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Bucknell NW, Hardcastle N, Bressel M, Moore A, Montgomery R, Murnane A, Mai GT, Ball D, Kron T, Siva S. Impact on Pulmonary Function in a Randomized Trial of Single-Fraction and Multifraction Stereotactic Body Radiation Therapy for Pulmonary Oligometastatic Disease: An Analysis of TROG 13.01 (SAFRON II). Int J Radiat Oncol Biol Phys 2024; 118:944-951. [PMID: 37871885 DOI: 10.1016/j.ijrobp.2023.09.052] [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: 07/21/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE The TROG 13.01 (SAFRON II) trial was a phase 2 multicenter trial comparing single-fraction (SF) and multifraction (MF) stereotactic body radiation therapy. Patients with 1 to 3 peripheral pulmonary oligometastases were randomized 1:1 between 28 Gy in 1 fraction and 48 Gy in 4 fractions. There were no differences between arms in efficacy or toxicity. We performed an analysis to assess changes in pulmonary function tests (PFTs) between arms over time and assessed the effect of the number and total volume of targets on PFT change over time. METHODS AND MATERIALS A linear mixed model was used to describe the PFTs by treatment arm over time. The effect of number and volume of targets on PFTs at 6 and 12 months was assessed by a simple linear model. RESULTS Ninety patients were randomized; 87 were treated for 133 pulmonary oligometastases. Forty-four were randomized to the SF arm and 43 to the MF arm. There were no differences in absolute or relative PFT measures of forced expiratory volume in 1 second (FEV1), diffusing capacity of the lungs for carbon monoxide (DLCO), or forced vital capacity (FVC) between the 2 arms. At 12 months, there was a reduction in absolute DLCO from baseline (-1.7 mL/min/mm Hg [95% CI, -2.5 to -1.0]), relative DLCO (-5.5% [95% CI, -8.4% to -2.6%]), absolute FEV1 (-0.17 L [95% CI, -0.23 to -0.11]), and absolute FVC (-0.20 L [95% CI, -0.27 to -0.13]). In patients with multiple pulmonary targets, increase in target number (per lesion) was associated with a reduction in the absolute FEV1 at 6 months of -0.10 L (95% CI, -0.18 to -0.03; P = .007), FEV1 at 12 months of -0.10 L (95% CI, -0.20 to -0.01; P = .04), FVC at 6 months of -0.11 L (95% CI, -0.20 to -0.03; P = .014), and FVC at 24 months of -0.13 L (95% CI, -0.25 to -0.01; P = .036). Reduction in FEV1 was also seen per 10-mL increase in PTV at 12 months (-0.03 L [95% CI, -0.06 to -0.00], P = .036). The number of targets and PTV were not associated with DLCO. CONCLUSIONS Treating multiple targets resulted in increased loss of FEV1 and FVC but not DLCO. There were no significant differences in PFT decline between SF and MF stereotactic body radiation therapy.
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Affiliation(s)
- Nicholas W Bucknell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alisha Moore
- TROG Cancer Research, Waratah, New South Wales, Australia
| | | | - Andrew Murnane
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Gang Tao Mai
- Department of Radiation Oncology, Princess Alexandria Hospital, Brisbane, Queensland, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Bensenane R, Helfre S, Cao K, Carton M, Champion L, Girard N, Glorion M, Vieira T, Waissi W, Crehange G, Beddok A. Optimizing lung cancer radiation therapy: A systematic review of multifactorial risk assessment for radiation-induced lung toxicity. Cancer Treat Rev 2024; 124:102684. [PMID: 38278078 DOI: 10.1016/j.ctrv.2024.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/27/2023] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Radiation therapy (RT) is essential in treating advanced lung cancer, but may lead to radiation pneumonitis (RP). This systematic review investigates the use of pulmonary function tests (PFT) and other parameters to predict and mitigate RP, thereby improving RT planning. METHODS A systematic review sifted through PubMed and on BioMed Central, targeting articles from September 2005 to December 2022 containing the keywords: Lung Cancer, Radiotherapy, and pulmonary function test. RESULTS From 1153 articles, 80 were included. RP was assessed using CTCAEv.4 in 30 % of these. Six studies evaluated post-RT quality of life in lung cancer patients, reporting no decline. Patients with RP and chronic obstructive pulmonary disease (COPD) generally exhibited poorer overall survival. Notably, forced expiratory volume in one second (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) declined 24 months post-RT, while forced vital capacity (FVC) stayed stable. In the majority of studies, age over 60, tumors located in the lower part of the lung, and low FEV1 before RT were associated with a higher risk of RP. Dosimetric factors (V5, V20, MLD) and metabolic imaging emerged as significant predictors of RP risk. A clinical checklist blending patient and tumor characteristics, PFT results, and dosimetric criteria was proposed for assessing RP risk before RT. CONCLUSION The review reveals the multifactorial nature of RP development following RT in lung cancer. This approach should guide individualized management and calls for a prospective study to validate these findings and enhance RP prevention strategies.
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Affiliation(s)
- Rayan Bensenane
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Sylvie Helfre
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Kim Cao
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | | | | | - Nicolas Girard
- Institut Curie, Department of Thoracic Oncology, Paris, France
| | | | - Thibaut Vieira
- Institut Mutualist Montsouris, Department of Pneumology, Paris, France
| | - Waisse Waissi
- Centre Léon Bérard, Department of Radiation Oncology, Lyon, France
| | - Gilles Crehange
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France
| | - Arnaud Beddok
- Institut Curie, PSL Research University, Radiation Oncology Department, Paris/Saint-Cloud/Orsay, France; Institut Curie, PSL Research University, University Paris Saclay, Inserm LITO, 91898 Orsay, France.
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Ahn J, Yeghiaian-Alvandi R, Hegi-Johnson F, Browne LH, Graham PH, Chin Y, Gee H, Vinod S, Ludbrook J, Last A, Dwyer P, Ong A, Aherne N, Azzi M, Hau E. SABR for Early Non-Small Cell Lung Cancer: Changes in Pulmonary Function, Dyspnea, and Quality of Life. Int J Radiat Oncol Biol Phys 2023; 117:1213-1221. [PMID: 37482136 DOI: 10.1016/j.ijrobp.2023.07.017] [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: 05/12/2023] [Revised: 06/29/2023] [Accepted: 07/14/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE The aim of this study was to report pulmonary function tests (PFTs) and clinician-reported and patient-reported quality-of-life (QoL) outcomes on a cohort of patients with non-small cell lung cancer (NSCLC) treated with SABR. METHODS AND MATERIALS A total of 119 patients with NSCLC were treated with SABR in the prospective cohort SSBROC study of patients with T1-T2N0M0 NSCLC. PFTs and QoL measures were obtained at baseline pretreatment and at 6-month intervals. Here we report on the 6- to 18-month time points. Analysis of covariance (ANCOVA) methods adjusting for baseline analyzed potential predictors on outcomes of PFTs and patient-reported dyspnea at 18 months. RESULTS The only statistically significant decline in PFTs was seen in forced expiratory volume in 1 second (FEV1) at 18 months post-SABR, with a decline of -0.11 L (P = .0087; 95% CI, -0.18 to -0.02). Of potential predictors of decline, only a 1-unit increase in smoking pack-years resulted in a -0.12 change in diffusing capacity for carbon monoxide (P = .026; 95% CI, -0.02 to -0.23) and a 0.003 decrease in FEV1 (P = .026; 95% CI, -0.006 to -0.0004). For patient-reported outcomes, statistically significant worsening in both the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire (QLQ-C30 Version 3) and the lung module (QLQ-LC13) dyspnea scores occurred at the 18-month time point, but not earlier. No potential predictors of worsening dyspnea were statistically significant. There was no statistically significant decline in clinician-reported outcomes or global QoL scores. CONCLUSIONS We found a statistically significant decline in FEV1 at 18 months posttreatment. Smoking pack-years was a predictor for decline in diffusing capacity for carbon monoxide and FEV1 at 18 months. Worsening of patient-reported dyspnea scores was observed, consistent with the expected progression of lung comorbid disease.
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Affiliation(s)
- Julie Ahn
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia.
| | - Roland Yeghiaian-Alvandi
- Department of Radiation Oncology, Nepean Cancer Centre, Sydney, New South Wales, Australia; Department of Radiation Oncology, Central Coast Cancer Centre, Gosford, New South Wales, Australia
| | - Fiona Hegi-Johnson
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Clinical Oncology, University of Melbourne, Victoria, Australia
| | - Lois H Browne
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia
| | - Peter Henry Graham
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Yaw Chin
- Department of Radiation Oncology, Cancer Care Centre, St George Hospital, Sydney, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia
| | - Harriet Gee
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia; Children's Medical Research Institute (CMRI), University of Sydney, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Radiation Oncology, Liverpool Cancer Therapy Centre, Liverpool Hospital, New South Wales, Australia
| | - Jane Ludbrook
- Department of Radiation Oncology, Calvary Mater Newcastle, New South Wales, Australia; School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Andrew Last
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Patrick Dwyer
- University of Sydney, Sydney, New South Wales, Australia; Department of Radiation Oncology, Northern NSW Cancer Institute, Lismore, New South Wales, Australia
| | - Anselm Ong
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia
| | - Noel Aherne
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Maria Azzi
- Department of Radiation Oncology, Nepean Cancer Centre, Sydney, New South Wales, Australia
| | - Eric Hau
- Sydney West Radiation Oncology Network (SWRON), Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia; Westmead Institute of Medical Research, Sydney, New South Wales, Australia
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Bucknell NW, Kron T, Herschtal A, Hardcastle N, Irving L, MacManus M, Hanna GG, Moore A, Murnane A, Siva S, Ball D. Comparison of Changes in Pulmonary Function After Stereotactic Body Radiation Therapy Versus Conventional 3-Dimensional Conformal Radiation Therapy for Stage I and IIA Non-Small Cell Lung Cancer: An Analysis of the TROG 09.02 (CHISEL) Phase 3 Trial. Int J Radiat Oncol Biol Phys 2023; 117:378-386. [PMID: 37087060 DOI: 10.1016/j.ijrobp.2023.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 04/24/2023]
Abstract
PURPOSE The TROG 09.02 CHISEL trial compared conventional radiation therapy (CRT) with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer. Patients randomized to SBRT had less local failure and improved overall survival. This analysis reports differences in pulmonary function tests (PFTs) and the 6-minute walk test (SMWT) between patients who received SBRT and those who received CRT. METHODS AND MATERIALS We analyzed the PFTs and SMWTs of all patients recruited to the CHISEL [trial. During this trial, patients underwent serial PFTs. Linear regression models were used to compare parameters between SBRT and CRT at 3 and 12 months after treatment. RESULTS One hundred and one patients were enrolled; 33 patients were treated with CRT, 61 were treated with SBRT, and 7 did not receive treatment. Primary tumor size was similar between arms: SBRT 25 mm (standard deviation [SD], 9) and CRT 28 mm (SD, 9). On regression analysis, at 3 and 12 months, there was no evidence of a difference between arms in PFT decline or distance walked in the SMWT. Planning target volume size was significantly larger in the CRT arm, 142.79 cc (SD, 61.14), compared with the SBRT group, 46.15 cc (SD, 23.39). The mean biologically effective dose received by the target was significantly larger in the SBRT group, 125.92 Gy (SD, 21.58), compared with CRT, 65.49 Gy (SD, 6.32). Mean dose to the lungs minus the gross target volume incorporating motion was 8.9 Gy (SD, 2.34) in the CRT group and 4.37 Gy (SD, 1.42) in the SBRT group. CONCLUSIONS Despite the considerably higher biologically effective doses delivered to the tumor in SBRT, there was no difference in decline in respiratory function observed between the 2 groups.
