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Deng Y, Qiu M, Wu S, Zhong J, Huang J, Luo N, Lu Y, Bao Y. A feasibility study of tumor motion monitoring for SBRT of lung cancer based on 3D point cloud detection and stacking ensemble learning. J Med Imaging Radiat Sci 2024; 55:101729. [PMID: 39128321 DOI: 10.1016/j.jmir.2024.101729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/03/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE To construct a tumor motion monitoring model for stereotactic body radiation therapy (SBRT) of lung cancer from a feasibility perspective. METHODS A total of 32 treatment plans for 22 patients were collected, whose planning CT and the centroid position of the planning target volume (PTV) were used as the reference. Images of different respiratory phases in 4DCT were acquired to redefine the targets and obtain the floating PTV centroid positions. In accordance with the planning CT and CBCT registration parameters, data augmentation was accomplished, yielding 2130 experimental recordings for analysis. We employed a stacking multi-learning ensemble approach to fit the 3D point cloud variations of body surface and the change of target position to construct the tumor motion monitoring model, and the prediction accuracy was assess using root mean squared error (RMSE) and R-Square (R2). RESULTS The prediction displacement of the stacking ensemble model shows a high degree of agreement with the reference value in each direction. In the first layer of model, the X direction (RMSE =0.019 ∼ 0.145mm, R2 =0.9793∼0.9996) and the Z direction (RMSE = 0.051 ∼ 0.168 mm, R2 = 0.9736∼0.9976) show the best results, while the Y direction ranked behind (RMSE = 0.088 ∼ 0.224 mm, R2 = 0.9553∼ 0.9933). The second layer model summarizes the advantages of unit models of first layer, and RMSE of 0.015 mm, 0.083 mm, 0.041 mm, and R2 of 0.9998, 0.9931, 0.9984 respectively for X, Y, Z were obtained. CONCLUSIONS The tumor motion monitoring method for SBRT of lung cancer has potential application of non-ionization, non-invasive, markerless, and real-time.
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Affiliation(s)
- Yongjin Deng
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Minmin Qiu
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Shuyu Wu
- Radiotherapy Center, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong, 510095, China
| | - Jiajian Zhong
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Jiexing Huang
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Ning Luo
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Yao Lu
- School of Computer Science and Engineering, Sun Yat-sen University, Guangzhou, Guangdong, 510006, China
| | - Yong Bao
- Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510080, China.
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Toussie D, Ginocchio LA, Cooper BT, Azour L, Moore WH, Villasana-Gomez G, Ko JP. Radiation Therapy for Lung Cancer: Imaging Appearances and Pitfalls. Clin Chest Med 2024; 45:339-356. [PMID: 38816092 DOI: 10.1016/j.ccm.2024.02.007] [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] [Indexed: 06/01/2024]
Abstract
Radiation therapy is part of a multimodality treatment approach to lung cancer. The radiologist must be aware of both the expected and the unexpected imaging findings of the post-radiation therapy patient, including the time course for development of post- radiation therapy pneumonitis and fibrosis. In this review, a brief discussion of radiation therapy techniques and indications is presented, followed by an image-heavy differential diagnostic approach. The review focuses on computed tomography imaging examples to help distinguish normal postradiation pneumonitis and fibrosis from alternative complications, such as infection, local recurrence, or radiation-induced malignancy.
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Affiliation(s)
- Danielle Toussie
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA.
