC) should treat the whole tumor, including its microscopic extensions, and protect adjacent organs at risk as much as possible. The aim of our study is to evaluate the size of microscopic tumor extension (MEmax) in NSCLC, and search for potential predictive factors. METHODS AND MATERIALS We retrospectively selected 70 patients treated with postoperative radiation therapy for a NSCLC with N2 nodal status, then 34 additional patients operated for a squamous cell lung cancer with N1 or N2 nodal status. On the digitized slides originating from the resected tumors of these 104 patients, we outlined the border of the tumor, as seen with the naked eye. We then searched for microscopic tumor extension outside of these borders with a magnification as high as 40 × and measured the maximum size of MEmax. RESULTS The median MEmax in the whole cohort was 0.85 mm (0-9.95). The MEmax was <5.3 mm in 95% of adenocarcinomas (6.5 mm in the subgroup without neoadjuvant chemotherapy) and <3.5 mm in 95% of squamous cell carcinomas (3.7 mm in the subgroup without neoadjuvant chemotherapy). After multivariate analysis, the factors associated with the size of MEmax were vascular invasion (P = .0002), histologic type, with a wider MEmax for adenocarcinomas in comparison with squamous cell carcinomas (P = .002), tumor size, which was inversely related with the size of MEmax (P = .024), and high blood pressure (P = .03). Macroscopic histologic tumor size was well correlated with both radiologic tumor size on a mediastinal setting computed tomography (correlation coefficient of 0.845) and on a parenchymal setting computed tomography (correlation coefficient of 0.836). CONCLUSIONS The clinical target volume margin, accounting for microscopic tumoral extension, could be reduced to 7 mm for adenocarcinomas and 4 mm for squamous cell carcinomas.
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Affiliation(s)
- Claire Meynard
- Radiation Oncology unit, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris University, Paris, France.
| | - Audrey Mansuet-Lupo
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Paris University, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Paris, France
| | - Nicolas Giraud
- Radiation Oncology Department, Hôpital Haut-Lévêque, CHU Bordeaux, Pessac, France
| | - Geoffroy Boulle
- Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Paris, France
| | - Paul Imbault
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris University, Paris, France
| | - Armelle Guénégou-Arnoux
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris University, Paris, France; INSERM CIC1418-EC, Georges Pompidou European Hospital, Paris, France
| | - Antonio Bobbio
- Department of Thoracic Surgery, Assistance Publique - Hôpitaux de Paris, Cochin Hospital, Paris University, Paris, France
| | - Catherine Durdux
- Radiation Oncology unit, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris University, Paris, France
| | - Diane Damotte
- Department of Pathology, Assistance Publique-Hôpitaux de Paris, Cochin Hospital, Paris University, Paris, France; Centre de Recherche des Cordeliers, Sorbonne Université, Inserm, Université de Paris, Paris, France
| | - Philippe Giraud
- Radiation Oncology unit, Assistance Publique-Hôpitaux de Paris, Georges Pompidou European Hospital, Paris University, Paris, France
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Diamant A, Heng VJ, Chatterjee A, Faria S, Bahig H, Filion E, Doucet R, Khosrow-Khavar F, Naqa IE, Seuntjens J. Comparing local control and distant metastasis in NSCLC patients between CyberKnife and conventional SBRT. Radiother Oncol 2020; 144:201-208. [PMID: 32044418 DOI: 10.1016/j.radonc.2020.01.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 12/01/2019] [Accepted: 01/20/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Previous literature suggests that the dose proximally outside the PTV could have an impact on the incidence of distant metastasis (DM) after SBRT in stage I NSCLC patients. We investigated this observation (along with local failure) in deliveries made by different treatment modalities: robotic mounted linac SBRT (CyberKnife) vs conventional SBRT (VMAT/CRT). MATERIALS AND METHODS This study included 422 stage I NSCLC patients from 2 institutions who received SBRT: 217 treated conventionally and 205 with CyberKnife. The dose behavior outside the PTV of both sub-cohorts were compared by analyzing the mean dose in continuous shells extending 1, 2, 3, …, 100 mm from the PTV. Kaplan-Meier analysis was performed between the two sub-cohorts with respect to DM-free survival and local progression-free survival. A multivariable Cox proportional hazards model was fitted to the combined cohort (n = 422) with respect to DM incidence and local failure. RESULTS The shell-averaged dose fall-off beyond the PTV was found to be significantly more modest in CyberKnife plans than in conventional SBRT plans. In a 30 mm shell around the PTV, the mean dose delivered with CyberKnife (38.1 Gy) is significantly larger than with VMAT/CRT (22.8 Gy, p<10-8). For 95% of CyberKnife plans, this region receives a mean dose larger than the 21 Gy threshold dose discovered in our previous study. In contrast, this occurs for only 75% of VMAT/CRT plans. The DM-free survival of the entire CyberKnife cohort is superior to that of the 25% of VMAT/CRT patients receiving less than the threshold dose (VMAT/CRT<21Gy), with a hazard ratio of 5.3 (95% CI: 3.0-9.3, p<10-8). The 2 year DM-free survival rates were 87% (95% CI: 81%-91%) and 44% (95% CI: 28%-58%) for CyberKnife and the below-threshold dose conventional cohorts, respectively. A multivariable analysis of the combined cohort resulted in the confirmation that threshold dose was a significant predictor of DM(HR = 0.28, 95% CI: 0.15-0.55, p<10-3) when adjusted for other clinical factors. CyberKnife was also found to be superior to the entire VMAT/CRT with respect to local control (HR = 3.44, CI: 1.6-7.3). The 2-year local progression-free survival rates for the CyberKnife cohort and the VMAT/CRT cohort were 96% (95% CI: 92%-98%) and 88% (95% CI: 82%-92%) respectively. CONCLUSIONS In standard-of-care CyberKnife treatments, dose distributions that aid distant control are achieved 95% of the time. Although similar doses could be physically achieved by conventional SBRT, this is not always the case with current prescription practices, resulting in worse DM outcomes for 25% of conventional SBRT patients. Furthermore, CyberKnife was found to provide superior local control compared to VMAT/CRT.
