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Bin Essa N, Kaplar Z, Balaji N, Alduraibi A, Bomanji J, Groves AM, Lilburn DML, Navani N, Fraioli F. PET/CT in treatment response assessment in lung cancer. When should it be recommended? Nucl Med Commun 2023; 44:1059-1066. [PMID: 37706268 DOI: 10.1097/mnm.0000000000001757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Non-small cell lung cancer (NSCLC) is the most common type of lung cancer. Different treatment options are now possible both for surgical candidates and for those NSCLC patients deemed not suitable for surgery. Despite the treatments available, only a limited number of less advanced stages are potentially curable, with many patients suffering local recurrence or distant metastases. FDG-PET/CT is commonly used in many centers for post-treatment evaluation, follow-up, or surveillance; Nonetheless, there is no clear consensus regarding the indications in these cases. Based upon the results of a literature review and local expertise from a large lung cancer unit, we built clinical evidence-based recommendations for the use of FDG-PET/CT in response assessment. We found that in general this is not recommended earlier than 3 months from treatment; however, as described in detail the correct timing will also depend upon the type of treatment used. We also present a structured approach to assessing treatment changes when reporting FDG-PET/CT, using visual or quantitative approaches.
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Affiliation(s)
- Noora Bin Essa
- Nuclear Medicine Department, Kuwait Cancer Control Center, Kuwait City, Kuwait,
| | - Zoltan Kaplar
- Institute of Nuclear Medicine, University College Hospital, London, UK,
| | - Nikita Balaji
- Institute of Nuclear Medicine, University College Hospital, London, UK,
| | - Alaa Alduraibi
- Department of Radiology, College of Medicine, Qassim University, Saudi Arabia and
| | - Jamshed Bomanji
- Institute of Nuclear Medicine, University College Hospital, London, UK,
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College Hospital, London, UK,
| | - David M L Lilburn
- Institute of Nuclear Medicine, University College Hospital, London, UK,
| | - Neal Navani
- Respiratory Medicine, University College Hospital, London, UK
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College Hospital, London, UK,
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2
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Sodji QH, Harris JP, Quon A, Modlin LA, Lau B, Jiang A, Trakul N, Maxim PG, Diehn M, Loo BW, Hiniker SM. Detection of Recurrence after Thoracic Stereotactic Ablative Radiotherapy Using FDG-PET-CT. Clin Lung Cancer 2022; 23:282-289. [DOI: 10.1016/j.cllc.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
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Imaging in Therapy Response Assessment and Surveillance of Lung Cancer: Evidenced-based Review With Focus on the Utility of 18F-FDG PET/CT. Clin Lung Cancer 2020; 21:485-497. [DOI: 10.1016/j.cllc.2020.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2020] [Accepted: 06/28/2020] [Indexed: 12/11/2022]
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Tan D, Gill S, Loh N. Timing of fluorodeoxyglucose positron emission tomography maximum standardized uptake value for diagnosis of local recurrence of non-small cell lung cancer after stereotactic body radiation therapy. Cancer Med 2020; 9:7469-7476. [PMID: 32846054 PMCID: PMC7571834 DOI: 10.1002/cam4.3302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/22/2020] [Accepted: 06/25/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction After treatment with stereotactic body radiation therapy (SBRT), local recurrence of non‐small cell cancer (NSCLC) can be difficult to differentiate from radiation‐induced changes. Maximum standardized uptake value (SUVmax), measured with 18‐F‐Fluorodeoxyglucose positron emission tomography (FDG‐PET), can have false positives due to acute radiation inflammation. The primary study objective was to determine the utility of SUVmax > 5 to identify local recurrence later than 9 months after SBRT. Method A retrospective review was performed of FDG‐PET scans for suspicious CT findings after SBRT treatment of stage 1 NSCLC. SUVmax was measured including surrounding opacification. Outcome measures were local recurrence, progression free survival, and overall survival. Receiver operator curve analysis, sensitivity, specificity, and Kaplan‐Meier analysis were performed. Results Of 118 patients treated, 42 patients had eligible FDG‐PET scans. They received SBRT (48‐60Gy in 3‐8 fractions) for 49 NSCLC and had 101 follow‐up PET scans. The median time to first PET scan was 9.3 months, and the median follow‐up period was 22.4 months. Local recurrence was diagnosed in 12 patients, at a median of 16 months. Due to selection bias, the included patients had poorer outcomes than the entire cohort, with progression free survival (PFS) at 1, 2, and 3 years of 82.7%, 57.8%, and 45.8%; and overall survival of 97.9%, 79.9%, and 59.1%, respectively. Thirty FDG‐PET scans were performed within 9 months, of which 17% were false positives. A total of 71 FDG‐PET scans were performed beyond 9 months, and the median SUVmax was significantly higher for patients with local recurrence (7.48 vs. 2.14, P < .0001). SUVmax > 5 has a sensitivity of 91% (95% CI 62%‐99.8%) and 100% (89.1%‐100%). Conclusion For local recurrence of NSCLC, SUVmax > 5 on FDG‐PET scan has good sensitivity and specificity after 6 months, but is highest beyond 9 months after SBRT.