| | - Luke A Ginocchio
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
| | - Benjamin T Cooper
- Department of Radiation Oncology, NYU Langone Health/NYU Grossman School of Medicine, 160 East 34th Street, New York, NY 10016, USA
| | - Lea Azour
- Department of Radiology, David Geffen School of Medicine/UCLA Medical Center, 1250 16th Street, Los Angeles, CA 90404, USA
| | - William H Moore
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
| | - Geraldine Villasana-Gomez
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
| | - Jane P Ko
- Department of Radiology, NYU Langone Health/NYU Grossman School of Medicine, 660 1st Avenue, New York, NY 10016, USA
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3
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Hagedorn KN, Nelson AT, Towbin AJ, Frederickson N, Mallinger P, Lucas JT, Dehner LP, Messinger YH, Shulkin BL, Mize WA, Schultz KAP. Assessing the role of positron emission tomography and bone scintigraphy in imaging of pleuropulmonary blastoma (PPB): A report from the International PPB/DICER1 Registry. Pediatr Blood Cancer 2023; 70:e30628. [PMID: 37592371 PMCID: PMC10538369 DOI: 10.1002/pbc.30628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/11/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Pleuropulmonary blastoma (PPB) is the most common primary lung neoplasm of infancy and early childhood. Given the rarity of PPB, the role of positron emission tomography (PET) and bone scintigraphy (bone scans) in diagnostic evaluation and surveillance has not been documented to date. Available PET and bone scan data are presented in this study. PROCEDURES Patients with PPB enrolled in the International PPB/DICER1 Registry and available PET imaging and/or bone scan reports were retrospectively abstracted. RESULTS On retrospective analysis, 133 patients with type II and III (advanced) PPB were identified with available report(s) (PET scan only = 34, bone scan only = 83, and both bone scan and PET = 16). All advanced primary PPB (n = 11) and recurrent (n = 8) tumors prior to treatment presented with 18 F-fluorodeoxyglucose (FDG)-avid lesions, with median maximum standardized uptake values of 7.4 and 6.7, respectively. False positive FDG uptake in the thorax was noted during surveillance (specificity: 59%). Bone metastases were FDG-avid prior to treatment. Central nervous system metastases were not discernable on PET imaging. Sensitivity and specificity of bone scans for metastatic bone disease were 89% and 92%, respectively. Bone scans had a negative predictive value of 99%, although positive predictive value was 53%. Four patients with distant bone metastases had concordant true positive bone scan and PET. CONCLUSION Primary, recurrent, and/or extracranial metastatic PPB presents with an FDG-avid lesion on PET imaging. Additional prospective studies are needed to fully assess the utility of nuclear medicine imaging in surveillance for patients with advanced PPB.
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Affiliation(s)
| | - Alexander T. Nelson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
- University of Minnesota Medical School, Minneapolis, MN
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Nicole Frederickson
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Paige Mallinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - John T. Lucas
- Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN
| | - Louis P. Dehner
- Lauren V. Ackerman Laboratory of Surgical Pathology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Yoav H. Messinger
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
| | - Barry L. Shulkin
- Department of Diagnostic Imaging, St. Jude Children’s Research Hospital, Memphis, TN
| | - William A. Mize
- Department of Radiology, Children’s Minnesota, Minneapolis, MN
| | - Kris Ann P. Schultz
- International Pleuropulmonary Blastoma/DICER1 Registry, Children’s Minnesota, Minneapolis, MN
- International Ovarian and Testicular Stromal Tumor Registry, Children’s Minnesota, Minneapolis, MN
- Cancer and Blood Disorders, Children’s Minnesota, Minneapolis, MN
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Li TC, Zhao X, Liu YN, Wang GL, Liu KF, Zhao K. Prognostic value of node-to-primary tumor maximum standardized uptake value ratio in T1-4N1-3M0 non-small cell lung cancer patients treated with concurrent chemo-radiotherapy. Nucl Med Commun 2022; 43:901-907. [PMID: 35551163 PMCID: PMC9278701 DOI: 10.1097/mnm.0000000000001576] [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: 02/07/2022] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND This study aimed to identify whether NTR is the independent risk factor for progression-free survival (PFS) and overall survival (OS) in patients treated with concurrent chemo-radiotherapy (cCRT). METHODS We retrospectively studied 106 T1-4N1-3M0 non-small cell lung cancer patients treated with cCRT. The maximum standardized uptake value (SUVTumor) of the primary tumor and the metastatic lymph nodes (SUVLN) were measured. The prognostic significance of NTR for predicting PFS and OS was assessed. A multi-adjusted spline regression model was conducted to provide more precise estimates and examine the shape of the associations between NTR and the risk of progression. RESULTS From 2012 to 2017, 106 eligible patients were analyzed. The median follow-up time was 15.3 months (3.5-44.6 months). We determined the maximizing area under the time-dependent receiver operating characteristic curve was at an NTR of 0.73 for predicting PFS. The two-year PFS was significantly lower in the high-NTR group (35.7% vs. 55.4%, P = 0.02) and two-year OS (43.4% vs. 61.1%, P = 0.03 was also significantly worse. Multivariable analysis revealed that only NTR was an independent prognostic factor for PFS (hazard ratio [HR]: 10.04, P < 0.001) and OS (HR: 4.19, P = 0.03). The restricted cubic spline regression model showed that NTR had a non-linear relationship with log relative risk for progression. CONCLUSION NTR was an independent risk factor for predicting PFS and OS in T1-4N1-3M0 non-small cell lung cancer patients treated with cCRT.