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Affiliation(s)
- André Diamant
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada.
| | - Veng Jean Heng
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada
| | - Avishek Chatterjee
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada
| | - Sergio Faria
- Department of Radiation Oncology, McGill University Health Centre, Montréal, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Edith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Canada
| | - Robert Doucet
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Canada
| | | | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, United States
| | - Jan Seuntjens
- Medical Physics Unit, McGill University and Cedars Cancer Center, Montréal, Canada
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Cao X, Li X, Wang X, Duan J, Zhu S, Zeng H, Yin Y, Yuan S, Hu X. Use CT Imaging to Predict the Short-Term Outcome of Concurrent Chemoradiotherapy in Patients With Locally Advanced Esophageal Squamous Cell Carcinoma. Dose Response 2020; 17:1559325819897175. [PMID: 31908624 PMCID: PMC6937540 DOI: 10.1177/1559325819897175] [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: 08/21/2019] [Revised: 11/17/2019] [Accepted: 12/01/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: To extract the computed tomography (CT) imaging features of the primary lesions in patients with advanced esophageal squamous cell carcinoma (ESCC) and to study whether these imaging features can predict the short-term outcome after concurrent chemoradiotherapy (CCRT). Methods: From January 2014 to December 2015, a total of 49 patients with locally advanced ESCC who underwent CCRT were analyzed retrospectively. They were randomly categorized into the training and validation groups. Collection of CT imaging of patients before and intermediate stage undergoing radiotherapy. The correlations between imaging characteristics and short-term outcome were analyzed. The accuracy of cutoff value was verified by imaging characteristics of patients in validation group. Result: There were 38 patients in the training group and 11 patients in the validation group. 13 patients in the training group were classified as responders and 25 patients as nonresponders. According to the CT imaging before radiotherapy, there are no significant differences between responders and nonresponders. According to the CT imaging in the middle stage of radiotherapy, responders showed significantly higher Roundness than nonresponders (P = .004, 95% confidence interval [CI] = 0.0419-0.212). The areas under the ROC curves for the ability to predict significantly tumor response were 0.768 for Roundness (P = .001, 95% CI = 0.603-0.889). The cutoff value of Roundness is 0.3099. Roundness showed no significant associations with survival parameters. Conclusions: Computed tomography imaging in the middle stage of radiotherapy can predict the short-term outcome of concurrent chemoradiotherapy for patients with locally advanced ESCC but have no predictive effect on the total survival time.
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Affiliation(s)
- Xiaolan Cao
- School of Medicine and Life Sciences, University of Jinan, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xindi Li
- Department of Oncology, Shandong Provincial Third Hospital, Jinan, China
| | - Xiaoyue Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinghao Duan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shouhui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Haiyan Zeng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xudong Hu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Correlation between combining 18F–FDG PET/CT metabolic parameters and other clinical features and ALK or ROS1 fusion in patients with non-small-cell lung cancer. Eur J Nucl Med Mol Imaging 2020; 47:1183-1197. [DOI: 10.1007/s00259-019-04652-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 12/09/2019] [Indexed: 01/03/2023]
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11
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Lv Y, Wang X, Liang L, Wang L, Lu J. SUVmax and metabolic tumor volume: surrogate image biomarkers of KRAS mutation status in colorectal cancer. Onco Targets Ther 2019; 12:2115-2121. [PMID: 30962693 PMCID: PMC6433102 DOI: 10.2147/ott.s196725] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The objective of this study was to explore the association between KRAS mutation status and PET/CT metabolic parameters in colorectal cancer (CRC) patients. Materials and methods One hundred and sixty-four CRC patients were enrolled in this study and received PET/CT examination before operation, then KRAS mutation status was analyzed through pathologically confirmed CRC samples. The association between tumor clinical characteristics and PET/CT metabolic parameters, including maximum standardized uptake value (SUVmax), SUVmean, and metabolic tumor volume (MTV), and KRAS mutation status was analyzed using chi-squared tests, Mann-Whitney U tests, and logistic regression analysis. Results The KRAS mutation type patients exhibited high MTV and high SUVmax using a threshold of 17.8 cm3 and 8.7 respectively and the predictive accuracy was 0.772 and 0.603 respectively. High MTV (P=0.001; 95% CI: 1.119-1.296) and high SUVmax (P=0.048; 95% CI: 0.564-0.985) were independent predictors for KRAS mutation status. Conclusion MTV and SUVmax were associated with KRAS mutation type in CRC patients. PET/CT metabolic parameters can be used for supplementing KRAS mutation status prediction in CRC patients.