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Affiliation(s)
- Nicholas W Bucknell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Nicholas Hardcastle
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Alisha Moore
- TROG Cancer Research, Waratah, New South Wales, Australia
| | - Andrew Murnane
- ONTrac at Peter Mac, Victorian Adolescent and Young Adult Cancer Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Shankar Siva
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - David Ball
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
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Ghassemi N, Castillo R, Castillo E, Jones BL, Miften M, Kavanagh B, Werner-Wasik M, Miller R, Barta JA, Grills I, Leiby BE, Guerrero T, Rusthoven CG, Vinogradskiy Y. Evaluation of variables predicting PFT changes for lung cancer patients treated on a prospective 4DCT-ventilation functional avoidance clinical trial. Radiother Oncol 2023; 187:109821. [PMID: 37516361 PMCID: PMC10529225 DOI: 10.1016/j.radonc.2023.109821] [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: 01/24/2023] [Revised: 06/09/2023] [Accepted: 07/18/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE Functional avoidance radiotherapy uses functional imaging to reduce pulmonary toxicity by designing radiotherapy plans that reduce doses to functional regions of the lung. A phase-II, multi-center, prospective study of 4DCT-ventilation functional avoidance was completed. Pre and post-treatment pulmonary function tests (PFTs) were acquired and assessed pulmonary function change. This study aims to evaluate which clinical, dose and dose-function factors predict PFT changes for patients treated with 4DCT-ventilation functional avoidance radiotherapy. MATERIALS AND METHODS 56 patients with locally advanced lung cancer receiving radiotherapy were accrued. PFTs were obtained at baseline and three months following radiotherapy and included forced expiratory volume in 1-second (FEV1), forced vital capacity (FVC), and FEV1/FVC. The ability of patient, clinical, dose (lung and heart), and dose-function metrics (metrics that combine dose and 4DCT-ventilation-based function) to predict PFT changes were evaluated using univariate and multivariate linear regression. RESULTS Univariate analysis showed that only dose-function metrics and the presence of chronic obstructive pulmonary disease (COPD) were significant (p<0.05) in predicting FEV1 decline. Multivariate analysis identified a combination of clinical (immunotherapy status, presence of thoracic comorbidities, smoking status, and age), along with lung dose, heart dose, and dose-function metrics in predicting FEV1 and FEV1/FVC changes. CONCLUSION The current work evaluated factors predicting PFT changes for patients treated in a prospective functional avoidance radiotherapy study. The data revealed that lung dose- function metrics could predict PFT changes, validating the significance of reducing the dose to the functional lung to mitigate the decline in pulmonary function and providing guidance for future clinical trials.
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Affiliation(s)
- Nader Ghassemi
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Richard Castillo
- Department of Radiation Oncology, Emory University, Atlanta, GA, USA
| | | | - Bernard L Jones
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Moyed Miften
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brian Kavanagh
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria Werner-Wasik
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan Miller
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julie A Barta
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Inga Grills
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Benjamin E Leiby
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Thomas Guerrero
- Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI, USA
| | - Chad G Rusthoven
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yevgeniy Vinogradskiy
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA, USA.
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Yamamoto T, Kabus S, Bal M, Keall PJ, Moran A, Wright C, Benedict SH, Holland D, Mahaffey N, Qi L, Daly ME. Four-Dimensional Computed Tomography Ventilation Image-Guided Lung Functional Avoidance Radiation Therapy: A Single-Arm Prospective Pilot Clinical Trial. Int J Radiat Oncol Biol Phys 2023; 115:1144-1154. [PMID: 36427643 DOI: 10.1016/j.ijrobp.2022.11.026] [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: 07/19/2022] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The primary objective of this prospective pilot trial was to assess the safety and feasibility of lung functional avoidance radiation therapy (RT) with 4-dimensional (4D) computed tomography (CT) ventilation imaging. METHODS AND MATERIALS Patients with primary lung cancer or metastatic disease to the lungs to receive conventionally fractionated RT (CFRT) or stereotactic body RT (SBRT) were eligible. Standard-of-care 4D-CT scans were used to generate ventilation images through image processing/analysis. Each patient required a standard intensity modulated RT plan and ventilation image guided functional avoidance plan. The primary endpoint was the safety of functional avoidance RT, defined as the rate of grade ≥3 adverse events (AEs) that occurred ≤12 months after treatment. Protocol treatment was considered safe if the rates of grade ≥3 pneumonitis and esophagitis were <13% and <21%, respectively for CFRT, and if the rate of any grade ≥3 AEs was <28% for SBRT. Feasibility of functional avoidance RT was assessed by comparison of dose metrics between the 2 plans using the Wilcoxon signed-rank test. RESULTS Between May 2015 and November 2019, 34 patients with non-small cell lung cancer were enrolled, and 33 patients were evaluable (n = 24 for CFRT; n = 9 for SBRT). Median follow-up was 14.7 months. For CFRT, the rates of grade ≥3 pneumonitis and esophagitis were 4.2% (95% confidence interval, 0.1%-21.1%) and 12.5% (2.7%-32.4%). For SBRT, no patients developed grade ≥3 AEs. Compared with the standard plans, the functional avoidance plans significantly (P < .01) reduced the lung dose-function metrics without compromising target coverage or adherence to standard organs at risk constraints. CONCLUSIONS This study, representing one of the first prospective investigations on lung functional avoidance RT, demonstrated that the 4D-CT ventilation image guided functional avoidance RT that significantly reduced dose to ventilated lung regions could be safely administered, adding to the growing body of evidence for its clinical utility.
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Affiliation(s)
- Tokihiro Yamamoto
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California.
| | - Sven Kabus
- Department of Medical Image Processing & Analytics, Philips Research, Hamburg, Germany
| | | | - Paul J Keall
- ACRF Image X Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Angel Moran
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Cari Wright
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Stanley H Benedict
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
| | - Devin Holland
- Office of Clinical Research, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Nichole Mahaffey
- Office of Clinical Research, University of California Davis Comprehensive Cancer Center, Sacramento, California
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, California
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California
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Yamamoto T, Katsuta Y, Sato K, Tsukita Y, Umezawa R, Takahashi N, Suzuki Y, Takeda K, Kishida K, Omata S, Miyauchi E, Saito R, Kadoya N, Jingu K. Longitudinal analyses and predictive factors of radiation-induced lung toxicity-related parameters after stereotactic radiotherapy for lung cancer. PLoS One 2022; 17:e0278707. [PMID: 36459528 PMCID: PMC9718403 DOI: 10.1371/journal.pone.0278707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND PURPOSE The purpose of this prospective study was to investigate changes in longitudinal parameters after stereotactic radiotherapy for lung cancer and to identify possible pretreatment factors related to radiation-induced lung toxicity and the decline in pulmonary function after radiotherapy. MATERIALS AND METHODS Protocol-specified examinations, including 4-D CT, laboratory tests, pulmonary function tests (PFTs) and body composition measurements, were performed before SRT and at 1 month, 4 months and 12 months after stereotactic radiotherapy. Longitudinal differences were tested by using repeated-measures analysis of variance. Correlations were examined by using the Pearson product-moment correlation coefficient (r). RESULTS Sixteen patients were analyzed in this study. During a median follow-up period of 26.6 months, grade 1 and 2 lung toxicity occurred in 11 patients and 1 patient, respectively. The mean Hounsfield units (HU) and standard deviation (SD) of the whole lung, as well as sialylated carbohydrate antigen KL-6 (KL-6) and surfactant protein-D (SP-D), peaked at 4 months after radiotherapy (p = 0.11, p<0.01, p = 0.04 and p<0.01, respectively). At 4 months, lung V20 Gy (%) and V40 Gy (%) were correlated with changes in SP-D, whereas changes in the mean HU of the lung were related to body mass index and lean body mass index (r = 0.54, p = 0.02; r = 0.57, p = 0.01; r = 0.69, p<0.01; and r = 0.69, p<0.01, respectively). The parameters of PFTs gradually declined over time. When regarding the change in PFTs from pretreatment to 12 months, lung V5 Gy (cc) showed significant correlations with diffusion capacity for carbon monoxide (DLCO), DLCO/alveolar volume and the relative change in DLCO (r = -0.72, p<0.01; r = -0.73, p<0.01; and r = -0.63, p = 0.01, respectively). CONCLUSIONS The results indicated that some parameters peaked at 4 months, but PFTs were the lowest at 12 months. Significant correlations between lung V5 Gy (cc) and changes in DLCO and DLCO/alveolar volume were observed.
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Affiliation(s)
- Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
- * E-mail:
| | - Yoshiyuki Katsuta
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kiyokazu Sato
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoko Tsukita
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yu Suzuki
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keita Kishida
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - So Omata
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eisaku Miyauchi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryota Saito
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Noriyuki Kadoya
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Wolf C, Harkenrider M, Stang K, Wesolowski M, Alite F. Development of Radiographic Radiation Pneumonitis (RP) in Non-small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy (SBRT) May Be Protective Against Further Disease Progression. Cureus 2022; 14:e25994. [PMID: 35859984 PMCID: PMC9288130 DOI: 10.7759/cureus.25994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/12/2022] Open
Abstract
Objectives: Radiation pneumonitis (RP) is a local inflammatory response, and we hypothesize that RP serves as an immune stimulator and is a protective factor against disease progression. Methods: We analyzed patients with early-stage non-small cell lung cancer (NSCLC) treated with stereotactic body radiation therapy (SBRT) at two institutions. Radiographic RP (RRP) was evaluated and maximal axial dimensions were measured at three-, six-, and twelve-month timepoints with surveillance CT. RRP was measured using radiographic markers such as ground-glass opacities and airspace consolidation. Disease recurrence was evaluated and categorized as local, regional, and distant. Results: Seventy-seven unique patient records were randomly selected from the database, 72 patients (93.5%) had RRP and five patients (6.5%) did not. The median follow-up was 24.3 months (IQR: 12.0 - 41.9). Disease failure occurred in 28.6% of patients with 6.5% local only, 2.6% regional only, 7.8% distant only, and 11.7% with multiple recurrences. Patients with RRP demonstrated a lower rate of disease failure with 25.0% of those with RRP experiencing disease failure and 80% of those without RRP experiencing disease failure (p=0.02). Patients with RRP had a 71% reduced risk of disease recurrence, compared to patients with no RRP, after adjusting for maximum tumor dimension (HR 0.29, p = 0.05). Among patients with RRP, there was no significant difference in recurrence based on extent of RRP (maximal area of RRP on CT). RRP did not correlate with overall survival. Discussion: Most patients who received SBRT had RRP, and this study suggests that it may be protective of cancer recurrence. These results are hypothesis-generating and will need to be validated in larger and independent datasets.