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Affiliation(s)
- Tian-cheng Li
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xin Zhao
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yi-nuo Liu
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guo-lin Wang
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kai-feng Liu
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Kui Zhao
- Departments of PET Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Dejanovic D, Specht L, Czyzewska D, Kiil Berthelsen A, Loft A. Response Evaluation Following Radiation Therapy With 18F-FDG PET/CT: Common Variants of Radiation-Induced Changes and Potential Pitfalls. Semin Nucl Med 2022; 52:681-706. [PMID: 35835618 DOI: 10.1053/j.semnuclmed.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 11/11/2022]
Abstract
Radiation therapy (RT) is one of the cornerstones in cancer treatment and approximately half of all patients will receive some form of RT during the course of their cancer management. Response evaluation after RT and follow-up imaging with 18F-Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) can be complicated by RT-induced acute, chronic or consequential effects. There is a general consensus that 18F-FDG PET/CT for response evaluation should be delayed for 12 weeks after completing RT to minimize the risk of false-positive findings. Radiation-induced late side effects in normal tissue can take years to develop and eventually cause symptoms that on imaging can potentially mimic recurrent disease. Imaging findings in radiation induced injuries depend on the normal tissue included in the irradiated volume and the radiation therapy regime including the total dose delivered, dose per fraction and treatment schedule. The intent for radiation therapy should be taken in consideration when evaluating the response on imaging, that is palliative vs curative or neoadjuvant vs adjuvant RT. Imaging findings can further be distorted by altered anatomy and sequelae following surgery within the radiation field. An awareness of common PET/CT-induced changes/injuries is essential when interpreting 18F-FDG PET/CT as well as obtaining a complete medical history, as patients are occasionally scanned for an unrelated cause to previously RT treated malignancy. In addition, secondary malignancies due to carcinogenic effects of radiation exposure in long-term cancer survivors should not be overlooked. 18F-FDG PET/CT can be very useful in response evaluation and follow-up in patients treated with RT, however, variants and pitfalls are common and it is important to remember that radiation-induced injury is often a diagnosis of exclusion.
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Affiliation(s)
- Danijela Dejanovic
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Lena Specht
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Dorota Czyzewska
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anne Kiil Berthelsen
- Department of Oncology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Annika Loft
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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6
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FLT-PET/CT in Non-Small Cell Lung Cancer treated with stereotactic body radiotherapy- A Pilot study. Adv Radiat Oncol 2022; 7:101037. [DOI: 10.1016/j.adro.2022.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/20/2022] Open
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7
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Vaz SC, Adam JA, Delgado Bolton RC, Vera P, van Elmpt W, Herrmann K, Hicks RJ, Lievens Y, Santos A, Schöder H, Dubray B, Visvikis D, Troost EGC, de Geus-Oei LF. Joint EANM/SNMMI/ESTRO practice recommendations for the use of 2-[ 18F]FDG PET/CT external beam radiation treatment planning in lung cancer V1.0. Eur J Nucl Med Mol Imaging 2022; 49:1386-1406. [PMID: 35022844 PMCID: PMC8921015 DOI: 10.1007/s00259-021-05624-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/15/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE 2-[18F]FDG PET/CT is of utmost importance for radiation treatment (RT) planning and response monitoring in lung cancer patients, in both non-small and small cell lung cancer (NSCLC and SCLC). This topic has been addressed in guidelines composed by experts within the field of radiation oncology. However, up to present, there is no procedural guideline on this subject, with involvement of the nuclear medicine societies. METHODS A literature review was performed, followed by a discussion between a multidisciplinary team of experts in the different fields involved in the RT planning of lung cancer, in order to guide clinical management. The project was led by experts of the two nuclear medicine societies (EANM and SNMMI) and radiation oncology (ESTRO). RESULTS AND CONCLUSION This guideline results from a joint and dynamic collaboration between the relevant disciplines for this topic. It provides a worldwide, state of the art, and multidisciplinary guide to 2-[18F]FDG PET/CT RT planning in NSCLC and SCLC. These practical recommendations describe applicable updates for existing clinical practices, highlight potential flaws, and provide solutions to overcome these as well. Finally, the recent developments considered for future application are also reviewed.