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Affiliation(s)
- Ying Lv
- Department of Gastroenterology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong, People's Republic of China
| | - Xin Wang
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, Shandong, People's Republic of China
| | - Lerong Liang
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong, People's Republic of China
| | - Lei Wang
- Department of Gastrointestinal Surgery, Jinan Central Hospital Affiliated to Shandong University, Jinan 250013, Shandong, People's Republic of China,
| | - Jie Lu
- Department of Neurosurgery, Shandong Province Qianfoshan Hospital of Shandong University, Jinan 250014, Shandong, People's Republic of China,
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12
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Lee J, Lee M, Koom WS, Kim HJ, Kim WC. Metabolic positron emission tomography parameters predict failure patterns in early non-small-cell lung cancer treated with stereotactic body radiation therapy: a single institution experience. Jpn J Clin Oncol 2018; 48:920-926. [PMID: 30124920 DOI: 10.1093/jjco/hyy115] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/20/2018] [Indexed: 12/11/2022] Open
Abstract
Objective The prognostic value of metabolic parameters using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has not been established for early non-small cell lung cancer (NSCLC). Accordingly, the authors investigated the prognostic value of metabolic parameters in terms of failure patterns in patients with early NSCLC who underwent stereotactic body radiation therapy (SBRT). Methods Data from 35 patients with Stage I NSCLC who underwent SBRT using CyberKnife and received pretreatment FDG PET/CT between 2008 and 2016 were retrospectively reviewed. Maximum standardized uptake value (SUVmax), metabolic tumor volume, and total lesion glycolysis were measured. The significance of these parameters with regard to failure patterns was assessed. Results The median follow-up was 23 months for all patients and 34 months for living patients. Ten patients experienced recurrence: three local failures, five regional failures (RF), and eight distant failures (DF). Three-year local, regional and distant control rates were 96.7%, 86.4% and 71.1%, respectively. High SUVmax (<9 vs. ≥9) was an independent predictive factor associated with increased RF (P = 0.027) and DF (P = 0.008). Furthermore, SUVmax was indicative of both progression-free (P = 0.015) and overall (P = 0.034) survival. Conclusions High SUVmax was a significant metabolic parameter associated with increased RF and DF in patients with early NSCLC who received SBRT, having a high propensity for dissemination. These results suggest that adjuvant treatment in conjunction with SBRT may be considered in patients with early NSCLC and high SUVmax.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon.,Department of Radiation Oncology, Yonsei University College of Medicine, Seoul
| | - Minkyung Lee
- Department of Nuclear Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea
| | - Woong Sub Koom
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul
| | - Hun Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon
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13
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Yegya-Raman N, Reyhan M, Kim S, Deek MP, Yue N, Zou W, Malhotra J, Aisner J, Jabbour SK. Association of Target Volume Margins With Locoregional Control and Acute Toxicities for Non-small cell lung cancer Treated With Concurrent Chemoradiation Therapy. Pract Radiat Oncol 2018; 9:e74-e82. [PMID: 30144583 DOI: 10.1016/j.prro.2018.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/23/2018] [Accepted: 08/09/2018] [Indexed: 12/25/2022]
Abstract
PURPOSE This study aimed to investigate the association between target volume margins and clinical outcomes for patients with inoperable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy. METHODS AND MATERIALS We reviewed the records of 82 patients with inoperable NSCLC treated between 2009 and 2016 with concurrent chemoradiation. All patients received positron emission tomography-based treatment planning, 4-dimensional computed tomography simulation to define an internal target volume, and daily cone beam computed tomography. We quantified variations in target volume margins with a margin deviation index (MDI), calculated as the percentage change in equivalent uniform dose between the original planning target volume (PTV) and a standard reference PTV 10 mm beyond the original gross tumor volume, consistent with the minimum margins mandated by recent NSCLC trials. Greater MDIs equated to smaller effective target volume margins. We dichotomized patients by the upper tercile MDI value (5.8%). Endpoints included time to locoregional progression and time to grade ≥ 3 radiation esophagitis (RE3) or radiation pneumonitis (RP3), modelled with the Fine-Gray method. RESULTS Median follow-up was 37.8 months (range, 5.9-58.1 months). Larger MDIs correlated with smaller clinical target volume (CTV) + PTV margins, larger gross tumor volumes, later treatment year, and intensity modulated radiation therapy use. The risk of locoregional progression did not differ for MDI ≥5.8% versus <5.8% (adjusted hazard ratio: 0.88; P = .76), but the risk of RE3 or RP3 was decreased for MDI ≥5.8% (adjusted hazard ratio: 0.27; P = .027). Patients with MDI ≥5.8% were treated with smaller CTV + PTV margins (median, 5.6 vs 8 mm; P < .0001) and a marginally lower volume of esophagus receiving ≥50 Gy (median, 31.1% vs 35.3%; P = .069). CONCLUSIONS Smaller margins were used for larger tumors but were not associated with an increase in locoregional failures. Additional studies could clarify whether smaller margins, when used alongside modern radiation therapy techniques, decrease treatment-related toxicity for inoperable NSCLC.
