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Owen D, Sio TT. Stereotactic body radiotherapy (SBRT) for central and ultracentral node-negative lung tumors. J Thorac Dis 2020; 12:7024-7031. [PMID: 33282407 PMCID: PMC7711409 DOI: 10.21037/jtd-2019-cptn-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Advancements in imaging and radiotherapy (RT) techniques have allowed for remarkably precise delivery of high radiation dose per treatment fraction to intrathoracic targets. As a non-invasive therapeutic modality (compared to surgery), stereotactic body radiotherapy (SBRT) is an attractive option for patients with early-stage non-small cell lung cancers and oligometastases, especially for older patients with significant comorbidities and pre-existing pulmonary dysfunction. However, the outcomes and side effect profile of SBRT are highly dependent on tumor location, especially if the tumor is located centrally (within 2 cm of the proximal bronchial tree (PBT)] or ultracentrally (touching or within 1 cm of the mediastinum, esophagus, and PBT). In this focused review, we will examine the contemporary practice and principles of using hypofractionated RT or SBRT for central and ultracentral thoracic tumors. We will identify future directions on how this practice may be incorporated into the increasingly complicated modern paradigm of lung cancer treatments which now include immunotherapy along with proton beam radiotherapy.
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Affiliation(s)
- Dawn Owen
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
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Decaluwé H, Petersen RH, Brunelli A, Pompili C, Seguin-Givelet A, Gust L, Aigner C, Falcoz PE, Rinieri P, Augustin F, Sokolow Y, Verhagen A, Depypere L, Papagiannopoulos K, Gossot D, D'Journo XB, Guerrera F, Baste JM, Schmid T, Stanzi A, Van Raemdonck D, Bardet J, Thomas PA, Massard G, Fieuws S, Moons J, Dooms C, De Leyn P, Hansen HJ. Multicentric evaluation of the impact of central tumour location when comparing rates of N1 upstaging in patients undergoing video-assisted and open surgery for clinical Stage I non-small-cell lung cancer†. Eur J Cardiothorac Surg 2019; 53:359-365. [PMID: 29029062 DOI: 10.1093/ejcts/ezx338] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/12/2017] [Accepted: 07/30/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Large retrospective series have indicated lower rates of cN0 to pN1 nodal upstaging after video-assisted thoracic surgery (VATS) compared with open resections for Stage I non-small-cell lung cancer (NSCLC). The objective of our multicentre study was to investigate whether the presumed lower rate of N1 upstaging after VATS disappears after correction for central tumour location in a multivariable analysis. METHODS Consecutive patients operated for PET-CT based clinical Stage I NSCLC were selected from prospectively managed surgical databases in 11 European centres. Central tumour location was defined as contact with bronchovascular structures on computer tomography and/or visibility on standard bronchoscopy. RESULTS Eight hundred and ninety-five patients underwent pulmonary resection by VATS (n = 699, 9% conversions) or an open technique (n = 196) in 2014. Incidence of nodal pN1 and pN2 upstaging was 8% and 7% after VATS and 15% and 6% after open surgery, respectively. pN1 was found in 27% of patients with central tumours. Less central tumours were operated on by VATS compared with the open technique (12% vs 28%, P < 0.001). Logistic regression analysis showed that only tumour location had a significant impact on N1 upstaging (OR 6.2, confidence interval 3.6-10.8; P < 0.001) and that the effect of surgical technique (VATS versus open surgery) was no longer significant when accounting for tumour location. CONCLUSIONS A quarter of patients with central clinical Stage I NSCLC was upstaged to pN1 at resection. Central tumour location was the only independent factor associated with N1 upstaging, undermining the evidence for lower N1 upstaging after VATS resections. Studies investigating N1 upstaging after VATS compared with open surgery should be interpreted with caution due to possible selection bias, i.e. relatively more central tumours in the open group with a higher chance of N1 upstaging.
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Affiliation(s)
- Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - René Horsleben Petersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alex Brunelli
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | - Cecilia Pompili
- Department of Thoracic Surgery, St. James's University Hospital, Leeds, UK
| | | | - Lucile Gust
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen, Essen, Germany
| | - Pierre-Emmanuel Falcoz
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Philippe Rinieri
- Department of Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Florian Augustin
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Youri Sokolow
- Department of Thoracic Surgery, Université Libre de Bruxelles, Brussels, Belgium
| | - Ad Verhagen
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Xavier Benoit D'Journo
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Francesco Guerrera
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jean-Marc Baste
- Department of Thoracic Surgery, University Hospital of Rouen, Rouen, France
| | - Thomas Schmid
- Department of Visceral, Transplant and Thoracic Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Alessia Stanzi
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jeremy Bardet
- Department of Thoracic Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Pascal-Alexandre Thomas
- Department of Thoracic Surgery, Lung Transplantation and Diseases of the Esophagus, North University Hospital, Marseille, France
| | - Gilbert Massard
- Department of Thoracic Surgery, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Steffen Fieuws
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), Leuven, Belgium
| | - Johnny Moons
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Dooms
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Henrik Jessen Hansen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Medbery RL, Fernandez FG. Nodal Upstaging: "Confounded" by Tumor Location? J Thorac Oncol 2016; 11:e90-1. [PMID: 27339414 DOI: 10.1016/j.jtho.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Rachel L Medbery
- Section of General Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, Georgia.
| | - Felix G Fernandez
- Section of General Thoracic Surgery, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, Georgia
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