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Affiliation(s)
- Sofia C. Vaz
- Nuclear Medicine Radiopharmacology, Champalimaud Centre for the Unkown, Champalimaud Foundation, Lisbon, Portugal
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judit A. Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Roberto C. Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño (La Rioja), Spain
| | - Pierre Vera
- Henri Becquerel Cancer Center, QuantIF-LITIS EA 4108, Université de Rouen, Rouen, France
| | - Wouter van Elmpt
- Department of Radiation Oncology (MAASTRO), GROW – School for Oncology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Rodney J. Hicks
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Yolande Lievens
- Radiation Oncology Department, Ghent University Hospital and Ghent University, Ghent, Belgium
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Heiko Schöder
- Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Bernard Dubray
- Department of Radiotherapy and Medical Physics, Centre Henri Becquerel, Rouen, France
- QuantIF-LITIS EA4108, University of Rouen, Rouen, France
| | | | - Esther G. C. Troost
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
- Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany
- National Center for Tumor Diseases (NCT), Partner Site Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Germany; Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; Helmholtz Association / Helmholtz-Zentrum Dresden – Rossendorf (HZDR), Dresden, Germany
- German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Greco C, Pares O, Pimentel N, Louro V, Morales J, Nunes B, Antunes I, Vasconcelos AL, Kociolek J, Castanheira J, Oliveira C, Silva A, Vaz S, Oliveira F, Carrasquinha E, Costa D, Fuks Z. Positron Emission Tomography-Derived Metrics Predict the Probability of Local Relapse After Oligometastasis-Directed Ablative Radiation Therapy. Adv Radiat Oncol 2022; 7:100864. [PMID: 35036636 PMCID: PMC8752878 DOI: 10.1016/j.adro.2021.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Early positron emission tomography-derived metrics post-oligometastasis radioablation may predict impending local relapses (LRs), providing a basis for a timely ablation. METHODS AND MATERIALS Positron emission tomography data of 623 lesions treated with either 24 Gy single-dose radiation therapy (SDRT) (n = 475) or 3 × 9 Gy stereotactic body radiation therapy (SBRT) (n = 148) were analyzed in a training data set (n = 246) to obtain optimal cutoffs for pretreatment maximum standardized uptake value (SUVmax) and its 3-month posttreatment decline (ΔSUVmax) in predicting LR risk, validated in a data set unseen to testing (n = 377). RESULTS At a median of 21.7 months, 91 lesions developed LRs: 39 of 475 (8.2%) after SDRT and 52 of 148 (35.1%) after SBRT. The optimal cutoff values were 12 for SUVmax and -75% for ΔSUVmax. Bivariate SUVmax/ΔSUVmax permutations rendered a 3-tiered LR risk stratification of dual-favorable (low risk), 1 adverse (intermediate risk) and dual-adverse (high risk). Actuarial 5-year local relapse-free survival rates were 93.9% versus 89.6% versus 57.1% (P < .0001) and 76.1% versus 48.3% versus 8.2% (P < .0001) for SDRT and SBRT, respectively. The SBRT area under the ROC curve was 0.71 (95% CI, 0.61-0.79) and the high-risk subgroup yielded a 76.5% true positive LR prediction rate. CONCLUSIONS The SBRT dual-adverse SUVmax/ΔSUVmax category LR prediction power provides a basis for prospective studies testing whether a timely ablation of impending LRs affects oligometastasis outcomes.