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Affiliation(s)
- Daren Tan
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Suki Gill
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Nelson Loh
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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Mitchell KG, Nelson DB, Corsini EM, Correa AM, Erasmus JJ, Hofstetter WL, Mehran RJ, Roth JA, Swisher SG, Sepesi B, Walsh GL, Vaporciyan AA, Rice DC, Nguyen QN, Antonoff MB. Surveillance After Treatment of Non-Small-Cell Lung Cancer: A Call for Multidisciplinary Standardization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 15:57-65. [PMID: 31875755 DOI: 10.1177/1556984519886281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Though interest in expansion of the use of less-invasive therapies among operable non-small-cell lung cancer (NSCLC) patients is growing, it is not clear that post-treatment surveillance has been comparable between treatment modalities. We sought to characterize institutional surveillance patterns after NSCLC therapy with stereotactic body radiation therapy (SBRT) and lobectomy. METHODS NSCLC patients treated with lobectomy or SBRT (2005 to 2016) at a single institution were identified. Natural language processing searched data fields within axial surveillance imaging reports for findings suggestive of recurrence. Duration and patterns of institutional surveillance were compared between the 2 groups. RESULTS Three thousand forty-two patients (73.5% lobectomy, 26.5% SBRT) met inclusion criteria. Patients had a longer median duration of surveillance after lobectomy (28.0 months vs SBRT 12.3 months, P < 0.001) and were more likely to undergo histopathological evaluation of clinically suspected relapse (206/274 [75.2%] vs SBRT 54/113 [47.8%], P < 0.001). Patients with clinical suspicion of recurrence had longer durations of institutional surveillance than those who did not among both cohorts (lobectomy 44.4 months vs 25.9, P < 0.001; SBRT 27.9 vs 10.3, P < 0.001). Landmark analyses at 1 and 3 years after therapy identified associations between receipt of lobectomy and ongoing surveillance at each time point (1 year odds ratio [OR] 2.10, P < 0.001; 3 years OR 1.71, P < 0.001) among all patients and those with documented stage I disease. CONCLUSIONS We identified potential heterogeneity in institutional surveillance patterns after treatment of NSCLC with 2 therapeutic modalities. As less-invasive treatment options for operable patients expand, it will be critical to implement rigorous surveillance paradigms across all modalities.
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Affiliation(s)
- Kyle G Mitchell
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David B Nelson
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Erin M Corsini
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Arlene M Correa
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jeremy J Erasmus
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wayne L Hofstetter
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Reza J Mehran
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack A Roth
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Stephen G Swisher
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Boris Sepesi
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Garrett L Walsh
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ara A Vaporciyan
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Quynh-Nhu Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mara B Antonoff
- 4002 Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Moran A, Daly ME. Surveillance imaging for non-small cell lung cancer: mounting evidence that less is more. Transl Lung Cancer Res 2019; 8:S343-S346. [PMID: 32038911 DOI: 10.21037/tlcr.2019.05.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Angel Moran
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA
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Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors. Sci Rep 2019; 9:15498. [PMID: 31664125 PMCID: PMC6820864 DOI: 10.1038/s41598-019-51900-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/24/2019] [Indexed: 12/19/2022] Open
Abstract
Stereotactic body radiotherapy (SBRT) is a standard treatment for inoperable early-stage NSCLC, with local control rates comparable to surgical series. Promising results have been achieved utilizing a high single-dose schedule. The aim of our study was to evaluate long-term local control and toxicity in a series of patients treated with SBRT delivered in a single dose of 30 Gy. 44 patients affected by early stage NSCLC were treated with SBRT delivered in a single dose of 30 Gy. Survival and prognostic factors were retrospectively evaluated. Median follow-up was 34 months (range 3-81). Three- and 5-year local progression-free survival (LPFS) were 87.8% and 87.8% respectively (median 30 months; range 6-81 months), 3- and 5-year OS and CSS were 64.9% and 36.9%, 80.9% and 65.5%, respectively. Two (4.6%) cases of grade 3 pneumonitis occurred. At the univariate analysis lesion diameter ≤ 25 mm was predictive of better 5-year LPFS (95.8% versus 56.3%; p = 0.003) and 5-year PFS (69.8% versus 27.8%; p = 0.002). The results of our study indicated a high local control, survival and tolerability after a long-term follow-up with the use of SBRT 30 Gy single dose. Further prospective studies could better define the role of this regimen.