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Park HS, Detterbeck FC, Madoff DC, Bade BC, Kumbasar U, Mase VJ, Li AX, Blasberg JD, Woodard GA, Brandt WS, Decker RH. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 4: systematic review of evidence involving SBRT and ablation. J Thorac Dis 2022; 14:2412-2436. [PMID: 35813762 PMCID: PMC9264060 DOI: 10.21037/jtd-21-1826] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation vs. resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT vs. surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation vs. surgery; there is less difference between ablation and SBRT. Conclusions A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation vs. resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
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Affiliation(s)
- Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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Cella L, Monti S, Thor M, Rimner A, Deasy JO, Palma G. Radiation-Induced Dyspnea in Lung Cancer Patients Treated with Stereotactic Body Radiation Therapy. Cancers (Basel) 2021; 13:cancers13153734. [PMID: 34359634 PMCID: PMC8345168 DOI: 10.3390/cancers13153734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Dyspnea is a common symptomatic side-effect of thoracic radiation therapy. The aim of this study is to build a predictive model of any-grade radiation-induced dyspnea within six months after stereotactic body radiation therapy in patients treated for non-small cell lung cancer. The occurrence of pre-treatment chronic obstructive pulmonary disease and higher relative lungs volume receiving more than 15 Gy as well as heart volume were shown to be risk factors for dyspnea. The obtained results encourage further studies on the topic, which could validate the present organ-based findings and explore the voxel-based landscape of radiation dose sensitivity in the development of dyspnea. Abstract In this study, we investigated the prognostic factors for radiation-induced dyspnea after hypo-fractionated radiation therapy (RT) in 106 patients treated with Stereotactic Body RT for Non-Small-Cell Lung Cancer (NSCLC). The median prescription dose was 50 Gy (range: 40–54 Gy), delivered in a median of four fractions (range: 3–12). Dyspnea within six months after SBRT was scored according to CTCAE v.4.0. Biologically Effective Dose (α/β = 3 Gy) volume histograms for lungs and heart were extracted. Dosimetric parameters along with patient-specific and treatment-related factors were analyzed, multivariable logistic regression method with Leave-One-Out (LOO) internal validation applied. Model performance was evaluated by the area under the receiver operating characteristic (ROC) curve (AUC) and calibration plot parameters. Fifty-seven patients (53.8%) out of 106 developed dyspnea of any grade after SBRT (25/57 grade ≥ 2 cases). A three-variable predictive model including patient comorbidity (COPD), heart volume and the relative lungs volume receiving more than 15 Gy was selected. The model displays an encouraging performance given by a training ROC-AUC = 0.71 [95%CI 0.61–0.80] and a LOO-ROC-AUC = 0.64 [95%CI 0.53–0.74]. Further modeling efforts are needed for dyspnea prediction in hypo-fractionated treatments in order to identify patients at high risk for developing lung toxicity more accurately.
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Affiliation(s)
- Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Napoli, Italy;
- Correspondence: (L.C.); (G.P.)
| | - Serena Monti
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Napoli, Italy;
| | - Maria Thor
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.T.); (J.O.D.)
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Joseph O. Deasy
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (M.T.); (J.O.D.)
| | - Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council, 80145 Napoli, Italy;
- Correspondence: (L.C.); (G.P.)
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11
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Yan P, Tong AN, Nie XL, Ma MG. Assessment of safety margin after microwave ablation of stage I NSCLC with three-dimensional reconstruction technique using CT imaging. BMC Med Imaging 2021; 21:96. [PMID: 34098894 PMCID: PMC8185913 DOI: 10.1186/s12880-021-00626-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 05/27/2021] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the ablative margin of microwave ablation (MWA) for stage I non-small cell lung cancer (NSCLC) using a three-dimensional (3D) reconstruction technique. Materials and methods We retrospectively analyzed 36 patients with stage I NSCLC lesions undergoing MWA and analyzed the relationship between minimal ablative margin and the local tumor progression (LTP) interval, the distant metastasis interval and disease-free survival (DFS). The minimal ablative margin was measured using the fusion of 3D computed tomography reconstruction technique. Results Univariate and multivariate analyses indicated that tumor size (hazard ratio [HR] = 1.91, P < 0.01; HR = 2.41, P = 0.01) and minimal ablative margin (HR = 0.13, P < 0.01; HR = 0.11, P < 0.01) were independent prognostic factors for the LTP interval. Tumor size (HR = 1.96, P < 0.01; HR = 2.35, P < 0.01) and minimal ablative margin (HR = 0.17, P < 0.01; HR = 0.13, P < 0.01) were independent prognostic factors for DFS by univariate and multivariate analyses. In the group with a minimal ablative margin < 5 mm, the 1-year and 2-year local progression-free rates were 35.7% and 15.9%, respectively. The 1-year and 2-year distant metastasis-free rates were 75.6% and 75.6%, respectively; the 1-year and 2-year disease-free survival rates were 16.7% and 11.1%, respectively. In the group with a minimal ablative margin ≥ 5 mm, the 1-year and 2-year local progression-free rates were 88.9% and 69.4%, respectively. The 1-year and 2-year distant metastasis-free rates were 94.4% and 86.6%, respectively; the 1-year and 2-year disease-free survival rates were 88.9% and 63.7%, respectively. The feasibility of 3D quantitative analysis of the ablative margins after MWA for NSCLC has been validated. Conclusions The minimal ablative margin is an independent factor of NSCLC relapse after MWA, and the fusion of 3D reconstruction technique can feasibly assess the minimal ablative margin. Supplementary Information The online version contains supplementary material available at 10.1186/s12880-021-00626-z.
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Affiliation(s)
- Peng Yan
- Department of Oncology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - An-Na Tong
- Department of Radiation, The 960th Hospital of the PLA Joint Logistics Support Force, Jinan, People's Republic of China
| | - Xiu-Li Nie
- Department of Radiology, Jinan Central Hospital Affiliated to Shandong University, Jinan, People's Republic of China
| | - Min-Ge Ma
- Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, People's Republic of China.
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12
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Bousabarah K, Blanck O, Temming S, Wilhelm ML, Hoevels M, Baus WW, Ruess D, Visser-Vandewalle V, Ruge MI, Treuer H, Kocher M. Radiomics for prediction of radiation-induced lung injury and oncologic outcome after robotic stereotactic body radiotherapy of lung cancer: results from two independent institutions. Radiat Oncol 2021; 16:74. [PMID: 33863358 PMCID: PMC8052812 DOI: 10.1186/s13014-021-01805-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 04/11/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To generate and validate state-of-the-art radiomics models for prediction of radiation-induced lung injury and oncologic outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT). METHODS Radiomics models were generated from the planning CT images of 110 patients with primary, inoperable stage I/IIa NSCLC who were treated with robotic SBRT using a risk-adapted fractionation scheme at the University Hospital Cologne (training cohort). In total, 199 uncorrelated radiomic features fulfilling the standards of the Image Biomarker Standardization Initiative (IBSI) were extracted from the outlined gross tumor volume (GTV). Regularized models (Coxnet and Gradient Boost) for the development of local lung fibrosis (LF), local tumor control (LC), disease-free survival (DFS) and overall survival (OS) were built from either clinical/ dosimetric variables, radiomics features or a combination thereof and validated in a comparable cohort of 71 patients treated by robotic SBRT at the Radiosurgery Center in Northern Germany (test cohort). RESULTS Oncologic outcome did not differ significantly between the two cohorts (OS at 36 months 56% vs. 43%, p = 0.065; median DFS 25 months vs. 23 months, p = 0.43; LC at 36 months 90% vs. 93%, p = 0.197). Local lung fibrosis developed in 33% vs. 35% of the patients (p = 0.75), all events were observed within 36 months. In the training cohort, radiomics models were able to predict OS, DFS and LC (concordance index 0.77-0.99, p < 0.005), but failed to generalize to the test cohort. In opposite, models for the development of lung fibrosis could be generated from both clinical/dosimetric factors and radiomic features or combinations thereof, which were both predictive in the training set (concordance index 0.71- 0.79, p < 0.005) and in the test set (concordance index 0.59-0.66, p < 0.05). The best performing model included 4 clinical/dosimetric variables (GTV-Dmean, PTV-D95%, Lung-D1ml, age) and 7 radiomic features (concordance index 0.66, p < 0.03). CONCLUSION Despite the obvious difficulties in generalizing predictive models for oncologic outcome and toxicity, this analysis shows that carefully designed radiomics models for prediction of local lung fibrosis after SBRT of early stage lung cancer perform well across different institutions.
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Affiliation(s)
- Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Cologne, Germany
| | - Oliver Blanck
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Kiel, Germany.,Saphir Radiosurgery Center Northern Germany, Guestrow, Germany
| | - Susanne Temming
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Maria-Lisa Wilhelm
- Saphir Radiosurgery Center Northern Germany, Guestrow, Germany.,Department of Radiation Oncology, University Medicine Rostock, Rostock, Germany
| | - Mauritius Hoevels
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology, University Hospital of Cologne, Cologne, Germany
| | - Daniel Ruess
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximilian I Ruge
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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13
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Takemoto S, Shibamoto Y, Hashizume C, Miyakawa A, Murai T, Yanagi T, Sugie C, Nagai A. Changes in pulmonary function and their correlation with dose-volume parameters in patients undergoing stereotactic body radiotherapy for lung cancer. JOURNAL OF RADIATION RESEARCH 2021; 62:338-345. [PMID: 33480428 PMCID: PMC7948829 DOI: 10.1093/jrr/rraa131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/13/2020] [Indexed: 06/12/2023]
Abstract
It is desirable to estimate the degree of the decrease in pulmonary function before lung stereotactic body radiation therapy (SBRT) especially for patients with poor pulmonary function. The purpose of this study was to investigate whether decreases in pulmonary function after SBRT may be predicted from radiation dose-volume parameters. A total of 70 patients undergoing SBRT were evaluated for changes in pulmonary function. Of these, 67 had primary lung cancer and 3 had lung metastasis. Twenty-six (37%) patients had chronic obstructive pulmonary disease. Pulmonary function tests (PFTs) were performed shortly before and at 18-24 months after SBRT. Radiation pneumonitis was Grade 2 in 10 patients and Grade 3 in 1. Mean forced vital capacity (FVC) decreased from 2.67 to 2.51 L (P < 0.01) and mean forced expiratory volume in 1 s (FEV1) decreased from 1.80 to 1.72 L (P < 0.01). Planning target volume (PTV) was correlated with changes in FVC. Changes in percent predicted FVC were correlated with %V5Gy (% of lung volume receiving > 5 Gy) and %V40Gy. Although the correlation was not significant, the %V20Gy value was the closest to the percent reduction in predicted FVC; %V20Gy of 10% tended to be associated with ~10% reduction in predicted FVC. Patients with poor pulmonary function did not necessarily show greater decreases in each PFT parameter. Decreases in FVC and FEV1 were within previously reported ranges. PTV was associated with decreases in FVC. The %V20Gy value was closest to the percentage decrease in predicted FVC.