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MESH Headings
- Adenocarcinoma/diagnostic imaging
- Adenocarcinoma/pathology
- Adenocarcinoma/therapy
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/pathology
- Carcinoma, Non-Small-Cell Lung/therapy
- Chemoradiotherapy/adverse effects
- Cone-Beam Computed Tomography
- Esophagitis/diagnosis
- Esophagitis/etiology
- Female
- Follow-Up Studies
- Four-Dimensional Computed Tomography
- Humans
- Image Processing, Computer-Assisted/methods
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Male
- Margins of Excision
- Middle Aged
- Neoplasm Recurrence, Local/diagnosis
- Neoplasm Recurrence, Local/epidemiology
- Neoplasm Recurrence, Local/etiology
- Positron-Emission Tomography
- Prognosis
- Radiation Pneumonitis/diagnosis
- Radiation Pneumonitis/etiology
- Radiotherapy Dosage
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Intensity-Modulated/methods
- Retrospective Studies
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Affiliation(s)
- Nikhil Yegya-Raman
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Meral Reyhan
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Sinae Kim
- Department of Biostatistics, School of Public Health, Rutgers University, Piscataway, New Jersey; Biometrics Division, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew P Deek
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey; Department of Radiation Oncology & Molecular Radiation Sciences, the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ning Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Wei Zou
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jyoti Malhotra
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Joseph Aisner
- Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey.
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14
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Chhabra A, Schneider C, Chowdhary M, Diwanji TP, Mohindra P, Mishra MV. How Histopathologic Tumor Extent and Patterns of Recurrence Data Inform the Development of Radiation Therapy Treatment Volumes in Solid Malignancies. Semin Radiat Oncol 2018; 28:218-237. [PMID: 29933882 DOI: 10.1016/j.semradonc.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The ability to deliver highly conformal radiation therapy using intensity-modulated radiation therapy and particle therapy provides for new opportunities to improve patient outcomes by reducing treatment-related morbidities following radiation therapy. By reducing the volume of normal tissue exposed to radiation therapy (RT), while also allowing for the opportunity to escalate the dose of RT delivered to the tumor, use of conformal RT delivery should also provide the possibility of expanding the therapeutic index of radiotherapy. However, the ability to safely and confidently deliver conformal RT is largely dependent on our ability to clearly define the clinical target volume for radiation therapy, which requires an in-depth knowledge of histopathologic extent of different tumor types, as well as patterns of recurrence data. In this article, we provide a comprehensive review of the histopathologic and radiographic data that provide the basis for evidence-based guidelines for clinical tumor volume delineation.
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Affiliation(s)
- Arpit Chhabra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Craig Schneider
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University, Chicago, IL
| | - Tejan P Diwanji
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Pranshu Mohindra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD
| | - Mark V Mishra
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD.
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15
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Diamant A, Chatterjee A, Faria S, Naqa IE, Bahig H, Filion E, Robinson C, Al-Halabi H, Seuntjens J. Can dose outside the PTV influence the risk of distant metastases in stage I lung cancer patients treated with stereotactic body radiotherapy (SBRT)? Radiother Oncol 2018; 128:513-519. [PMID: 29801721 DOI: 10.1016/j.radonc.2018.05.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 05/08/2018] [Accepted: 05/09/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE In an era where little is known about the "abscopal" (out-of-the-field) effects of lung SBRT, we investigated correlations between the radiation dose proximally outside the PTV and the risk of cancer recurrence after SBRT in patients with primary stage I non-small cell lung cancer (NSCLC). MATERIALS AND METHODS This study included 217 stage I NSCLC patients across 2 institutions who received SBRT. Correlations between clinical and dosimetric factors were investigated. The clinical factors considered were distant metastasis (DM), loco-regional control (LRC) and radiation pneumonitis (RP). The dose (converted to EQD2) delivered to regions of varying size directly outside of the PTV was computed. For each feature, area under the curve (AUC) and odds ratios with respect to the outcome parameters DM, LRC and RP were estimated; Kaplan-Meier (KM) analysis was also performed. RESULTS Thirty-seven (17%) patients developed DM after a median follow-up of 24 months. It was found that the mean dose delivered to a shell-shaped region of thickness 30 mm outside the PTV had an AUC of 0.82. Two years after treatment completion, the rate of DM in patients where the mean dose delivered to this region was higher than 20.8 Gy2 was 5% compared to 60% in those who received a dose lower than 20.8 Gy2. KM analysis resulted in a hazard ratio of 24.2 (95% CI: 10.7, 54.4); p < 10-5. No correlations were found between any factor and either LRC or RP. CONCLUSIONS The results of this study suggest that the dose received by the region close to the PTV has a significant impact on the risk of distant metastases in stage I NSCLC patients treated with SBRT. If these results are independently confirmed, caution should be taken, particularly when a treatment plan results in a steep dose gradient extending outwards from the PTV.