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Omballi M, Fernandez-Bussy S, Patel PP, Jantz MA, Becnel D, Patel NM, Mehta HJ. Surveillance Imaging After Curative Intent Therapy for Lung Cancer. Semin Roentgenol 2019; 55:60-69. [PMID: 31964482 DOI: 10.1053/j.ro.2019.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mohamed Omballi
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
| | | | - Priya P Patel
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Michael A Jantz
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
| | - David Becnel
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL
| | - Neal M Patel
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, University of Florida, Gainesville, FL.
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Mohan S, Beydoun N, Nasser E, Nguyen A, Shafiq J, Vinod S. Patterns of follow‐up care after curative radiotherapy ± chemotherapy for stage I–III non–small cell lung cancer. Asia Pac J Clin Oncol 2019; 15:172-180. [DOI: 10.1111/ajco.13127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/30/2018] [Indexed: 01/23/2023]
Affiliation(s)
- Sharanya Mohan
- South Western Sydney Clinical SchoolUniversity of NSW NSW Australia
| | - Nadine Beydoun
- St George Hospital Cancer Care Centre Kogarah NSW Australia
| | - Elias Nasser
- Illawarra Cancer Care Centre Wollongong NSW Australia
| | - Andrew Nguyen
- South Western Sydney Clinical SchoolUniversity of NSW NSW Australia
| | - Jesmin Shafiq
- South Western Sydney Clinical SchoolUniversity of NSW NSW Australia
- Ingham Institute for Applied Medical Research Liverpool NSW Australia
| | - Shalini Vinod
- South Western Sydney Clinical SchoolUniversity of NSW NSW Australia
- Cancer Therapy CentreLiverpool Hospital Liverpool NSW Australia
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IJsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg KCA, Lebenthal A, Ten Broek RPG. Survival After Stereotactic Body Radiation Therapy for Clinically Diagnosed or Biopsy-Proven Early-Stage NSCLC: A Systematic Review and Meta-Analysis. J Thorac Oncol 2019; 14:583-595. [PMID: 30721798 DOI: 10.1016/j.jtho.2018.12.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/30/2018] [Accepted: 12/01/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Stereotactic body radiation therapy (SBRT) is a promising curative treatment for early-stage NSCLC. It is unclear if survival outcomes for SBRT are influenced by a lack of pathological confirmation of malignancy and staging of disease in these patients. In this systematic review and meta-analysis, we assess survival outcomes after SBRT in studies with patients with clinically diagnosed versus biopsy-proven early-stage NSCLC. METHODS The main databases were searched for trials and cohort studies without restrictions to publication status or language. Two independent researchers performed the screening and selection of eligible studies. Outcomes were overall survival, cancer-specific survival, and disease-free survival. The inverse variance method and the random effects method for meta-analysis were used to assess pooled survival estimates. RESULTS A total of 11,195 nonduplicate records were identified by the original search strategy. After screening by title and abstract, 1051 potentially eligible records were identified. A total of 43 articles were included. The comparative studies showed lower 3-year overall survival and lower 2-year and 5-year cancer-specific survival for biopsy-proven disease compared to clinical disease. However, 5-year overall survival was the same for both groups. For the pooled estimates, 3-year disease-free survival and 2-year cancer-specific survival were lower for biopsied disease. CONCLUSIONS Results of this systematic review and meta-analysis show a discrepancy in oncological outcomes for patients undergoing SBRT for suspected early-stage NSCLC in whom there is pathologic conformation of malignancy and those who there is only a clinical diagnose of NSCLC. These results emphasize the importance of obtaining pathologic proof of malignancy.