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Affiliation(s)
- Carlo Greco
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Oriol Pares
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Nuno Pimentel
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Vasco Louro
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Javier Morales
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Beatriz Nunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Inês Antunes
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Ana Luisa Vasconcelos
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Justyna Kociolek
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Joana Castanheira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Carla Oliveira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Angelo Silva
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sofia Vaz
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Francisco Oliveira
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Eunice Carrasquinha
- Computational Clinical Imaging Group, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Durval Costa
- Department of Nuclear Medicine-Radiopharmacology, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Zvi Fuks
- Department of Radiation Oncology, Champalimaud Centre for the Unknown, Lisbon, Portugal
- Memorial Sloan Kettering Cancer Center, New York, New York
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9
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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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10
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PET imaging of lung and pleural cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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11
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Lee K, Le T, Hau E, Hanna GG, Gee H, Vinod S, Dammak S, Palma D, Ong A, Yeghiaian-Alvandi R, Buck J, Lim R. A systematic review into the radiological features predicting local recurrence after stereotactic ablative body radiotherapy (SABR) in patients with non-small cell lung cancer (NSCLC): Local recurrence features of NSCLC post-SABR. Int J Radiat Oncol Biol Phys 2021; 113:40-59. [PMID: 34879247 DOI: 10.1016/j.ijrobp.2021.11.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 11/19/2021] [Accepted: 11/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Post-treatment surveillance for local recurrence (LR) following SABR can include both fluorodeoxyglucose-positron emission tomography (FDG-PET) and computed tomography (CT). Radiation-induced lung injury (RILI) shares a similar appearance to LR after treatment making the detection of LR on imaging difficult for clinicians. We aimed to summarise radiological features of CT and FDG-PET predicting LR, and to evaluate radiomics as another tool for detecting LR. METHODS AND MATERIALS We searched MEDLINE, EMBASE and PubMed databases for published studies and Web of Science, Wiley Online and Science Direct databases for conference abstracts that had patient populations with NSCLC and reported post-SABR radiological features of FDG-PET or CT and radiomics from either FDG-PET or CT. Studies for inclusion were independently reviewed by two authors. RESULTS Across 32 relevant studies, the incidence of LR was 13% (222/1726). On CT, certain gross radiological appearances, and kinetic features of changes in size, diameter, volume or 3 consecutive rises in volume of mass-like consolidation are suggestive of LR. Particular regard should be made for the presence of any ≥3 high-risk features (HRF) on CT or the individual HRF of enlarging opacity at ≥12 month's post-SABR as being highly suspicious of LR. On FDG-PET a relative reduction of <5% of SUVmax from baseline in the first 12 months or cut-offs of SUVmax >5 and SUVmean >3.44 after 12 months can indicate LR. There is limited evidence available to corroborate radiomic features suggestive of LR. CONCLUSION This research has identified common features of LR compared to RILI which may aid in early and accurate detection of LR post-SABR; further research is required to validate these findings.
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Affiliation(s)
- Katherine Lee
- Westmead Hospital, Sydney, New South Wales, Australia; Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
| | - Tue Le
- Radiation Oncology - Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Eric Hau
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia; Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia; Westmead Institute of Medical Research, Sydney, New South Wales, Australia
| | - Gerard G Hanna
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Harriet Gee
- Sydney West Radiation Oncology Network, Sydney, New South Wales, Australia; Children's Medical Research Institute, Sydney, New South Wales, Australia; The University of Sydney, Sydney, New South Wales, Australia
| | - Shalini Vinod
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
| | - Salma Dammak
- The School of Biomedical Engineering, Western University, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada
| | - David Palma
- Division of Radiation Oncology, Western University, London, Ontario, Canada
| | - Anselm Ong
- Department of Radiation Oncology, The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead Sydney, New South Wales, Australia
| | | | - Jacqueline Buck
- Department of Medical Oncology, Nepean Cancer Care Centre, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Rebecca Lim
- Department of Radiology, Westmead Hospital, Sydney, New South Wales, Australia
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12
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Christensen TN, Langer SW, Persson G, Larsen KR, Amtoft AG, Keller SH, Kjaer A, Fischer BM. Impact of [ 18F]FDG-PET and [ 18F]FLT-PET-Parameters in Patients with Suspected Relapse of Irradiated Lung Cancer. Diagnostics (Basel) 2021; 11:diagnostics11020279. [PMID: 33670242 PMCID: PMC7916960 DOI: 10.3390/diagnostics11020279] [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: 12/21/2020] [Revised: 01/26/2021] [Accepted: 02/07/2021] [Indexed: 12/25/2022] Open
Abstract
Radiation-induced changes may cause a non-malignant high 2-deoxy-2-[18F]fluoro-d-glucose (FDG)-uptake. The 3′-deoxy-3′-[18F]fluorothymidine (FLT)-PET/CT performs better in the differential diagnosis of inflammatory changes and lung lesions with a higher specificity than FDG-PET/CT. We investigated the association between post-radiotherapy FDG-PET-parameters, FLT-PET-parameters, and outcome. Sixty-one patients suspected for having a relapse after definitive radiotherapy for lung cancer were included. All the patients had FDG-PET/CT and FLT-PET/CT. FDG-PET- and FLT-PET-parameters were collected from within the irradiated high-dose volume (HDV) and from recurrent pulmonary lesions. For associations between PET-parameters and relapse status, respectively, the overall survival was analyzed. Thirty patients had a relapse, of these, 16 patients had a relapse within the HDV. FDG-SUVmax and FLT-SUVmax were higher in relapsed HDVs compared with non-relapsed HDVs (median FDG-SUVmax: 12.8 vs. 4.2; p < 0.001; median FLT-SUVmax 3.9 vs. 2.2; p < 0.001). A relapse within HDV had higher FDG-SUVpeak (median FDG-SUVpeak: 7.1 vs. 3.5; p = 0.014) and was larger (median metabolic tumor volume (MTV50%): 2.5 vs. 0.7; 0.014) than the relapsed lesions outside of HDV. The proliferative tumor volume (PTV50%) was prognostic for the overall survival (hazard ratio: 1.07 pr cm3 [1.01–1.13]; p = 0.014) in the univariate analysis, but not in the multivariate analysis. FDG-SUVmax and FLT-SUVmax may be helpful tools for differentiating the relapse from radiation-induced changes, however, they should not be used definitively for relapse detection.