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Affiliation(s)
- André Diamant
- Medical Physics Unit, McGill University Health Centre, Canada.
| | | | - Sergio Faria
- Department of Radiation Oncology, McGill University Health Centre, Canada
| | - Issam El Naqa
- Department of Radiation Oncology, Michigan University, United States
| | - Houda Bahig
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal, Canada
| | - Edith Filion
- Département de Radio-oncologie, Centre Hospitalier de l'Université de Montréal, Canada
| | - Cliff Robinson
- Department of Radiation Oncology, Washington University in St. Louis, United States
| | - Hani Al-Halabi
- Department of Radiation Oncology, McGill University Health Centre, Canada
| | - Jan Seuntjens
- Medical Physics Unit, McGill University Health Centre, Canada
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16
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Liu A, Han A, Zhu H, Ma L, Huang Y, Li M, Jin F, Yang Q, Yu J. The role of metabolic tumor volume (MTV) measured by [18F] FDG PET/CT in predicting EGFR gene mutation status in non-small cell lung cancer. Oncotarget 2018; 8:33736-33744. [PMID: 28422710 PMCID: PMC5464907 DOI: 10.18632/oncotarget.16806] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/15/2017] [Indexed: 12/02/2022] Open
Abstract
Many noninvasive methods have been explored to determine the mutation status of the epidermal growth factor receptor (EGFR) gene, which is important for individualized treatment of non-small cell lung cancer (NSCLC). We evaluated whether metabolic tumor volume (MTV), a parameter measured by [18F] fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) might help predict EGFR mutation status in NSCLC. Overall, 87 patients who underwent EGFR genotyping and pretreatment PET/CT between January 2013 and September 2016 were reviewed. Clinicopathologic characteristics and metabolic parameters including MTV were evaluated. Univariate and multivariate analyses were used to assess the independent variables that predict mutation status to create prediction models. Forty-one patients (41/87) were identified as having EGFR mutations. The multivariate analysis showed that patients with lower MTV (MTV≤11.0 cm3, p=0.001) who were non-smokers (p=0.037) and had a peripheral tumor location (p=0.033) were more likely to have EGFR mutations. Prediction models using these criteria for EGFR mutation yielded a high AUC (0.805, 95% CI 0.712–0.899), which suggests that the analysis had good discrimination. In conclusion, NSCLC patients with EGFR mutations showed significantly lower MTV than patients with wild-type EGFR. Prediction models based on MTV and clinicopathologic characteristics could provide more information for the identification of EGFR mutations.
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Affiliation(s)
- Ao Liu
- School of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Anqin Han
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Hui Zhu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Li Ma
- Department of Nuclear Medicine, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Yong Huang
- Department of Nuclear Medicine, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Minghuan Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Feng Jin
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
| | - Qiuan Yang
- Department of Radiation Oncology, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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17
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Zhang Y, Li J, Duan Y, Wang W, Li F, Shao Q, Xu M. Comparison of biological target volume metrics based on FDG PET-CT and 4DCT for primary non-small-cell lung cancer. Oncotarget 2017; 8:79629-79635. [PMID: 29108342 PMCID: PMC5668075 DOI: 10.18632/oncotarget.18917] [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: 11/18/2016] [Accepted: 06/02/2017] [Indexed: 11/25/2022] Open
Abstract
Fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) and four-dimensional CT (4DCT) are used in several methods for defining the biological target volume (BTV) in primary non-small cell lung cancer (NSCLC). Disagreements between the assessments using these methodologies make the use of BTV for radiotherapy planning controversial. In this study, we compared existing methods with our proposed internal biological target volume (IBTV) metric, derived by combining internal target volume (ITV) and BTV metrics. We defined the IBTV from ITV (IBTVi) or BTV (IBTVb) based on ITV or BTV with symmetrical margin expansion. We detected large differences between IBTV, IBTVi and IBTVb (p < 0.001), but no difference between ITV and BTV. A margin expansion of about 13 mm was necessary for ITV or BTV to encompass > 95% IBTV. The conformity index correlated negatively with IBTV/ITV, IBTV/BTV, IBTVi/ITV, and IBTVb/BTV volume ratios (p < 0.05). VR also increased the margins of IBTVi and IBTVb. Indeed, IBTV was much smaller than IBTVi or IBTVb, suggesting that using IBTV for radiotherapy planning could improve treatment by minimizing the radiation exposure of healthy tissue and organs surrounding tumors.
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Affiliation(s)
- Yingjie Zhang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China
| | - Jianbin Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China
| | - Yili Duan
- Changqing People's Hospital, Jinan, China
| | - Wei Wang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China
| | - Fengxiang Li
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China
| | - Qian Shao
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China
| | - Min Xu
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.,Shandong Academy of Medical Sciences, Jinan, China
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18
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Apolle R, Rehm M, Bortfeld T, Baumann M, Troost EGC. The clinical target volume in lung, head-and-neck, and esophageal cancer: Lessons from pathological measurement and recurrence analysis. Clin Transl Radiat Oncol 2017; 3:1-8. [PMID: 29658006 PMCID: PMC5893525 DOI: 10.1016/j.ctro.2017.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy research has achieved remarkable progress in target volume definition. Advances in medical imaging facilitate more precise localization of the gross tumor volume, alongside a more detailed understanding of the geometric uncertainties associated with treatment delivery that has enabled robust safety margins to be customized to the specific treatment scenario at hand. By contrast, the clinical target volume, meant to encompass gross tumor, as well as, adjacent sub-clinical disease, has evolved very little. It is more often defined by clinician experience and institutional convention than on a patient-specific basis. This disparity arises from the inherent invisibility of sub-clinical disease in current medical imaging. Its incidence and expanse can only be ascertained via indirect means. This article reviews two such strategies: histopathological measurements on resection specimen and analyses of locoregional recurrences after radiotherapy.