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Affiliation(s)
- Shinya Takemoto
- Corresponding author. Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan. Tel: +81-52-853-8274; Fax: +81-52-852-5244; E-mail:
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Chisa Hashizume
- Nagoya Radiosurgery Center, Nagoya Kyoritsu Hospital, 1-172, Hokke, Nakagawa-ku, Nagoya, Aichi, 454-0933, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, 4-1-1, Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Taro Murai
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, 467-8601, Japan
| | - Takeshi Yanagi
- Narita Memorial Proton Center, 78 Shirakawa-cho, Toyohashi, Aichi, 441-8021, Japan
| | - Chikao Sugie
- Department of Radiology, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, Aichi, 466-8650, Japan
| | - Aiko Nagai
- Department of Radiation Oncology, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai, Aichi, 477-8522, Japan
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14
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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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15
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Falcinelli L, Mendichi M, Chierchini S, Tenti MV, Bellavita R, Saldi S, Ingrosso G, Reggioli V, Bini V, Aristei C. Pulmonary function in stereotactic body radiotherapy with helical tomotherapy for primary and metastatic lung lesions. Radiol Med 2020; 126:163-169. [PMID: 32415475 DOI: 10.1007/s11547-020-01223-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
AIMS This retrospective study reports outcomes after stereotactic body radiation therapy (SBRT) as delivered by helical tomotherapy (HT) for lung lesions. It promotes a dose escalation program. METHODS Histological and/or radiological findings and/or case histories identified 41 primary and 15 metastatic lesions. Thirty patients received 40 Gy in 5 fractions (BED 72 Gy10Gy) and 26 50 Gy in 5 fractions (BED 100Gy10Gy). Primary end point was lung toxicity. Secondary end points were respiratory function, local control and local progression-free survival. RESULTS Acute toxicity developed in 18/56 patients and late toxicity in 8/54. Median FEV-1 variations versus baseline were - 0.5% (range - 16 to + 43%) at 6 months and - 4.00% (range - 42 to + 18%) at 24 months. Median DLCO variations versus baseline were - 1% (range - 38 to + 36%) at 6 months and - 12.2% (range - 48 to + 11%) at 24 months. At 6 months, a significant positive correlation emerged between FEV-1 change and KPS (p = 0.047). At 24 months, a significant negative correlation emerged between FEV-1 change and the ipsilateral lung V5 (p = 0.006). A low baseline DLCO correlated with more marked DLCO worsening at 6 months (p = 0.012). At 24 months, DLCO worsening correlated significantly with the median contralateral lung dose (p = 0.003). At the last checkup, 23 patients were in complete remission, 16 were in partial remission, 5 had stable disease, and 7 were in relapse. Median follow-up was 12 months (range 5-56). CONCLUSIONS In patients with lung disease, SBRT, as delivered by HT, was well tolerated and provided good local control.
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Affiliation(s)
| | - Monia Mendichi
- Radiation Oncology Unit, University of Perugia, Perugia, Italia
| | - Sara Chierchini
- Radiation Oncology Unit, University of Perugia, Perugia, Italia.
| | | | - Rita Bellavita
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italia
| | - Simonetta Saldi
- Radiation Oncology Section, Perugia General Hospital, Perugia, Italia
| | - Gianluca Ingrosso
- Radiation Oncology Unit, University of Perugia and Perugia General Hospital, Perugia, Italia
| | | | - Vittorio Bini
- Endocrine and Metabolic Science Unit, University of Perugia, Perugia, Italia
| | - Cynthia Aristei
- Radiation Oncology Unit, University of Perugia and Perugia General Hospital, Perugia, Italia
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16
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Zhou Y, Yan T, Zhou X, Cao P, Luo C, Zhou L, Xu Y, Liu Y, Xue J, Wang J, Wang Y, Lu Y, Liang B, Gong Y. Acute severe radiation pneumonitis among non-small cell lung cancer (NSCLC) patients with moderate pulmonary dysfunction receiving definitive concurrent chemoradiotherapy: Impact of pre-treatment pulmonary function parameters. Strahlenther Onkol 2019; 196:505-514. [PMID: 31828393 DOI: 10.1007/s00066-019-01552-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE Severe acute radiation pneumonitis (SARP) is a life-threatening complication of thoracic radiotherapy. Pre-treatment pulmonary function (PF) may influence its incidence. We have previously reported on the incidence of SARP among patients with moderate pulmonary dysfunction who received definitive concurrent chemoradiotherapy (dCCRT) for non-small cell lung cancer (NSCLC). METHODS The clinical outcomes, dose-volume histograms (DVH), and PF parameters of 122 patients (forced expiratory volume in 1 s [FEV1%]: 60-69%) receiving dCCRT between 2013 and 2019 were recorded. SARP was defined as grade ≥3 RP occurring during or within 3 months after CCRT. Logistic regression, receiver operating characteristics curves (ROC), and hazard ratio (HR) analyses were performed to evaluate the predictive value of each factor for SARP. RESULTS Univariate and multivariate analysis indicated that the ratio of carbon monoxide diffusing capacity (DLCO%; odds ratio [OR]: 0.934, 95% confidence interval [CI] 0.896-0.974, p = 0.001) and mean lung dose (MLD; OR: 1.002, 95% CI 1.001-1.003, p = 0.002) were independent predictors of SARP. The ROC AUC of combined DLCO%/MLD was 0.775 (95% confidence interval [CI]: 0.688-0.861, p = 0.001), with a sensitivity and specificity of 0.871 and 0.637, respectively; this was superior to DLCO% (0.656) or MLD (0.667) alone. Compared to the MLD-low/DLCO%-high group, the MLD-high/DLCO%-low group had the highest risk for SARP, with an HR of 9.346 (95% CI: 2.133-40.941, p = 0.003). CONCLUSION The DLCO% and MLD may predict the risk for SARP among patients with pre-treatment moderate pulmonary dysfunction who receive dCCRT for NSCLC. Prospective studies are needed to validate our findings.
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Affiliation(s)
- Ying Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Tiansheng Yan
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Xiaojuan Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Peng Cao
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Chunli Luo
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Lin Zhou
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yong Xu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yongmei Liu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jianxin Xue
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Jin Wang
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Yongsheng Wang
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - You Lu
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Binmiao Liang
- Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, 610041, Chengdu, China
| | - Youling Gong
- Department of Thoracic Oncology and State Key Laboratory of Biotherapy, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China. .,Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, 610041, Chengdu, China.
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17
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Kaiss H, Mornex F. [Stereotactic radiotherapy of stage I non-small cell lung cancer. State of the art in 2019 and recommendations: Stereotaxy as an alternative to surgery?]. Cancer Radiother 2019; 23:720-731. [PMID: 31471255 DOI: 10.1016/j.canrad.2019.07.132] [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: 07/19/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/24/2022]
Abstract
Stereotactic radiotherapy (or Stereotactic body radiotherapy [SBRT]) is a technique currently well established in the therapeutic arsenal for the management of bronchial cancers. It represents the standard treatment for inoperable patients or who refuses surgery. It is well tolerated, especially in elderly and frail patients, and the current issue is to define its indications in operated patients, based on retrospective and randomized trials comparing stereotactic radiotherapy and surgery, with results equivalents. This work analyzes in detail the different aspects of pulmonary stereotactic radiotherapy and suggests arguments that help in the therapeutic choice between surgery and stereotaxic irradiation. In all cases, the therapeutic decision must be discussed in a multidisciplinary consultation meeting, while informing the patient of the possible therapeutic options.
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Affiliation(s)
- H Kaiss
- Département de radiothérapie oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
| | - F Mornex
- Département de radiothérapie oncologie, centre hospitalier Lyon-Sud, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
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18
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Palma G, Monti S, Thor M, Rimner A, Deasy JO, Cella L. Spatial signature of dose patterns associated with acute radiation-induced lung damage in lung cancer patients treated with stereotactic body radiation therapy. Phys Med Biol 2019; 64:155006. [PMID: 31261141 DOI: 10.1088/1361-6560/ab2e16] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic radiation therapy (RT) is often associated with lung side effects, whose etiology is still controversial. Our aim was to explore correlations between local dose in the thoracic anatomy and the radiation-induced lung damage (RILD). To this end, we designed a robust scheme for voxel-based analysis (VBA) to explore dose patterns associated with RILD in non-small-cell lung cancer (NSCLC) patients receiving stereotactic body RT (SBRT). We analyzed 106 NSCLC SBRT patients (median prescription dose: 50 Gy; range: [40-54] Gy) in 4 fractions (range: [3-5]) with clinical and dosimetric records suitable for the analysis. The incidence of acute G1 RILD (RTOG grade ⩾ 1) was 68%. Each planning CT and dose map was spatially normalized to a common anatomical reference using a B-spline inter-patient registration algorithm after masking the gross tumor volume. The tumor-subtracted dose maps were converted into biologically effective dose maps (α/β = 3 Gy). VBA was performed according to a non-parametric permutation test accounting for multiple comparison, based on a cluster analysis method. The underlying general linear model of RILD was designed to include dose maps and each non-dosimetric variable significantly correlated with RILD. The clusters of voxels with dose differences significantly correlated with RILD at a given p -level (S p ) were generated. The only non-dosimetric variable significantly correlated with RILD was the chronic obstructive pulmonary disease (p = 0.034). Patients with G1 RILD received significantly (p ⩽ 0.05) higher doses in two voxel clusters S 0.05 in the lower-left lung (14 cm3) and in an area (64 cm3) largely included within the ventricles. The applied VBA represents a powerful tool to probe the dose susceptibility of inhomogeneous organs in clinical radiobiology studies. The identified subregions with dose differences associated with G1 RILD in both the heart and lower lungs endorse a trend of previously reported hypotheses on lung toxicity radiobiology.
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Affiliation(s)
- Giuseppe Palma
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Via T. De Amicis, 95, 80145, Napoli, Italy. Author to whom any correspondence should be addressed
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19
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Bousabarah K, Temming S, Hoevels M, Borggrefe J, Baus WW, Ruess D, Visser-Vandewalle V, Ruge M, Kocher M, Treuer H. Radiomic analysis of planning computed tomograms for predicting radiation-induced lung injury and outcome in lung cancer patients treated with robotic stereotactic body radiation therapy. Strahlenther Onkol 2019; 195:830-842. [PMID: 30874846 DOI: 10.1007/s00066-019-01452-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 03/02/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To predict radiation-induced lung injury and outcome in non-small cell lung cancer (NSCLC) patients treated with robotic stereotactic body radiation therapy (SBRT) from radiomic features of the primary tumor. METHODS In all, 110 patients with primary stage I/IIa NSCLC were analyzed for local control (LC), disease-free survival (DFS), overall survival (OS) and development of local lung injury up to fibrosis (LF). First-order (histogram), second-order (GLCM, Gray Level Co-occurrence Matrix) and shape-related radiomic features were determined from the unprocessed or filtered planning CT images of the gross tumor volume (GTV), subjected to LASSO (Least Absolute Shrinkage and Selection Operator) regularization and used to construct continuous and dichotomous risk scores for each endpoint. RESULTS Continuous scores comprising 1-5 histogram or GLCM features had a significant (p = 0.0001-0.032) impact on all endpoints that was preserved in a multifactorial Cox regression analysis comprising additional clinical and dosimetric factors. At 36 months, LC did not differ between the dichotomous risk groups (93% vs. 85%, HR 0.892, 95%CI 0.222-3.590), while DFS (45% vs. 17%, p < 0.05, HR 0.457, 95%CI 0.240-0.868) and OS (80% vs. 37%, p < 0.001, HR 0.190, 95%CI 0.065-0.556) were significantly lower in the high-risk groups. Also, the frequency of LF differed significantly between the two risk groups (63% vs. 20% at 24 months, p < 0.001, HR 0.158, 95%CI 0.054-0.458). CONCLUSION Radiomic analysis of the gross tumor volume may help to predict DFS and OS and the development of local lung fibrosis in early stage NSCLC patients treated with stereotactic radiotherapy.