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Affiliation(s)
- Michiel A IJsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Gelderland, Netherlands; Division of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, Massachusetts
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Gelderland, Netherlands
| | | | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, Gelderland, Netherlands; Division of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
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Amin NP, Nalichowski A, Campbell S, Hyder J, Spink R, Konski AA, Dominello M. Helical Therapy is Safe for Lung Stereotactic Body Radiation Therapy Despite Limitations in Achieving Sharp Dose Gradients. Technol Cancer Res Treat 2017; 16:1173-1178. [PMID: 29332448 PMCID: PMC5762086 DOI: 10.1177/1533034617740265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 08/15/2017] [Accepted: 09/29/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE We observed that many of our helical therapy lung stereotactic body radiation therapy plans did not meet the Radiation Therapy Oncology Group (RTOG) recommended R50% (volume of 50% of the prescription dose/planning target volume), which characterizes the steepness of dose fall off. We hypothesized that despite not meeting R50%, helical therapy lung stereotactic body radiation therapy plans would confer similar local control and minimal side effects as previously reported using nonhelical treatment platforms. MATERIALS AND METHODS We report a retrospective review of all consecutive patients treated off-protocol with stereotactic body radiation therapy for peripheral lung lesions from 2008 to 2013 utilizing helical therapy. Seventy-four patients (81 lesions and 79 plans) were treated with doses ranging from 48 to 60 Gy in 3 to 5 fractions prescribed to the edge of the planning target volume. RESULTS Forty-eight (61%) plans had major deviation from R50%. Only 1 (<1%) plan had a major deviation from the R100%. All plans had > 95% planning target volume coverage by prescription dose, 7(8.6%) plans with 121% to 133% maximum dose, and lung V20 Gy <10% in 70 (89%) plans. With a median follow-up of 4.7 years (95% confidence interval: 4.1-5.3), local control for all patients at 1, 2, and 5 years was 94.6%, 83.4%, and 74%, respectively. For patients with primary stage I-II lung cancer (n = 46), the 1, 2, and 5-year local control: 97.2%, 94.2%, and 86.9%; RC: 97.6%, 82.5%, and 69.5%; and DM: 3%, 16%, and 33.4%, respectively. Patients treated for lung metastases (n = 26) had worse local control at 1, 2, and 5 years: 94.4%, 69.3%, and 55.5%, respectively. Side effects were rare with 2 (3%) patients reporting chest wall pain and 6 (8%) patients experiencing radiation pneumonitis, including 1 patient who had grade 5 radiation pneumonitis. CONCLUSIONS Helical therapy delivers a safe and effective lung stereotactic body radiation therapy plan, despite not being able to meet RTOG's recommended R50 conformality constraint.
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Affiliation(s)
- Neha P. Amin
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA
| | - Adrian Nalichowski
- Division of Radiation Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Shauna Campbell
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Jal Hyder
- Division of Radiation Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA
| | - Robyn Spink
- Department of Radiation Oncology, Genesis Healthcare System, Zanesville, OH, USA
| | - Andre A. Konski
- Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Michael Dominello
- Division of Radiation Oncology, Department of Oncology, Wayne State University, Detroit, MI, USA
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Narsule CK, Sridhar P, Nair D, Gupta A, Oommen RG, Ebright MI, Litle VR, Fernando HC. Percutaneous thermal ablation for stage IA non-small cell lung cancer: long-term follow-up. J Thorac Dis 2017; 9:4039-4045. [PMID: 29268414 DOI: 10.21037/jtd.2017.08.142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Surgical resection is the most effective curative therapy for non-small cell lung cancer (NSCLC). However, many patients are unable to tolerate resection secondary to poor reserve or comorbid disease. Radiofrequency ablation (RFA) and microwave ablation (MWA) are methods of percutaneous thermal ablation that can be used to treat medically inoperable patients with NSCLC. We present long-term outcomes following thermal ablation of stage IA NSCLC from a single center. Methods Patients with stage IA NSCLC and factors precluding resection who underwent RFA or MWA from July 2005 to September 2009 were studied. CT and PET-CT scans were performed at 3 and 6 month intervals, respectively, for first 24 months of follow-up. Factors associated with local progression (LP) and overall survival (OS) were analyzed. Results Twenty-one patients underwent 21 RFA and 4 MWA for a total of 25 ablations. Fifteen patients had T1a and six patients had T1b tumors. Mean follow-up was 42 months, median survival was 39 months, and OS at three years was 52%. There was no significant difference in median survival between T1a nodules and T1b nodules (36 vs. 39 months, P=0.29) or for RFA and MWA (36 vs. 50 months, P=0.80). Ten patients had LP (47.6%), at a median time of 35 months. There was no significant difference in LP between T1a and T1b tumors (22 vs. 35 months, P=0.94) or RFA and MWA (35 vs. 17 months, P=0.18). Median OS with LP was 32 months compared to 39 months without LP (P=0.68). Three patients underwent repeat ablations. Mean time to LP following repeat ablation was 14.75 months. One patient had two repeat ablations and was disease free at 40-month follow-up. Conclusions Thermal ablation effectively treated or controlled stage IA NSCLC in medically inoperable patients. Three-year OS exceeded 50%, and LP did not affect OS. Therefore, thermal ablation is a viable option for medically inoperable patients with early stage NSCLC.