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Affiliation(s)
- Rudi Apolle
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany
| | - Maximilian Rehm
- OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,Department of Radiation Oncology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany
| | - Thomas Bortfeld
- Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael Baumann
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,Department of Radiation Oncology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esther G C Troost
- Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany.,OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany.,Department of Radiation Oncology, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.,German Cancer Consortium (DKTK), Partner Site Dresden, Dresden, Germany.,National Center for Tumor Diseases (NCT), Partner Site Dresden, Dresden, Germany
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19
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Leeman JE, Rimner A, Montecalvo J, Hsu M, Zhang Z, von Reibnitz D, Panchoo K, Yorke E, Adusumilli PS, Travis W, Wu AJ. Histologic Subtype in Core Lung Biopsies of Early-Stage Lung Adenocarcinoma is a Prognostic Factor for Treatment Response and Failure Patterns After Stereotactic Body Radiation Therapy. Int J Radiat Oncol Biol Phys 2016; 97:138-145. [PMID: 27839909 DOI: 10.1016/j.ijrobp.2016.09.037] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/12/2016] [Accepted: 09/22/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) has emerged as an effective treatment for early-stage lung cancer. The histologic subtype of surgically resected lung adenocarcinoma is recognized as a prognostic factor, with the presence of solid or micropapillary patterns predicting poor outcomes. We describe the outcomes after SBRT for early-stage lung adenocarcinoma stratified by histologic subtype. METHODS AND MATERIALS We identified 119 consecutive patients (124 lesions) with stage I to IIA lung adenocarcinoma who had undergone definitive SBRT at our institution from August 2008 to August 2015 and had undergone core biopsy. Histologic subtyping was performed according to the 2015 World Health Organization classification. Of the 124 tumors, 37 (30%) were a high-risk subtype, defined as containing a component of solid and/or micropapillary pattern. The cumulative incidences of local, nodal, regional, and distant failure were compared between the high-risk and non-high-risk adenocarcinoma subtypes using Gray's test, and multivariable-adjusted hazard ratios (HRs) were estimated from propensity score-weighted Cox regression models. RESULTS The median follow-up for the entire cohort was 17 months and for surviving patients was 21 months. The 1-year cumulative incidence of and adjusted HR for local, nodal, regional, and distant failure in high-risk versus non-high-risk lesions was 7.3% versus 2.7% (HR 16.8; 95% confidence interval [CI] 3.5-81.4), 14.8% versus 2.6% (HR 3.8; 95% CI 0.95-15.0), 4.0% versus 1.2% (HR 20.9; 95% CI 2.3-192.3), and 22.7% versus 3.6% (HR 6.9; 95% CI 2.2-21.1), respectively. No significant difference was seen with regard to overall survival. CONCLUSIONS The outcomes after SBRT for early-stage adenocarcinoma of the lung correlate highly with histologic subtype, with micropapillary and solid tumors portending significantly higher rates of locoregional and metastatic progression. In this context, the histologic subtype determined from core biopsies is a prognostic factor and could have important implications for patient selection, adjuvant treatment, biopsy methods, and clinical trial design.
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Affiliation(s)
- Jonathan E Leeman
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Joseph Montecalvo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meier Hsu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Zhigang Zhang
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Donata von Reibnitz
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kelly Panchoo
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York.
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Value of volume-based early metabolic response in patients with unresectable thymic epithelial tumor. Lung Cancer 2016; 100:24-29. [PMID: 27597277 DOI: 10.1016/j.lungcan.2016.07.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/04/2016] [Accepted: 07/25/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We conducted this study to investigate the value of early metabolic responses assessed by (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in predicting prognosis and monitoring treatment response in patients with unresectable thymic epithelial tumors (TETs). PATIENTS AND METHODS Study subjects were selected from the prospective dataset of a phase II clinical trial for cisplatin plus Cremorphor EL-free paclitaxel. A total of thirty patients with unresectable TETs who underwent baseline and early post treatment scan after two cycles of chemotherapy were enrolled (22 Male; mean age 55.0±15.0years). Metabolic parameters including metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the tumor lesions were measured. RESULTS Multivariate analysis using Cox proportional hazards regression model showed that percent decrease of MTV (HR=0.995 by 1% decrease, P=0.037) and TLG (HR=0.996 by 1% decrease, P=0.044) were significant predictors of progression-free survival (PFS). Receiver operating characteristic curve identified an 88.0% decrease in MTV and a 92.0% decrease in TLG as the optimal cut-off value for disease progression. Responders with ≥88% of ΔMTV and ≥92% of Δ TLG had significantly longer PFS than non-responders (P=0.012, 0.026, respectively). CONCLUSION The percent decrease in MTV and TLG of tumor lesions measured by early post treatment FDG PET/CT significantly associated with disease progression in this study. Early metabolic response based on these volumetric parameters has the potential to monitor treatment response and predict prognosis in patients with unresectable TETs.