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Affiliation(s)
- Khaled Bousabarah
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Susanne Temming
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Mauritius Hoevels
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Jan Borggrefe
- Institute of Diagnostic and Interventional Radiology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang W Baus
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Daniel Ruess
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Maximilian Ruge
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Martin Kocher
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
- Department of Radiation Oncology, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Harald Treuer
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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20
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Scotti V, Bruni A, Francolini G, Perna M, Vasilyeva P, Loi M, Simontacchi G, Viggiano D, Lanfranchi B, Gonfiotti A, Topulli J, Olmetto E, Maragna V, Ferrari K, Bonti V, Comin C, Balduzzi S, D'Amico R, Lohr F, Voltolini L, Livi L. Stereotactic Ablative Radiotherapy as an Alternative to Lobectomy in Patients With Medically Operable Stage I NSCLC: A Retrospective, Multicenter Analysis. Clin Lung Cancer 2018; 20:e53-e61. [PMID: 30348595 DOI: 10.1016/j.cllc.2018.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stereotactic ablative body radiation therapy (SBRT) has evolved as the standard treatment for patients with inoperable stage I non-small-cell lung cancer (NSCLC). We report the results of a retrospective analysis conducted on a large, well-controlled cohort of patients with stage I to II NSCLC who underwent lobectomy (LOB) or SBRT. MATERIALS AND METHODS One hundred eighty-seven patients with clinical-stage T1a-T2bNoMO NSCLC were treated in 2 academic hospitals between August 2008 and May 2015. Patients underwent LOB or SBRT; those undergoing SBRT were sub-classified as surgical candidates and nonsurgical candidates, according to the presence of surgical contraindications or comorbidities. RESULTS In univariate analysis, no significant difference was found in local control between patients who underwent SBRT and LOB, with a trend in favor of surgery (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.07-1.01; P < .053). Univariate analysis showed that overall survival (OS) was significantly better in patients who underwent LOB (HR, 0.44; 95% CI, 0.23-0.85) with a 3-year OS of 73.4% versus 65.2% for surgery and radiation therapy patients, respectively (P < .01). However, no difference in OS was observed between operable patients undergoing SBRT and patients who underwent LOB (HR, 1.68; 95% CI, 0.72-3.90). Progression-free survival was comparable between patients who underwent LOB and SBRT (HR, 0.61; P = .09). CONCLUSION SBRT is a valid therapeutic approach in early-stage NSCLC. Furthermore, SBRT seems to be very well-tolerated and might lead to the same optimal locoregional control provided by surgery for patients with either operable or inoperable early-stage NSCLC.
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Affiliation(s)
- Vieri Scotti
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Alessio Bruni
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Giulio Francolini
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Marco Perna
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Polina Vasilyeva
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Mauro Loi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Gabriele Simontacchi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | | | - Biancaluisa Lanfranchi
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | | | - Juljana Topulli
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Emanuela Olmetto
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy.
| | - Virginia Maragna
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
| | - Katia Ferrari
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Viola Bonti
- Section of Respiratory Medicine, Careggi University Hospital, Florence, Italy
| | - Camilla Comin
- Department of Pathology, Careggi University Hospital, Florence, Italy
| | - Sara Balduzzi
- Department of Diagnostic, Clinical and Public Health Medicine, Modena and Reggio Emilia University Hospital, Modena, Italy
| | - Roberto D'Amico
- Department of Maternal-Infant and Adult Medical and Surgical Sciences, Research and Innovation Area, Modena and Reggio Emilia University Hospital, Modena, Italy
| | - Frank Lohr
- Radiotherapy Unit, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Luca Voltolini
- Thoracic Surgery Unit, Careggi University Hospital, Florence, Italy
| | - Lorenzo Livi
- Department of Oncology, Radiation Therapy Unit, Careggi University Hospital, Florence, Italy
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21
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Choi JI. Medically inoperable stage I non-small cell lung cancer: best practices and long-term outcomes. Transl Lung Cancer Res 2018; 8:32-47. [PMID: 30788233 DOI: 10.21037/tlcr.2018.06.11] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Early-stage non-small cell lung cancer (ES-NSCLC) currently represents a minority of all NSCLC diagnoses but, with ongoing refinement and improvement of treatment approaches, is a group with increasing likelihood of long-term disease control and survival. A significant proportion of this population will not be optimal candidates for definitive surgical resection due to tumor characteristics, patient frailty, or comorbid status. The clinical evidence to support the use of stereotactic body radiation therapy (SBRT) in patients with medically inoperable stage I NSCLC is growing as long-term data are obtained. In this review, initial workup, SBRT delivery considerations, recent trial data, and post-treatment surveillance of this population are discussed.
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Affiliation(s)
- J Isabelle Choi
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
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22
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De Ruysscher D, Lambrecht M, van Baardwijk A, Peeters S, Reymen B, Verhoeven K, Wanders R, Öllers M, van Elmpt W, van Loon J. Standard of care in high-dose radiotherapy for localized non-small cell lung cancer. Acta Oncol 2017; 56:1610-1613. [PMID: 28840754 DOI: 10.1080/0284186x.2017.1349337] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
- Radiation Oncology, KU Leuven, Leuven, Belgium
| | - Maarten Lambrecht
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Angela van Baardwijk
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stéphanie Peeters
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bart Reymen
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karolien Verhoeven
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rinus Wanders
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michel Öllers
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Wouter van Elmpt
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Judith van Loon
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
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23
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Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy? Eur Respir Rev 2017; 26:26/146/170079. [DOI: 10.1183/16000617.0079-2017] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/03/2017] [Indexed: 12/23/2022] Open
Abstract
Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.
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24
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Avanzo M, Barbiero S, Trovo M, Bissonnette JP, Jena R, Stancanello J, Pirrone G, Matrone F, Minatel E, Cappelletto C, Furlan C, Jaffray DA, Sartor G. Voxel-by-voxel correlation between radiologically radiation induced lung injury and dose after image-guided, intensity modulated radiotherapy for lung tumors. Phys Med 2017; 42:150-156. [PMID: 29173909 DOI: 10.1016/j.ejmp.2017.09.127] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 07/24/2017] [Accepted: 09/17/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To correlate radiation dose to the risk of severe radiologically-evident radiation-induced lung injury (RRLI) using voxel-by-voxel analysis of the follow-up computed tomography (CT) of patients treated for lung cancer with hypofractionated helical Tomotherapy. METHODS AND MATERIALS The follow-up CT scans from 32 lung cancer patients treated with various regimens (5, 8, and 25 fractions) were registered to pre-treatment CT using deformable image registration (DIR). The change in density was calculated for each voxel within the combined lungs minus the planning target volume (PTV). Parameters of a Probit formula were derived by fitting the occurrences of changes of density in voxels greater than 0.361gcm-3 to the radiation dose. The model's predictive capability was assessed using the area under receiver operating characteristic curve (AUC), the Kolmogorov-Smirnov test for goodness-of-fit, and the permutation test (Ptest). RESULTS The best-fit parameters for prediction of RRLI 6months post RT were D50 of 73.0 (95% CI 59.2.4-85.3.7)Gy, and m of 0.41 (0.39-0.46) for hypofractionated (5 and 8 fractions) and D50 of 96.8 (76.9-123.9)Gy, and m of 0.36 (0.34-0.39) for 25 fractions RT. According to the goodness-of-fit test the null hypothesis of modeled and observed occurrence of RRLI coming from the same distribution could not be rejected. The AUC was 0.581 (0.575-0.583) for fractionated and 0.579 (0.577-0.581) for hypofractionated patients. The predictive models had AUC>upper 95% band of the Ptest. CONCLUSIONS The correlation of voxel-by-voxel density increase with dose can be used as a support tool for differential diagnosis of tumor from benign changes in the follow-up of lung IMRT patients.
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Affiliation(s)
- Michele Avanzo
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy.
| | - Sara Barbiero
- Radiotherapy Department, Casa di Cura S. Rossore, Pisa, Italy
| | - Marco Trovo
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy; Radiation Oncology Department, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Jean-Pierre Bissonnette
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Rajesh Jena
- Department of Oncology, University of Cambridge, Cambridge CB2 0QQ, UK
| | | | - Giovanni Pirrone
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Fabio Matrone
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Emilio Minatel
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Cristina Cappelletto
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - Carlo Furlan
- Radiation Oncology Department, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
| | - David A Jaffray
- Department of Radiation Oncology, University of Toronto, Toronto, Canada; Department of Medical Physics, Princess Margaret Cancer Centre, Toronto, Canada
| | - Giovanna Sartor
- Medical Physics, Centro di Riferimento Oncologico IRCCS Aviano, 33081 Aviano, Italy
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25
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Hörner-Rieber J, Dern J, Bernhardt D, König L, Adeberg S, Verma V, Paul A, Kappes J, Hoffmann H, Debus J, Heussel CP, Rieken S. Parenchymal and Functional Lung Changes after Stereotactic Body Radiotherapy for Early-Stage Non-Small Cell Lung Cancer-Experiences from a Single Institution. Front Oncol 2017; 7:215. [PMID: 28975083 PMCID: PMC5610686 DOI: 10.3389/fonc.2017.00215] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/29/2017] [Indexed: 12/25/2022] Open
Abstract
Introduction This study aimed to evaluate parenchymal and functional lung changes following stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer (NSCLC) patients and to correlate radiological and functional findings with patient and treatment characteristics as well as survival. Materials and methods Seventy patients with early-stage NSCLC treated with SBRT from 2004 to 2015 with more than 1 year of CT follow-up scans were analyzed. Incidence, morphology, severity of acute and late lung abnormalities as well as pulmonary function changes were evaluated and correlated with outcome. Results Median follow-up time was 32.2 months with 2-year overall survival (OS) of 83% and local progression-free survival of 88%, respectively. Regarding parenchymal changes, most patients only developed mild to moderate CT abnormalities. Mean ipsilateral lung dose (MLD) in biological effective dose and planning target volume size were significantly associated with maximum severity score of parenchymal changes (p = 0.014, p < 0.001). Furthermore, both maximum severity score and MLD were significantly connected with OS in univariate analysis (p = 0.043, p = 0.025). For functional lung changes, we detected significantly reduced total lung capacity, forced expiratory volume in 1 s, and forced vital capacity (FVC) parameters after SBRT (p ≤ 0.001). Multivariate analyses revealed SBRT with an MLD ≥ 9.72 Gy and FVC reduction ≥0.54 L as independent prognostic factors for inferior OS (p = 0.029, p = 0.004). Conclusion SBRT was generally tolerated well with only mild toxicity. For evaluating the possible prognostic impact of MLD and FVC reduction on survival detected in this analysis, larger prospective studies are truly needed.