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Affiliation(s)
- Chaitan K Narsule
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Praveen Sridhar
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Divya Nair
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Avneesh Gupta
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Roy G Oommen
- Department of Surgery, Columbia University, NewYork-Presbytarian/Lawrence Hospital Center, Bronxville, NY, USA
| | - Michael I Ebright
- Section of Thoracic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Virginia R Litle
- Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Hiran C Fernando
- Division of Thoracic Surgery, Inova Fairfax Medical Center, Inova Schar Cancer Institute, Falls Church, VA, USA
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Dyer BA, Daly ME. Surveillance imaging following definitive radiotherapy for non-small cell lung cancer: What is the clinical impact? Semin Oncol 2017; 44:303-309. [PMID: 29580432 PMCID: PMC5903453 DOI: 10.1053/j.seminoncol.2018.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 01/31/2018] [Indexed: 12/17/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide. Recurrence rates at all stages are high, but evidence-based post-treatment surveillance imaging strategies to detect recurrence are poorly defined, and salvage options are frequently limited. A number of national and international oncology guidelines address post-treatment imaging, but are largely based on low-level, retrospective evidence because of a paucity of high-quality data, particularly in regard to cost-effectiveness and quality-of-life endpoints. Given the lack of randomized data addressing appropriate surveillance imaging modality and interval following definitive treatment of lung cancer, there remains an unmet clinical need. Meaningful surveillance endpoints should include the financial impact, patient quality-of-life outcomes, and access-to-care issues associated with intensive follow-up to ensure that guidelines reflect quality and sustainability. A need for prospective randomized data on the subject of imaging surveillance after definitive local therapy remains an unmet need, and an opportunity for collaboration and further research.
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Affiliation(s)
- Brandon A Dyer
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
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Chi A, Chen H, Wen S, Yan H, Liao Z. Comparison of particle beam therapy and stereotactic body radiotherapy for early stage non-small cell lung cancer: A systematic review and hypothesis-generating meta-analysis. Radiother Oncol 2017; 123:346-354. [PMID: 28545956 DOI: 10.1016/j.radonc.2017.05.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 03/28/2017] [Accepted: 05/05/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To assess hypo-fractionated particle beam therapy (PBT)'s efficacy relative to that of photon stereotactic body radiotherapy (SBRT) for early stage (ES) non-small cell lung cancer (NSCLC). METHODS Eligible studies were identified through extensive searches of the PubMed, Medline, Google-scholar, and Cochrane library databases from 2000 to 2016. Original English publications of ES NSCLC were included. A meta-analysis was performed to compare the survival outcome, toxicity profile, and patterns of failure following each treatment. RESULTS 72 SBRT studies and 9 hypo-fractionated PBT studies (mostly single-arm) were included. PBT was associated with improved overall survival (OS; p=0.005) and progression-free survival (PFS; p=0.01) in the univariate meta-analysis. The OS benefit did not reach its statistical significance after inclusion of operability into the final multivariate meta-analysis (p=0.11); while the 3-year local control (LC) still favored PBT (p=0.03). CONCLUSION Although hypo-fractionated PBT may lead to additional clinical benefit when compared with photon SBRT, no statistically significant survival benefit from PBT over SBRT was observed in the treatment of ES NSCLC in this hypothesis-generating meta-analysis after adjusting for potential confounding variables.
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Affiliation(s)
- Alexander Chi
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China.
| | - Haiquan Chen
- Department of Thoracic Surgery, Fudan University Shanghai Cancer Center, China
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, USA.
| | - Haijuan Yan
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, USA
| | - Zhongxing Liao
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
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Nodal recurrence after stereotactic body radiotherapy for early stage non-small cell lung cancer: Incidence and proposed risk factors. Cancer Treat Rev 2017; 56:8-15. [PMID: 28437679 DOI: 10.1016/j.ctrv.2017.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/30/2017] [Accepted: 04/02/2017] [Indexed: 12/15/2022]
Abstract
Stereotactic body radiotherapy (SBRT) is an alternative to surgery for patients with early stage non-small cell lung cancer (NSCLC) who are inoperable due to comorbid disease or who refuse surgery. SBRT results in an excellent local control rate of more than 90%, which is comparable to surgery, while short and long-term overall toxicity is low. Surgically treated patients are often more extensively staged pre-operatively, e.g. with endobronchial ultrasound and/or mediastinoscopy, and typically undergo intra-operative lymph node dissection or sampling. Occult nodal metastases (ONM), detected by lymph node dissection, have been shown to increase the incidence of regional recurrence (RR) after surgery, which is associated with poor outcome. In patients undergoing SBRT, however, definite pathological nodal staging is lacking and so other ways to identify patients at high risk for ONM and RR are desirable. The aim of this systematic review is to summarize the incidence of, and risk factors for, RR after SBRT and compare these to those after surgery. The available evidence shows the incidence of RR after SBRT or surgery to be comparable, despite more elaborate pre- and intra-operative lymph node evaluation in surgical patients. However, the fact that this finding is based on mostly retrospective studies in which the majority of patients treated with SBRT were inoperable, needs to be taken into consideration. For now, there is no evidence that inoperable clinical stage I patients with no indication of pathological lymph nodes on PET/CT will benefit from more invasive lymph node staging prior to SBRT.