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Wu J, Aguilera T, Shultz D, Gudur M, Rubin DL, Loo BW, Diehn M, Li R. Early-Stage Non-Small Cell Lung Cancer: Quantitative Imaging Characteristics of (18)F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis. Radiology 2016; 281:270-8. [PMID: 27046074 DOI: 10.1148/radiol.2016151829] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose To identify quantitative imaging biomarkers at fluorine 18 ((18)F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials and Methods In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment (18)F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with early-stage NSCLC were identified. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Jia Wu
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Todd Aguilera
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - David Shultz
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Madhu Gudur
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Daniel L Rubin
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Billy W Loo
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Maximilian Diehn
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
| | - Ruijiang Li
- From the Department of Radiation Oncology (J.W., T.A., D.S., M.G., B.W.L., M.D., R.L.), Department of Radiology and Medicine (Biomedical Informatics Research) (D.L.R.), Stanford Cancer Institute (B.W.L., M.D., R.L.), and Institute for Stem Cell Biology and Regenerative Medicine (M.D.), Stanford University School of Medicine, 1070 Arastradero Rd, Palo Alto, CA 94304
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Kadota K, Nitadori JI, Sima CS, Ujiie H, Rizk NP, Jones DR, Adusumilli PS, Travis WD. Tumor Spread through Air Spaces is an Important Pattern of Invasion and Impacts the Frequency and Location of Recurrences after Limited Resection for Small Stage I Lung Adenocarcinomas. J Thorac Oncol 2016; 10:806-814. [PMID: 25629637 DOI: 10.1097/jto.0000000000000486] [Citation(s) in RCA: 399] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Tumor invasion in lung adenocarcinoma is defined as infiltration of stroma, blood vessels, or pleura. Based on observation of tumor spread through air spaces (STAS), we considered whether this could represent new patterns of invasion and investigated whether it correlated with locoregional versus distant recurrence according to limited resection versus lobectomy. METHODS We reviewed resected small (less than or equal to 2 cm) stage I lung adenocarcinomas (n = 411; 1995-2006). Tumor STAS was defined as tumor cells-micropapillary structures, solid nests, or single cells-spreading within air spaces in the lung parenchyma beyond the edge of the main tumor. Competing risks methods were used to estimate risk of disease recurrence and its associations with clinicopathological risk factors. RESULTS STAS was observed in 155 cases (38%). In the limited resection group (n = 120), the risk of any recurrence was significantly higher in patients with STAS-positive tumors than that of patients with STAS-negative tumors (5-year cumulative incidence of recurrence, 42.6% versus 10.9%; P < 0.001); the presence of STAS correlated with higher risk of distant (P = 0.035) and locoregional recurrence (P = 0.001). However, in the lobectomy group (n = 291), the presence of STAS was not associated with either any (P = 0.50) or distant recurrence (P = 0.76). In a multivariate analysis, the presence of tumor STAS remained independently associated with the risk of developing recurrence (hazard ratio, 3.08; P = 0.014). CONCLUSION The presence of STAS is a significant risk factor of recurrence in small lung adenocarcinomas treated with limited resection. These findings support our proposal that STAS should formally be recognized as a pattern of invasion in lung adenocarcinoma.
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Affiliation(s)
- Kyuichi Kadota
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY; Faculty of Medicine, Department of Diagnostic Pathology, Kagawa University, Kagawa, Japan
| | - Jun-Ichi Nitadori
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Camelia S Sima
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hideki Ujiie
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nabil P Rizk
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
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Nakamura H, Saji H, Marushima H, Kimura H, Tagaya R, Kurimoto N, Hoshikawa M, Takagi M. Standardized Uptake Values in the Primary Lesions of Non-Small-Cell Lung Cancer in FDG-PET/CT Can Predict Regional Lymph Node Metastases. Ann Surg Oncol 2015; 22 Suppl 3:S1388-93. [DOI: 10.1245/s10434-015-4564-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Indexed: 11/18/2022]
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Hong SP, Lee SE, Choi YL, Seo SW, Sung KS, Koo HH, Choi JY. Prognostic value of 18F-FDG PET/CT in patients with soft tissue sarcoma: comparisons between metabolic parameters. Skeletal Radiol 2014; 43:641-8. [PMID: 24531303 DOI: 10.1007/s00256-014-1832-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/12/2014] [Accepted: 01/20/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the relationship between volume-based PET parameters and prognosis in patients with soft tissue sarcoma (STS). METHODS We retrospectively reviewed 55 patients with pathologically proven STS who underwent pretreatment with (18) F-Fluorodeoxyglucose ((18)F-FDG) PET/CT. The maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of primary tumors were measured using a threshold SUV as liver activity for determining the boundary of tumors. Univariate and multivariate survival analyses for overall survival were performed according to the metabolic parameters and other clinical variables. RESULTS Cancer-related death occurred in 19 of 55 patients (35 %) during the follow-up period (29 ± 23 months). On univariate analysis, AJCC stage (stage IV vs. I-III, hazard ratio (HR) = 2.837, p = 0.028), necrosis (G2 vs. G0-G1, HR = 3.890, p = 0.004), SUVmax (1 unit - increase, HR = 1.146, p = 0.008), SUVavg (1 unit - increase, HR = 1.469, p = 0.032) and treatment modality (non-surgical therapy vs. surgery, HR = 4.467, p = 0.002) were significant predictors for overall survival. On multivariate analyses, SUVmax (HR = 1.274, p = 0.015), treatment modality (HR = 3.353, p = 0.019) and necrosis (HR = 5.985, p = 0.006) were identified as significant independent prognostic factors associated with decreased overall survival. CONCLUSIONS The SUVmax of the primary tumor is a significant independent metabolic prognostic factor for overall survival in patients with STS. Volume-based PET parameters may not add prognostic information outside of the SUVmax.