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Affiliation(s)
- Juliane Hörner-Rieber
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Julian Dern
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Denise Bernhardt
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Laila König
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Sebastian Adeberg
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Vivek Verma
- University of Nebraska Medical Center, Department of Radiation Oncology, Nebraska Medical Center, Omaha, NE, United States
| | - Angela Paul
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Jutta Kappes
- Department of Pneumology, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Hans Hoffmann
- Translational Research Unit, Thoraxklinik, Heidelberg University, Germany Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Thoracic Surgery, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Juergen Debus
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
| | - Claus P Heussel
- Translational Research Unit, Thoraxklinik, Heidelberg University, Germany Translational Lung Research Centre Heidelberg (TLRC-H), German Centre for Lung Research (DZL), Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, University-Hospital, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University-Hospital, Heidelberg, Germany
| | - Stefan Rieken
- Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology, Heidelberg, Germany
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26
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Prévention médicale et traitement des complications pulmonaires secondaires à la radiothérapie. Cancer Radiother 2017; 21:411-423. [DOI: 10.1016/j.canrad.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/13/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
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27
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Manapov F, Roengvoraphoj O, Li M, Eze C. Moderate hypofractionated image-guided thoracic radiotherapy for locally advanced node-positive non-small cell lung cancer patients with very limited lung function: a case report. Radiat Oncol J 2017; 35:180-184. [PMID: 28712277 PMCID: PMC5518457 DOI: 10.3857/roj.2017.00129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/05/2017] [Accepted: 05/29/2017] [Indexed: 12/16/2022] Open
Abstract
Patients with locally advanced lung cancer and very limited pulmonary function (forced expiratory volume in 1 second [FEV1] ≤ 1 L) have dismal prognosis and undergo palliative treatment or best supportive care. We describe two cases of locally advanced node-positive non-small cell lung cancer (NSCLC) patients with very limited lung function treated with induction chemotherapy and moderate hypofractionated image-guided radiotherapy (Hypo-IGRT). Hypo-IGRT was delivered to a total dose of 45 Gy to the primary tumor and involved lymph nodes. Planning was based on positron emission tomography-computed tomography (PET/ CT) and four-dimensional computed tomography (4D-CT). Internal target volume (ITV) was defined as the overlap of gross tumor volume delineated on 10 phases of 4D-CT. ITV to planning target volume margin was 5 mm in all directions. Both patients showed good clinical and radiological response. No relevant toxicity was documented. Hypo-IGRT is feasible treatment option in locally advanced node-positive NSCLC patients with very limited lung function (FEV1 ≤ 1 L).
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Affiliation(s)
- Farkhad Manapov
- Department of Radiation Oncology, Ludwig-Maximilian University of Munich, Germany
| | - Olarn Roengvoraphoj
- Department of Radiation Oncology, Ludwig-Maximilian University of Munich, Germany
| | - Minglun Li
- Department of Radiation Oncology, Ludwig-Maximilian University of Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, Ludwig-Maximilian University of Munich, Germany
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28
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Niezink AGH, de Jong RA, Muijs CT, Langendijk JA, Widder J. Pulmonary Function Changes After Radiotherapy for Lung or Esophageal Cancer: A Systematic Review Focusing on Dose-Volume Parameters. Oncologist 2017; 22:1257-1264. [PMID: 28550029 DOI: 10.1634/theoncologist.2016-0324] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/28/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite technical developments in treatment delivery, radiation-induced lung toxicity (RILT) remains a crucial problem in thoracic radiotherapy. Clinically based RILT scores have their limitations, and more objective measures such as pulmonary functions tests (PFTs) might help to improve treatment strategies. PURPOSE To summarize the available evidence about the effect of dose to the lung in thoracic radiotherapy on forced expiratory volume in one second (FEV1) and diffusion capacity (DLCO) in patients with lung and esophageal cancer treated with curative intent. MATERIAL AND METHODS A systematic review following the PRISMA guidelines was performed, using MEDLINE and including clinical studies using (chemo)radiotherapy (CRT) or stereotactic ablative radiotherapy (SABR) for lung or CRT for esophageal cancer that reported both lung dose-volume histogram (DVH) parameters and changes in PFT results. Search terms included lung and esophageal neoplasms, respiratory function tests, and radiotherapy. RESULTS Fifteen studies met the inclusion criteria. Seven out of 13 studies on lung cancer reported significant declines (defined as a p value < .05) in PFT results. Both esophageal studies reported significant DLCO declines. One SABR study found a correlation between low lung-dose parameters and FEV1 decline. Relations between decline of FEV1 (three studies) or decline of DLCO (five studies), respectively, and DVH parameters were found in eight studies analyzing CRT. Furthermore, a heterogeneous range of clinical risk factors for pulmonary function changes were reported in the selected studies. CONCLUSIONS There is evidence that pulmonary function declines after RT in a dose-dependent manner, but solid data about lung DVH parameters predicting changes in PFT results are scarce. A major disadvantage was the wide variety of methods used, frequently lacking multivariable analyses. Studies using prospective high-quality data, analyzed with appropriate statistical methods, are needed. The Oncologist 2017;22:1257-1264 IMPLICATIONS FOR PRACTICE: Radiation-induced lung toxicity remains crucial in thoracic radiotherapy. To prevent this toxicity in the future and individualize patient treatment, objective measures of pulmonary toxicity are needed. Pulmonary function tests may provide such objective measures. This systematic review, included all available clinical studies using external beam radiotherapy for lung or esophageal cancer reporting pulmonary function combined with dose-volume histogram parameters. There is preliminary evidence that pulmonary function declines post radiotherapy in a dose-dependent manner. Data quality and analyses were generally limited. Analyses of high-quality data are therefore urgently needed to improve individualization of advanced radiation therapy.
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Affiliation(s)
- Anne G H Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Renske A de Jong
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Christina T Muijs
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Joachim Widder
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiation Oncology, Medical University of Vienna, Vienna, Austria
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Binkley MS, King MT, Shrager JB, Bush K, Chaudhuri AA, Popat R, Gensheimer MF, Maxim PG, Henry Guo H, Diehn M, Nair VS, Loo BW. Pulmonary function after lung tumor stereotactic ablative radiotherapy depends on regional ventilation within irradiated lung. Radiother Oncol 2017; 123:270-275. [PMID: 28460826 DOI: 10.1016/j.radonc.2017.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/07/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE To determine if regional ventilation within irradiated lung volume predicts change in pulmonary function test (PFT) measurements after stereotactic ablative radiotherapy (SABR) of lung tumors. METHODS We retrospectively identified 27 patients treated from 2007 to 2014 at our institution who received: (1) SABR without prior thoracic radiation; (2) pre-treatment 4-dimensional computed tomography (4-D CT) imaging; (3) pre- and post-SABR PFTs <15months from treatment. We defined the ventilation ratio (VR20BED3) as the quotient of mean ventilation (mean Jacobian-based per-voxel volume change on deformably registered inhale/exhale 4-D CT phases) within the 20Gy biologically effective dose (α/β=3Gy) isodose volume and that of the total lung volume (TLV). RESULTS Most patients had moderate to very severe COPD by GOLD criteria (n=19, 70.1%). Higher VR20BED3 significantly predicted worse change in Forced Expiratory Volume/s normalized by baseline value (ΔFEV1/FEV1pre, p=0.04); n=7 had VR20BED3>1 (high regional ventilation) and worse ΔFEV1/FEV1pre (median=-0.16, range=-0.230 to -0.20). Five had VR20BED3<1 (low regional ventilation) and improved ΔFEV1/FEV1pre (median=0.13, range=0.07 to 0.20). In a multivariable linear model, increasing VR20BED3 and time to post-SABR PFT predicted decreasing ΔFEV1/FEV1pre (R2=0.25, p=0.03). CONCLUSIONS After SABR to high versus low functioning lung regions, we found worsened or improved global pulmonary function, respectively. If pre-SABR VR20BED3 is validated as a predictor of eventual post-SABR PFT in larger studies, it may be used for individualized treatment planning to preserve or even improve pulmonary function after SABR.
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Affiliation(s)
- Michael S Binkley
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Martin T King
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Joseph B Shrager
- Department of Cardiothoracic Surgery, Division of Thoracic Surgery, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Karl Bush
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Aadel A Chaudhuri
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Rita Popat
- Department of Health Research & Policy, Stanford University School of Medicine, United States
| | - Michael F Gensheimer
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States
| | - Peter G Maxim
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine, United States
| | - Maximilian Diehn
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Institute for Stem Cell Biology & Regenerative Medicine, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States
| | - Viswam S Nair
- Department of Radiology, Stanford University School of Medicine, United States; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford Cancer Institute and Department of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
| | - Billy W Loo
- Department of Radiation Oncology and Cancer Institute, Stanford University School of Medicine, United States; Stanford Cancer Institute and Department of Medicine, United States.
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30
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Falkson CB, Vella ET, Yu E, El-Mallah M, Mackenzie R, Ellis PM, Ung YC. Radiotherapy With Curative Intent in Patients With Early-stage, Medically Inoperable, Non–Small-cell Lung Cancer: A Systematic Review. Clin Lung Cancer 2017; 18:105-121.e5. [DOI: 10.1016/j.cllc.2016.10.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 12/23/2022]
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31
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Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal Tissue Constraints for Abdominal and Thoracic Stereotactic Body Radiotherapy. Semin Radiat Oncol 2017; 27:197-208. [PMID: 28577827 DOI: 10.1016/j.semradonc.2017.02.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Although stereotactic body radiotherapy (SBRT) or stereotactic ablative radiotherapy has become an established standard of care for the treatment of a variety of malignancies, our understanding of normal tissue dose tolerance with extreme hypofractionation remains immature. Since Timmerman initially proposed normal tissue dose constraints for SBRT in the 2008 issue of Seminars of Radiation Oncology, experience with SBRT has grown, and more long-term clinical outcome data have been reported. This article reviews the modern toxicity literature and provides updated clinically practical and useful recommendations of SBRT dose constraints for extracranial sites. We focus on the major organs of the thoracic and upper abdomen, specifically the liver and the lung.
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Affiliation(s)
- Erqi L Pollom
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Alexander L Chin
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Maximilian Diehn
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Billy W Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA.
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32
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Schröder C, Engenhart-Cabillic R, Vorwerk H, Schmidt M, Huhnt W, Blank E, Sidow D, Buchali A. Changes in pulmonary function and influencing factors after high-dose intrathoracic radio(chemo)therapy. Strahlenther Onkol 2016; 193:125-131. [PMID: 27783103 DOI: 10.1007/s00066-016-1067-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE Using prospectively collected patient-related, dose-related, and pulmonary function test (PFT) data before radiotherapy (RT) and at several follow-up visits after RT, the time course of PFT changes after high-dose radio(chemo)therapy and influencing factors were analyzed. MATERIALS AND METHODS From April 2012 to October 2015, 81 patients with non-small-cell lung carcinoma (NSCLC), small cell lung carcinoma (SCLC), or esophageal carcinoma where treated with high-dose radio(chemo)therapy. PFT data were collected before treatment and 6 weeks, 12 weeks, and 6 months after RT. The influence of patient- and treatment-related factors on PFT was analyzed. RESULTS Mean forced expiratory volume in 1 s (FEV1) constantly declined during follow-up (p = 0.001). In total, 68% of patients had a reduced FEV1 at 6 months. Mean vital capacity (VC) didn't change during follow-up (p > 0.05). Mean total lung capacity (TLC) showed a constant decline after RT (p = 0.026). At 6 months, 60% of patients showed a decline in VC and 73% in TLC. The mean diffusion capacity for carbon monoxide (DLCO) declined at 6 and 12 weeks, but recovered slightly at 6 months (p < 0.0005). At 6 months, 86% of patients had a reduced DLCO. After treatment, the partial pressure of CO2 in the blood (pCO2) was increased and pO2 was decreased (p > 0.05). Only the pretreatment PFT classification had a significant influence on the post-RT FEV1. CONCLUSION DLCO seems to be the most reliable indicator for lung tissue damage after thoracic RT. Ventilation parameters appear to be less reliable. Concerning patient- or treatment-related factors, no reliable conclusion can be drawn regarding which factors may be relevant.