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Sheikhbahaei S, Mena E, Yanamadala A, Reddy S, Solnes LB, Wachsmann J, Subramaniam RM. The Value of FDG PET/CT in Treatment Response Assessment, Follow-Up, and Surveillance of Lung Cancer. AJR Am J Roentgenol 2017; 208:420-433. [PMID: 27726427 DOI: 10.2214/ajr.16.16532] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The purpose of this article is to summarize the evidence regarding the role of FDG PET/CT in treatment response assessment and surveillance of lung cancer and to provide suggested best practices. CONCLUSION FDG PET/CT is a valuable imaging tool for assessing treatment response for patients with lung cancer, though evidence for its comparative effectiveness with chest CT is still evolving. FDG PET/CT is most useful when there is clinical suspicion or other evidence for disease recurrence or metastases. The sequencing, cost analysis, and comparative effectiveness of FDG PET/CT and conventional imaging modalities in the follow-up setting need to be investigated.
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Affiliation(s)
- Sara Sheikhbahaei
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Esther Mena
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Anusha Yanamadala
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Siddaling Reddy
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Lilja B Solnes
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
| | - Jason Wachsmann
- 2 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Rathan M Subramaniam
- 1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD
- 2 Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
- 3 Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, TX
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Simone CB, Houshmand S, Kalbasi A, Salavati A, Alavi A. PET-Based Thoracic Radiation Oncology. PET Clin 2016; 11:319-32. [DOI: 10.1016/j.cpet.2016.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Sawada S, Suehisa H, Ueno T, Sugimoto R, Yamashita M. Monitoring and management of lung cancer patients following curative-intent treatment: clinical utility of 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography. LUNG CANCER-TARGETS AND THERAPY 2016; 7:45-51. [PMID: 28210160 PMCID: PMC5310700 DOI: 10.2147/lctt.s83644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A large number of studies have demonstrated that 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) is superior to conventional modalities for the diagnosis of lung cancer and the evaluation of the extent of the disease. However, the efficacy of PET/CT in a follow-up surveillance setting following curative-intent treatments for lung cancer has not yet been established. We reviewed previous papers and evaluated the potential efficacy of PET-CT in the setting of follow-up surveillance. The following are our findings: 1) PET/CT is considered to be superior or equivalent to conventional modalities for the detection of local recurrence. However, inflammatory changes and fibrosis after treatments in local areas often result in false-positive findings; 2) the detection of asymptomatic distant metastasis is considered to be an advantage of PET/CT in a follow-up setting. However, it should be noted that detection of brain metastasis with PET/CT has some limitation, similar to its use in pretreatment staging; 3) additional radiation exposure and higher medical cost arising from the use of PET/CT should be taken into consideration, particularly in patients who might not have cancer after curative-intent treatment and are expected to have a long lifespan. The absence of any data regarding survival benefits and/or improvements in quality of life is another critical issue. In summary, PET/CT is considered to be more accurate and sensitive than conventional modalities for the detection of asymptomatic recurrence after curative-intent treatments. These advantages could modify subsequent management in patients with suspected recurrence and might contribute to the selection of appropriate treatments for recurrence. Therefore, PET/CT may be an alternative to conventional follow-up modalities. However, several important issues remain to be solved. PET/CT in a follow-up surveillance setting is generally not recommended in clinical practice at the moment.