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Affiliation(s)
- Sun-pyo Hong
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Microscopic disease extensions as a risk factor for loco-regional recurrence of NSCLC after SBRT. Radiother Oncol 2013; 109:26-31. [DOI: 10.1016/j.radonc.2013.08.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Revised: 08/16/2013] [Accepted: 08/17/2013] [Indexed: 12/31/2022]
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Moon SH, Hyun SH, Choi JY. Prognostic significance of volume-based PET parameters in cancer patients. Korean J Radiol 2012; 14:1-12. [PMID: 23323025 PMCID: PMC3542291 DOI: 10.3348/kjr.2013.14.1.1] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 10/12/2012] [Indexed: 12/17/2022] Open
Abstract
Accurate prediction of cancer prognosis before the start of treatment is important since these predictions often affect the choice of treatment. Prognosis is usually based on anatomical staging and other clinical factors. However, the conventional system is not sufficient to accurately and reliably determine prognosis. Metabolic parameters measured by 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) have the potential to provide valuable information regarding prognosis and treatment response evaluation in cancer patients. Among these parameters, volume-based PET parameters such as metabolic tumor volume and total lesion glycolysis are especially promising. However, the measurement of these parameters is significantly affected by the imaging methodology and specific image characteristics, and a standard method for these parameters has not been established. This review introduces volume-based PET parameters as potential prognostic indicators, and highlights methodological considerations for measurement, potential implications, and prospects for further studies.
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Affiliation(s)
- Seung Hwan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A. Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging 2012; 40:290-301. [PMID: 23151913 DOI: 10.1007/s00259-012-2280-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/10/2012] [Indexed: 12/13/2022]
Abstract
Data available in patients suffering from squamous cell carcinoma of the head and neck, lung carcinoma, oesophageal carcinoma and gynaecological malignancies suggest that metabolic tumour volume and to a lesser extent total lesion glycolysis have the potential to become valuable in the imaging of human solid tumours as prognostic biomarkers for short- to intermediate-term survival outcomes, adding value to clinical staging, for assessment of response to treatment with neoadjuvant and concurrent chemotherapy, and for treatment optimization; for example, based on early treatment response assessment using changes in metabolic tumour volume over time, it might be possible to select patients who require a more aggressive treatment to improve their outcome. Prospective studies enrolling consecutive patients, adopting standardized protocols for FDG PET acquisition and processing, adjusting for potential confounders in the analysis (tumour size and origin) and determining the optimal methodology for determination of these novel markers are mandatory.
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Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, P7, University Hospital Ghent, De Pintelaan 185-B, 9000 Ghent, Belgium.
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Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer. Nucl Med Mol Imaging 2012; 46:286-93. [PMID: 24900076 DOI: 10.1007/s13139-012-0165-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 08/13/2012] [Accepted: 08/14/2012] [Indexed: 12/20/2022] Open
Abstract
PURPOSE This study aimed to further stratify prognostic factors in patients with stage IV non-small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS The subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F-18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were measured by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier survival curves were used for evaluation of progression-free survival (PFS). The univariate and multivariate Cox proportional hazards models were used to select the significant prognostic factors. RESULTS Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV-lung and TLG-lung) were significant factors for prediction of PFS (P < 0.001, P = 0.038, respectively). Patients showing lower values of MTV-lung and TLG-lung than the cutoff values had significantly longer mean PFS than those with higher values. Hazard ratios (95 % confidence interval) of MTV-lung and TLG-lung measured by univariate analysis were 6.4 (2.5-16.3) and 2.4 (1.0-5.5), respectively. Multivariate analysis revealed that MTV-lung was the only significant factor for prediction of prognosis. Hazard ratio was 13.5 (1.6-111.1, P = 0.016). CONCLUSION Patients with stage IV NSCLC could be further stratified into subgroups of significantly better and worse prognosis by MTV of primary lung lesion.
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Lee P, Kupelian P, Czernin J, Ghosh P. Current concepts in F18 FDG PET/CT-based radiation therapy planning for lung cancer. Front Oncol 2012; 2:71. [PMID: 22798989 PMCID: PMC3393879 DOI: 10.3389/fonc.2012.00071] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 06/25/2012] [Indexed: 11/13/2022] Open
Abstract
Radiation therapy is an important component of cancer therapy for early stage as well as locally advanced lung cancer. The use of F18 FDG PET/CT has come to the forefront of lung cancer staging and overall treatment decision-making. FDG PET/CT parameters such as standard uptake value and metabolic tumor volume provide important prognostic and predictive information in lung cancer. Importantly, FDG PET/CT for radiation planning has added biological information in defining the gross tumor volume as well as involved nodal disease. For example, accurate target delineation between tumor and atelectasis is facilitated by utilizing PET and CT imaging. Furthermore, there has been meaningful progress in incorporating metabolic information from FDG PET/CT imaging in radiation treatment planning strategies such as radiation dose escalation based on standard uptake value thresholds as well as using respiratory-gated PET and CT planning for improved target delineation of moving targets. In addition, PET/CT-based follow-up after radiation therapy has provided the possibility of early detection of local as well as distant recurrences after treatment. More research is needed to incorporate other biomarkers such as proliferative and hypoxia biomarkers in PET as well as integrating metabolic information in adaptive, patient-centered, tailored radiation therapy.
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Affiliation(s)
- Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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