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Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany. .,Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany.
| | - Rita Engenhart-Cabillic
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
| | - Hilke Vorwerk
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
| | - Michael Schmidt
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Winfried Huhnt
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Dietrich Sidow
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
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Nguyen NP, Godinez J, Shen W, Vinh-Hung V, Gorobets H, Thariat J, Ampil F, Vock J, Karlsson U, Chi A. Is surgery indicated for elderly patients with early stage nonsmall cell lung cancer, in the era of stereotactic body radiotherapy? Medicine (Baltimore) 2016; 95:e5212. [PMID: 27787380 PMCID: PMC5089109 DOI: 10.1097/md.0000000000005212] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/30/2016] [Accepted: 10/04/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The aim of this article is to assess the influence of comorbidities among elderly patients (at least 70 year old) undergoing surgery for early stage nonsmall cell lung cancer (NSCLC) and to explore the tolerability and efficacy of surgery in relation to stereotactic body radiotherapy (SBRT) in this patient population. METHODS A review of the literature on the prevalence of comorbidities among elderly patients with early stage NSCLC, and the impact of comorbidity factors on survival following surgery was conducted. Survival rates and the incidence of complications following SBRT for this patient population were also identified. RESULTS Comorbidities in elderly patients with early stage NSCLC may preclude surgery or lead to poor survival following surgery. However, chronological age alone should not be used as a deciding factor to deny curative treatment in elderly, but fit patients. Stereotactic body radiotherapy is well tolerated by elderly lung cancer patients and may result in survival rates similar to that following surgery. CONCLUSION SBRT should be the treatment of choice for early stage NSCLC in elderly patients with multiple comorbidities that preclude surgery. The roles of surgery and SBRT for elderly, -fit patients with early stage NSCLC needs to be further defined in future prospective trials.
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Affiliation(s)
- Nam P. Nguyen
- Department of Radiation Oncology, Howard University, Washington DC
| | - Juan Godinez
- Department of Radiation Oncology, Rochester General Hospital, Rochester, NY
| | - Wei Shen
- Division of Pulmonary Medicine, University of Arizona, Tucson, AZ
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University of Martinique, Martinique, France
| | - Helena Gorobets
- Department of Oral Maxillofacial Surgery, University of Kiev, Kiev, Ukraine
| | - Juliette Thariat
- Department of Radiation Oncology, University of Nice, Nice, France
| | - Fred Ampil
- Department of Radiation Oncology, Louisiana State University, Shreveport, Louisiana
| | - Jacqueline Vock
- Department of Radiation Oncology, Lindenhofspital, Bern, Switzerland
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic, Marshfield
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia, Morgantown, West Virginia
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Schröder C, Engenhart-Cabillic R, Vorwerk H, Schmidt M, Huhnt W, Blank E, Sidow D, Buchali A. A lot to a little or a little to a lot-which dose-volume relationship ensures the best clinical outcome in the high dose radiation therapy of thoracic tumors? A prospective approach. J Thorac Dis 2016; 8:2053-60. [PMID: 27621859 DOI: 10.21037/jtd.2016.07.92] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The purpose of this prospective randomized trial is to determine which constellation of dose and corresponding volume of the lung tissue-either a lot to a little or a little to a lot-should be preferred to ensure the best possible outcome for patients with thoracic carcinomas. METHODS From Apr 2012 to Oct 2015, 81 patients with NSCLC, SCLC or esophageal carcinoma were randomized and treated with either a 4-field-IMRT or a VMAT technique with or without additional chemotherapy. Data regarding clinical outcome, pulmonary function tests (PFT) and quality of life (QoL) was collected before RT, 6 weeks, 12 weeks and 6 months after treatment, QoL data additionally 1 year post RT. Follow up CTs were done 12 weeks and 6 months after RT. RESULTS There is no significant difference regarding the local (P=0.954) and distant (P=0.206) outcome, side effects (all P>0.05) or survival (P=0.633) at any follow-up appointment. The comparison of the PFT shows a statistically significant difference for the DLCO 6 weeks post RT (P=0.028). All other parameters do not differ significantly at any follow up appointment. Regarding the QoL there is no statistically significant difference at any follow up appointment (P>0.1). There is a statistically significant difference between the mean density of the lung parenchyma at 12 weeks (P<0.0005) and 6 months post RT (P<0.0005). CONCLUSIONS Since there is no significant and relevant difference between both treatment arms regarding PFT, clinical outcome and QoL it does not seem to relevant how the DVH is shaped exactly as long as established dose constraints for the organs at risk are respected. As to whether the difference between the CT density changes is clinically relevant further analysis is needed.
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Affiliation(s)
- Christina Schröder
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany;; Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Rita Engenhart-Cabillic
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
| | - Hilke Vorwerk
- Clinic for Radiotherapy and Radiation Oncology, University Clinic Giessen and Marburg, Marburg, Germany
| | - Michael Schmidt
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Winfried Huhnt
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Eyck Blank
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - Dietrich Sidow
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
| | - André Buchali
- Clinic for Radiotherapy and Radiation Oncology, Ruppiner Kliniken GmbH, Neuruppin, Germany
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Giuliani M, Sampson LR, Wong O, Gay J, Le LW, Cho BCJ, Brade A, Sun A, Bezjak A, Hope AJ. Prognostic value of pretreatment circulating neutrophils, monocytes, and lymphocytes on outcomes in lung stereotactic body radiotherapy. ACTA ACUST UNITED AC 2016; 23:e362-8. [PMID: 27536185 DOI: 10.3747/co.23.3051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE In the present study, we determined the association of pretreatment circulating neutrophils, monocytes, and lymphocytes with clinical outcomes after lung stereotactic body radiotherapy (sbrt). METHODS All patients with primary lung cancer and with a complete blood count within 3 months of lung sbrt from 2005 to 2012 were included. Overall survival (os) was calculated using the Kaplan-Meier method. Factors associated with os were investigated using univariable and multivariable Cox proportional hazards regression. Fine-Gray competing risk regression was performed to test the association of the neutrophil:lymphocyte (nlr) and monocyte:lymphocyte (mlr) ratios with two types of failure: disease-related failure and death, and death unrelated to disease. RESULTS Of the 299 sbrt patients identified, 122 were eligible for analysis. The median and range of the nlr and mlr were 3.0 (0.3-22.0) and 0.4 (0.1-1.9) respectively. On multivariable analysis, sex (p = 0.02), T stage (p = 0.04), and nlr (p < 0.01) were associated with os. On multivariable analysis, T stage (p < 0.01) and mlr (p < 0.01) were associated with disease-related failure; mlr (p = 0.03), nlr (p < 0.01), and sbrt dose of 48 Gy in 4 fractions (p = 0.03) and 54 Gy or 60 Gy in 3 fractions (p = 0.02) were associated with disease-unrelated death. Median survival was 4.3 years in the nlr≤3 group (95% confidence interval: 3.5 to not reached) and 2.5 years in the nlr>3 group (95% confidence interval: 1.7 to 4.8; p < 0.01). CONCLUSIONS In lung sbrt patients, nlr and mlr are independently associated with os and disease-unrelated death. If validated, nlr and mlr could help to identify patients who would benefit most from sbrt.
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Affiliation(s)
- M Giuliani
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - L R Sampson
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - O Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - J Gay
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | | | - B C J Cho
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Brade
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Sun
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A Bezjak
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - A J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON
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Navarro-Martin A, Aso S, Cacicedo J, Arnaiz M, Navarro V, Rosales S, de Blas R, Ramos R, Guedea F. Phase II Trial of SBRT for Stage I NSCLC: Survival, Local Control, and Lung Function at 36 Months. J Thorac Oncol 2016; 11:1101-11. [PMID: 27103512 DOI: 10.1016/j.jtho.2016.03.021] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The long-term impact of stereotactic body radiotherapy (SBRT) on respiratory function in patients with inoperable non-small cell lung cancer (NSCLC) has not been well studied. The aim of this phase II trial was to assess local control, survival, and lung function at 36 months after treatment. METHODS From July 2008 to February 2012, 42 patients in whom inoperable NSCLC with peripheral lesions was diagnosed were consecutively enrolled. Lung function testing included measurement of forced expiratory vital capacity, forced expiratory volume in 1 second, and diffusing capacity for carbon monoxide. All lung function parameters were registered at baseline and evaluated prospectively after SBRT every 6 months for 2 years and annually thereafter. RESULTS Of the 42 initial patients, four were excluded. At 36 months after SBRT, 22 patients were still evaluable (12 deaths and four patients lost to follow-up). At 36 months, the rate of local control was 94%. At 1, 2, and 3 years, respectively, overall survival rates were 92%, 75%, and 66%. Median overall survival was 57 months. Grade (G) 3 acute toxicity was observed in four patients (10%). Chronic G1 toxicity was observed in all 38 cases (100%), with the most common type being pneumonitis (26 patients [68%]). The mean lung function parameters at baseline and at 36 months after treatment were as follows: forced expiratory vital capacity 83% versus 79%; forced expiratory volume in 1 second 62% versus 57%; and diffusing capacity for carbon monoxide 54% versus 54%. These changes were not significant. CONCLUSIONS In this trial, local control and survival rates after SBRT were very good. Treatment with SBRT had no significant impact on lung function at 36 months. These findings provide further support for the use of SBRT as a radical treatment for NSCLC. Lung toxicity is minimal, even in patients with poor pulmonary function before treatment.
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Affiliation(s)
- Arturo Navarro-Martin
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Samantha Aso
- Department of Pneumology, Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jon Cacicedo
- Radiation Oncology Department, Cruces University Hospital, Barakaldo, Bizcaya, Spain
| | - Maria Arnaiz
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Valentin Navarro
- Medical Research Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Samuel Rosales
- Radiation Oncology Department, Hospital de Oncologia, National Medical Center XXI Century, Mexico City, Mexico
| | - Rodolfo de Blas
- Medical Physics Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ricard Ramos
- Thoracic Surgery Department, Bellvitge Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
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Schytte T, Bentzen SM, Brink C, Hansen O. Changes in pulmonary function after definitive radiotherapy for NSCLC. Radiother Oncol 2015; 117:23-8. [PMID: 26455451 DOI: 10.1016/j.radonc.2015.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 09/04/2015] [Accepted: 09/26/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The objective of this study was to identify factors associated with early and long-term pulmonary function (PF) changes after definitive radiotherapy for NSCLC patients. PF was measured by spirometry i.e. forced expiratory volume in 1s (FEV1), and forced vital capacity (FVC). MATERIALS Early (within the first year) PF change was analyzed in 211 patients with 986 pairs of PF-tests (PFTs). Long-term PF change was analyzed relative to the PF at 12months after radiotherapy in 106 patients (1286 PFTs). To investigate the impact of patient and treatment related factors on PF, they were tested as covariates in multivariable analysis. RESULTS Early PF change was quantified at six months after the start of radiotherapy. Smoking status and increasing V60 was associated with a significant decrease in PF, whereas smoking was protective. In addition, neoadjuvant chemotherapy had a negative impact on FVC. Long-term FEV1 and FVC were analyzed using linear regression. Treatment year and V60 had a significant impact on loss of FEV1. V60 had a significant impact on FVC changes. CONCLUSION In this study, early PF change reached a plateau at 6months after the start of radiotherapy for NSCLC. Large volume of lung receiving high dose was associated with long-term FEV1 change.