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Affiliation(s)
- Tine N. Christensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark; (A.G.A.); (S.H.K.); (A.K.); (B.M.F.)
- Cluster for Molecular Imaging, University of Copenhagen, 2200 Copenhagen N, Denmark
- Correspondence:
| | - Seppo W. Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark;
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen Ø, Denmark;
| | - Gitte Persson
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen Ø, Denmark;
- Department of Oncology, Herlev-Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark
| | - Klaus Richter Larsen
- Department of Pulmonary Medicine, Bispebjerg University Hospital, 2400 Copenhagen NV, Denmark;
| | - Annemarie G. Amtoft
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark; (A.G.A.); (S.H.K.); (A.K.); (B.M.F.)
| | - Sune H. Keller
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark; (A.G.A.); (S.H.K.); (A.K.); (B.M.F.)
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark; (A.G.A.); (S.H.K.); (A.K.); (B.M.F.)
- Cluster for Molecular Imaging, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Barbara Malene Fischer
- Department of Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen Ø, Denmark; (A.G.A.); (S.H.K.); (A.K.); (B.M.F.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen Ø, Denmark;
- The PET Centre, School of Biomedical Engineering and Imaging Science, King’s College London, London SE1 7EH, UK
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13
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Yang DM, Palma DA, Kwan K, Louie AV, Malthaner R, Fortin D, Rodrigues GB, Yaremko BP, Laba J, Gaede S, Warner A, Inculet R, Lee TY. Predicting pathological complete response (pCR) after stereotactic ablative radiation therapy (SABR) of lung cancer using quantitative dynamic [ 18F]FDG PET and CT perfusion: a prospective exploratory clinical study. Radiat Oncol 2021; 16:11. [PMID: 33441162 PMCID: PMC7805034 DOI: 10.1186/s13014-021-01747-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: 06/11/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stereotactic ablative radiation therapy (SABR) is effective in treating inoperable stage I non-small cell lung cancer (NSCLC), but imaging assessment of response after SABR is difficult. This prospective study aimed to develop a predictive model for true pathologic complete response (pCR) to SABR using imaging-based biomarkers from dynamic [18F]FDG-PET and CT Perfusion (CTP). METHODS Twenty-six patients with early-stage NSCLC treated with SABR followed by surgical resection were included, as a pre-specified secondary analysis of a larger study. Dynamic [18F]FDG-PET and CTP were performed pre-SABR and 8-week post. Dynamic [18F]FDG-PET provided maximum and mean standardized uptake value (SUV) and kinetic parameters estimated using a previously developed flow-modified two-tissue compartment model while CTP measured blood flow, blood volume and vessel permeability surface product. Recursive partitioning analysis (RPA) was used to establish a predictive model with the measured PET and CTP imaging biomarkers for predicting pCR. The model was compared to current RECIST (Response Evaluation Criteria in Solid Tumours version 1.1) and PERCIST (PET Response Criteria in Solid Tumours version 1.0) criteria. RESULTS RPA identified three response groups based on tumour blood volume before SABR (BVpre-SABR) and change in SUVmax (ΔSUVmax), the thresholds being BVpre-SABR = 9.3 mL/100 g and ΔSUVmax = - 48.9%. The highest true pCR rate of 92% was observed in the group with BVpre-SABR < 9.3 mL/100 g and ΔSUVmax < - 48.9% after SABR while the worst was observed in the group with BVpre-SABR ≥ 9.3 mL/100 g (0%). RPA model achieved excellent pCR prediction (Concordance: 0.92; P = 0.03). RECIST and PERCIST showed poor pCR prediction (Concordance: 0.54 and 0.58, respectively). CONCLUSIONS In this study, we developed a predictive model based on dynamic [18F]FDG-PET and CT Perfusion imaging that was significantly better than RECIST and PERCIST criteria to predict pCR of NSCLC to SABR. The model used BVpre-SABR and ΔSUVmax which correlates to tumour microvessel density and cell proliferation, respectively and warrants validation with larger sample size studies. TRIAL REGISTRATION MISSILE-NSCLC, NCT02136355 (ClinicalTrials.gov). Registered May 8, 2014, https://clinicaltrials.gov/ct2/show/NCT02136355.