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Affiliation(s)
- Shigeki Sawada
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hiroshi Suehisa
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Ryujiro Sugimoto
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Motohiro Yamashita
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
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Knoll MA, Salvatore M, Sheu RD, Knoll AD, Kerns SL, Lo YC, Rosenzweig KE. The use of isodose levels to interpret radiation induced lung injury: a quantitative analysis of computed tomography changes. Quant Imaging Med Surg 2016; 6:35-41. [PMID: 26981453 DOI: 10.3978/j.issn.2223-4292.2016.02.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients treated with stereotactic body radiation therapy (SBRT) for lung cancer are often found to have radiation-induced lung injury (RILI) surrounding the treated tumor. We investigated whether treatment isodose levels could predict RILI. METHODS Thirty-seven lung lesions in 32 patients were treated with SBRT and received post-treatment follow up (FU) computed tomography (CT). Each CT was fused with the original simulation CT and treatment isodose levels were overlaid. The RILI surrounding the treated lesion was contoured. The RILI extension index [fibrosis extension index (FEI)] was defined as the volume of RILI extending outside a given isodose level relative to the total volume of RILI and was expressed as a percentage. RESULTS Univariate analysis revealed that the planning target volume (PTV) was positively correlated with RILI volume at FU: correlation coefficient (CC) =0.628 and P<0.0001 at 1(st) FU; CE =0.401 and P=0.021 at 2(nd) FU; CE =0.265 and P=0.306 at 3(rd) FU. FEI -40 Gy at 1(st) FU was significantly positively correlated with FEI -40 Gy at subsequent FU's (CC =0.689 and P=6.5×10(-5) comparing 1(st) and 2(nd) FU; 0.901 and P=0.020 comparing 2(nd) and 3(rd) FU. Ninety-six percent of the RILI was found within the 20 Gy isodose line. Sixty-five percent of patients were found to have a decrease in RILI on the second 2(nd) CT. CONCLUSIONS We have shown that RILI evolves over time and 1(st) CT correlates well with subsequent CTs. Ninety-six percent of the RILI can be found to occur within the 20 Gy isodose lines, which may prove beneficial to radiologists attempting to distinguish recurrence vs. RILI.
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Affiliation(s)
- Miriam A Knoll
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Mary Salvatore
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Ren Dih Sheu
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Abraham D Knoll
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Sarah L Kerns
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Yeh-Chi Lo
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
| | - Kenneth E Rosenzweig
- 1 Department of Radiation Oncology, 2 Department of Radiology, Mount Sinai School of Medicine, 1 Gustave Levy Place, New York, NY 10029, USA
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Treatment and Prognosis of Isolated Local Relapse after Stereotactic Body Radiotherapy for Clinical Stage I Non-Small-Cell Lung Cancer. J Thorac Oncol 2015; 10:1616-24. [DOI: 10.1097/jto.0000000000000662] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Pan Y, Brink C, Schytte T, Petersen H, Wu YL, Hansen O. Planned FDG PET-CT Scan in Follow-Up Detects Disease Progression in Patients With Locally Advanced NSCLC Receiving Curative Chemoradiotherapy Earlier Than Standard CT. Medicine (Baltimore) 2015; 94:e1863. [PMID: 26512597 PMCID: PMC4985411 DOI: 10.1097/md.0000000000001863] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The role of positron emission tomography-computed tomography (PET-CT) in surveillance of patients with nonsmall cell lung cancer (NSCLC) treated with curatively intended chemoradiotherapy remains controversial. However, conventional chest X-ray and computed tomography (CT) are of limited value in discriminating postradiotherapy changes from tumor relapse. The aim of this study was to evaluate the clinical value of PET-CT scan in the follow-up for patients with locally advanced (LA) NSCLC receiving concomitant chemoradiotherapy (CCRT).Between 2009 and 2013, eligible patients with stages IIB-IIIB NSCLC were enrolled in the clinical trial NARLAL and treated in Odense University Hospital (OUH). All patients had a PET-CT scan scheduled 9 months (PET-CT9) after the start of the radiation treatment in addition to standard follow-up (group A). Patients who presented with same clinical stage of NSCLC and received similar treatment, but outside protocol in OUH during this period were selected as control group (group B). Patients in group B were followed in a conventional way without PET-CT9. All patients were treated with induction chemotherapy followed by CCRT.Group A included 37 and group B 55 patients. The median follow-up was 16 months. Sixty-six (72%) patients were diagnosed with progression after treatment. At the time of tumor progression, patients in group A had better performance status (PS) than those in group B (P = 0.02). Because of death (2 patients), poor PS (3) or retreatment of relapse (9), only 23 patients had PET-CT9 in group A. Eleven (48%) patients were firstly diagnosed with progression by PET-CT9 without any clinical symptoms of progression. The median progression-free survival (PFS) was 8.8 months in group A and 12.5 months in group B (P = 0.04). Hazard function PFS showed that patients in group A had higher risk of relapse than in group B.Additional FDG PET-CT scan at 9 months in surveillance increases probability of early detection of disease progression in advanced NSCLC patients treated with curatively intended CCRT.