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Affiliation(s)
- Tine Schytte
- Department of Oncology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
| | - Søren M Bentzen
- Division of Biostatistics and Bioinformatics, University of Maryland Greenebaum Cancer Center and Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, USA
| | - Carsten Brink
- Laboratory of Radiation Physics, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Denmark; Institute of Clinical Research, University of Southern Denmark, Denmark
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Antoni D, Srour I, Mornex F. Cancer du poumon : radiothérapie en conditions stéréotaxiques et chirurgie. Cancer Radiother 2015; 19:371-6. [DOI: 10.1016/j.canrad.2015.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/15/2015] [Indexed: 12/17/2022]
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Li H, Zhang Z, Zhao X, Sun X, Ye C, Zhou X. Quantitative evaluation of radiation-induced lung injury with hyperpolarized xenon magnetic resonance. Magn Reson Med 2015; 76:408-16. [PMID: 26400753 DOI: 10.1002/mrm.25894] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/21/2015] [Accepted: 07/25/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE To demonstrate the feasibility of quantitative and comprehensive global evaluation of pulmonary function and microstructural changes in rats with radiation-induced lung injury (RILI) using hyperpolarized xenon MR. METHODS Dissolved xenon spectra were dynamically acquired using a modified chemical shift saturation recovery pulse sequence in five rats with RILI (bilaterally exposed by 6-MV x-ray with a dose of 14 Gy 3 mo. prior to MR experiments) and five healthy rats. The dissolved xenon signals were quantitatively analyzed, and the pulmonary physiological parameters were extracted with the model of xenon exchange. RESULTS The obtained pulmonary physiological parameters and the ratio of (129) Xe signal in red blood cells (RBCs) versus barrier showed a significant difference between the groups. In RILI rats versus controls, the exchange time increased from 44.5 to 112 ms, the pulmonary capillary transit time increased from 0.51 to 1.48 s, and the ratio of (129) Xe spectroscopic signal in RBCs versus barrier increased from 0.294 to 0.484. CONCLUSION Hyperpolarized xenon MR is effective for quantitative and comprehensive global evaluation of pulmonary function and structural changes without the use of radiation. This may open the door for its use in the diagnosis of lung diseases that are related to gas exchange. Magn Reson Med 76:408-416, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Haidong Li
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P. R. China
| | - Zhiying Zhang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P. R. China
| | - Xiuchao Zhao
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P. R. China
| | - Xianping Sun
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P. R. China
| | - Chaohui Ye
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P. R. China
| | - Xin Zhou
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, P. R. China
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The mean lung dose (MLD) : predictive criterion for lung damage? Strahlenther Onkol 2015; 191:557-65. [PMID: 25865281 DOI: 10.1007/s00066-015-0833-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/06/2015] [Indexed: 12/25/2022]
Abstract
AIM The purpose of this work was to prove the validity of the mean lung dose (MLD), widely used in clinical practice to estimate the lung toxicity of a treatment plan, by reevaluating experimental data from mini pigs. MATERIALS AND METHODS A total of 43 mini pigs were irradiated in one of four dose groups (25, 29, 33, and 37 Gy). Two regimens were applied: homogeneous irradiation of the right lung or partial irradiation of both lungs-including parts with lower dose-but with similar mean lung doses. The animals were treated with five fractions with a linear accelerator applying a CT-based treatment plan. The clinical lung reaction (breathing frequency) and morphological changes in CT scans were examined frequently during the 48 weeks after irradiation. RESULTS A clear dose-effect relationship was found for both regimens of the trial. However, a straightforward relationship between the MLD and the relative number of responders with respect to different grades of increased breathing frequency for both regimens was not found. A morphologically based parameter NTCPlung was found to be more suitable for this purpose. The dependence of this parameter on the MLD is markedly different for the two regimens. CONCLUSION In clinical practice, the MLD can be used to predict lung toxicity of a treatment plan, except for dose values that could lead to severe side effects. In the latter mentioned case, limitations to the predictive value of the MLD are possible. Such severe developments of a radiation-induced pneumopathy are better predicted by the NTCPlung formalism. The predictive advantage of this parameter compared to the MLD seems to remain in the evaluation and comparison of widely differing dose distributions, like in the investigated trial.
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Yamashita H, Takahashi W, Haga A, Nakagawa K. Radiation pneumonitis after stereotactic radiation therapy for lung cancer. World J Radiol 2014; 6:708-715. [PMID: 25276313 PMCID: PMC4176787 DOI: 10.4329/wjr.v6.i9.708] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 06/24/2014] [Accepted: 07/15/2014] [Indexed: 02/07/2023] Open
Abstract
Stereotactic body radiation therapy (SBRT) has a local control rate of 95% at 2 years for non-small cell lung cancer (NSCLC) and should improve the prognosis of inoperable patients, elderly patients, and patients with significant comorbidities who have early-stage NSCLC. The safety of SBRT is being confirmed in international, multi-institutional Phase II trials for peripheral lung cancer in both inoperable and operable patients, but reports so far have found that SBRT is a safe and effective treatment for early-stage NSCLC and early metastatic lung cancer. Radiation pneumonitis (RP) is one of the most common toxicities of SBRT. Although most post-treatment RP is Grade 1 or 2 and either asymptomatic or manageable, a few cases are severe, symptomatic, and there is a risk for mortality. The reported rates of symptomatic RP after SBRT range from 9% to 28%. Being able to predict the risk of RP after SBRT is extremely useful in treatment planning. A dose-effect relationship has been demonstrated, but suggested dose-volume factors like mean lung dose, lung V20, and/or lung V2.5 differed among the reports. We found that patients who present with an interstitial pneumonitis shadow on computed tomography scan and high levels of serum Krebs von den Lungen-6 and surfactant protein D have a high rate of severe radiation pneumonitis after SBRT. At our institution, lung cancer patients with these risk factors have not received SBRT since 2006, and our rate of severe RP after SBRT has decreased significantly since then.
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Kishan AU, Wang PC, Sheng K, Yu V, Ruan D, Cao M, Tenn S, Low DA, Lee P. Correlation of Clinical and Dosimetric Parameters With Radiographic Lung Injury Following Stereotactic Body Radiotherapy. Technol Cancer Res Treat 2014; 14:411-8. [PMID: 25261069 DOI: 10.1177/1533034614551476] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/28/2014] [Indexed: 12/25/2022] Open
Abstract
Radiographic changes occur in over half of patients treated with stereotactic body radiotherapy (SBRT) to the lung, correlating histopathologically with injury. We quantified radiographic density changes (ie, fibrosis) at 3, 6, and 12 months and investigated the relationship between these volumes and clinical and dosimetric parameters. The study population consisted of patients treated with SBRT to the lung for stage I primary lung cancers (n = 39) or oligometastatic lesions (n = 17). Fractionation schemes included 3 fractions of 12, 14, or 18 gray (Gy) and 4 fractions of 12 or 12.5 Gy prescribed to cover 95% of the planning target volume (PTV). Planning computed tomography (CT) scans were rigidly registered to follow-up CT scans obtained at intervals of 3, 6, and 12 months. Fibrotic volumes were contoured on the follow-up scans. Associations between the volume of fibrosis and clinical and dosimetric parameters were investigated using univariate linear regression. Scans were available for 65 and 47 lesions at 6 and 12 months, respectively. Age, years since quitting smoking, and GOLD Global Initiative for Chronic Obstructive Lung Disease score were significantly associated with increasing volume of fibrosis (P < .05). Total dose, dose per fraction, PTV, and volumetric parameters (V0-V55) were also significantly associated with increasing volumes of fibrosis (P < .01). For dosimetric parameters, the effect was largest for V55. Age, significant smoking history, and GOLD score were significantly associated with increasing volumes of fibrosis following SBRT. In a multivariate model adjusted for age and smoking history, V10 through V50 and PTV size remained significant predictors of fibrotic volume. Further, there is a strong dose-response relationship between the volume of lung exposed to a certain dose and the fibrotic volume. The predominant kinetic patterns of fibrosis demonstrate peaking fibrotic volumes at 6 and 12 months. These results provide insight for expectations of fibrosis after SBRT.
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Affiliation(s)
- Amar U Kishan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pin-Chieh Wang
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ke Sheng
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Victoria Yu
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dan Ruan
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Minsong Cao
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Stephen Tenn
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel A Low
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Percy Lee
- Department of Radiation Oncology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
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Antoni D, Srour I, Noël G, Mornex F. [Stereotactic ablative irradiation for lung cancer]. Cancer Radiother 2014; 18:297-307. [PMID: 24907006 DOI: 10.1016/j.canrad.2014.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 05/06/2014] [Indexed: 12/11/2022]
Abstract
Stereotactic radiotherapy for lung cancer is a technique that is now well established in the therapeutic arsenal. Protocols are effective, with very high local control rate and an acceptable rate of survival if one takes into account the patient's age and comorbidities. Complications are rare. This review of the literature analyses the whole process of the therapeutic indications and future prospects.
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Affiliation(s)
- D Antoni
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; EA 3430, laboratoire de radiobiologie, université de Strasbourg, 67000 Strasbourg, France.
| | - I Srour
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France
| | - G Noël
- Département universitaire de radiothérapie, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France; EA 3430, laboratoire de radiobiologie, université de Strasbourg, 67000 Strasbourg, France
| | - F Mornex
- Département de radiothérapie oncologique, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France; EA 3738, université Claude-Bernard Lyon-1, domaine Rockefeller, 8, avenue Rockefeller, 69373 Lyon cedex 08, France
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Westover KD, Timmerman R. Developments in stereotactic ablative radiotherapy for the treatment of early-stage lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Stereotactic ablative radiotherapy (SABR), also known as stereotactic body radiation therapy, has emerged as an effective treatment for inoperable early-stage non-small-cell lung cancer. SABR differs from conventional radiotherapy by virtue of its tight spatial tolerances and use of oligofractionated radiation. The modern technique is characterized by management of tumor motion, image guidance before each fraction and specialized radiation delivery techniques. The result is a highly conformal target dose with a sharp gradient that spares normal tissues with great accuracy. This enables delivery of very potent (ablative) doses, causing more rapid and durable responses than traditional radiation therapy treatment regimens can achieve. The established techniques, new developments and ongoing questions related to SABR for early-stage non-small-cell lung cancer are reviewed herein.
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Affiliation(s)
- Kenneth D Westover
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, TX 75390-9183, USA.
| | - Robert Timmerman
- Department of Radiation Oncology, University of Texas, Southwestern Medical Center, Dallas, TX 75390-9183, USA
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