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Affiliation(s)
- Yi Pan
- From the Southern Medical University (YP, Y-LW), Department of Radiation Oncology, Guangdong General Hospital & Guangdong Academy of Medical Science, Guangzhou, P.R. China (YP), Department of Oncology, Odense University Hospital (YP, TS, OH), Institution of Clinical Research, University of Southern Denmark (YP, CB, TS, OH), Laboratory of Radiation Physics, Odense University Hospital (CB), Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark (HP); and Guangdong Lung Cancer Institute, Guangzhou, P.R. China (Y-LW)
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Halpenny D, Ridge CA, Hayes S, Zheng J, Moskowitz CS, Rimner A, Ginsberg MS. Computed tomographic features predictive of local recurrence in patients with early stage lung cancer treated with stereotactic body radiation therapy. Clin Imaging 2014; 39:254-8. [PMID: 25571791 DOI: 10.1016/j.clinimag.2014.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 09/13/2014] [Accepted: 12/06/2014] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The objective of this study is to identify computed tomography (CT) features of local recurrence (LR) after stereotactic body radiation therapy (SBRT) for lung cancer. METHODS Two hundred eighteen patients underwent SBRT for lung cancer from January 1st, 2006 to March 1st, 2011. Signs of LR recorded: opacity with new bulging margin, opacification of air bronchograms, enlarging pleural effusion, new or enlarging mass, and increased lung density at the treatment site. RESULTS A new bulging margin at the treatment site was the only feature significantly associated with LR (P<.005). CONCLUSION Most CT features classically associated with LR following conventional radiation therapy are unreliable for predicting LR following SBRT.
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Affiliation(s)
- Darragh Halpenny
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York
| | - Carole A Ridge
- Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Sara Hayes
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York
| | - Chaya S Moskowitz
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York
| | - Andreas Rimner
- Department of Thoracic Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan-Kettering Cancer Center (MSKCC), New York.
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Daly ME, Beckett LA, Chen AM. Does early posttreatment surveillance imaging affect subsequent management following stereotactic body radiation therapy for early-stage non-small cell lung cancer? Pract Radiat Oncol 2013; 4:240-6. [PMID: 25012832 DOI: 10.1016/j.prro.2013.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 08/26/2013] [Accepted: 08/27/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE Uncertainty exists regarding the optimal surveillance imaging strategy following stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC), particularly with respect to timing. We sought to determine how routine use of early (<6 months) posttreatment imaging affects subsequent management. METHODS AND MATERIALS The records of all patients treated with SBRT between January 2007 and January 2013 for early-stage NSCLC were reviewed. Eligible patients underwent ≥ 1 early (defined as within 6 months following SBRT) surveillance imaging study. Radiographic findings and subsequent diagnostic or therapeutic interventions were identified. Proportions and exact 95% confidence intervals (CI) with early posttreatment surveillance findings and altered treatment were calculated, and cases were examined descriptively. RESULTS Sixty-two patients with 67 lung tumors underwent 92 early surveillance imaging studies (86 computed tomographic [CT] and 6 positron emission/CT) at a median of 2.1 months (range, 0.1-5.9 months). New lung nodules were identified in 8 patients (13%), leading to a diagnosis of metastatic disease treated with systemic therapy in 2 patients and biopsy proven solitary lung recurrence in 2 patients, both treated successfully with local therapy. Tumor growth meeting Response Evaluation Criteria in Solid Tumors (RECIST) criteria was identified in 1 patient, who was followed with subsequent radiographic regression. In aggregate, the treatment of 4 patients (6.5%, 95% CI 1.7%-15.2%) was altered by early imaging; 2 (3.2%, 95% CI 0.4%-10.8%) with a potentially curative intervention. No predictors for utility of early surveillance were identified. CONCLUSIONS Imaging within 6 months following SBRT for early-stage NSCLC resulted in a definitive intervention in approximately 3% of patients. In the era of cost-effective health care, a first scan at 6 months posttreatment may be adequate for most patients. Larger scale prospective studies are needed to address the optimal surveillance regimen following SBRT and to identify patients who may benefit from more aggressive surveillance regimens.
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Affiliation(s)
- Megan E Daly
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California.
| | - Laurel A Beckett
- Department of Biostatistics, University of California Davis, Comprehensive Cancer Center, Sacramento, California
| | - Allen M Chen
- Department of Radiation Oncology, University of California Davis, Comprehensive Cancer Center, Sacramento, California
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