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Affiliation(s)
- Dae-Myoung Yang
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St N, London, ON, N6A 5C1, Canada.,Robarts Research Institute, University of Western Ontario, 1151 Richmond St N, London, ON, N6A 3K7, Canada.,Lawson Imaging Research Program, Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada
| | - David A Palma
- Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.,Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Keith Kwan
- Pathology and Laboratory Medicine, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Richard Malthaner
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Dalilah Fortin
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - George B Rodrigues
- Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.,Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Brian P Yaremko
- Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.,Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Joanna Laba
- Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.,Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St N, London, ON, N6A 5C1, Canada.,Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.,Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, 1151 Richmond St N, London, ON, N6A 5C1, Canada. .,Robarts Research Institute, University of Western Ontario, 1151 Richmond St N, London, ON, N6A 3K7, Canada. .,Lawson Imaging Research Program, Lawson Health Research Institute, 268 Grosvenor St, London, ON, N6A 4V2, Canada. .,Department of Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.
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14
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Vu N, Onishi H, Saito M, Kuriyama K, Komiyama T, Marino K, Araya M, Aoki S, Saito R, Nonaka H, Funayama S, Watanabe H, Sano N. Tumor volume shrinkage during stereotactic body radiotherapy is related to better prognoses in patients with stage I non-small-cell lung cancer. JOURNAL OF RADIATION RESEARCH 2020; 61:740-746. [PMID: 32657333 PMCID: PMC7482165 DOI: 10.1093/jrr/rraa040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 05/24/2020] [Indexed: 06/11/2023]
Abstract
The purpose of the study was to investigate the association between tumor volume changes during stereotactic body radiation therapy (SBRT) and prognoses in stage I non-small-cell lung cancer (NSCLC). This retrospective review included stage I NSCLC patients in whom SBRT was performed at a total dose of 48.0-50.5 Gy in four or five fractions. The tumor volumes observed on computed tomography (CT) simulation and on the CT performed at the last treatment session using a CT-on-rails system were measured and compared. Then, the tumor volume changes during the SBRT period were measured and assessed for their association with prognoses (overall survival, local control, lymph node metastases and distant metastases). A total of 98 patients with a mean age of 78.6 years were enrolled in the study. The T-stage was T1a in 42%, T1b in 32% and T2a in 26% of the cases. The gross tumor volume (GTV) shrank and increased ≥10% in 23 (23.5%) and 36 (36.7%) of the cases, respectively. The 5-year local control and overall survival rates in the groups with a tumor shrinkage of ≥10% vs the group with a shrinkage of <10% were 94.7 vs 70.8% and 85.4 vs 47.6%, respectively; these differences were significant, with a P-value < 0.05. During a short SBRT period, the tumor shrank or enlarged in a small number of cases. A decrease of ≥10% in the GTV during SBRT was significantly related to better overall survival and local control.
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Affiliation(s)
- Nam Vu
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
- Department of Radiology, Hospital 175, Ho Chi Minh, Vietnam
| | - Hiroshi Onishi
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Masahide Saito
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Kengo Kuriyama
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Kan Marino
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | | | - Shinichi Aoki
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Ryo Saito
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hotaka Nonaka
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Satoshi Funayama
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Hiroaki Watanabe
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
| | - Naoki Sano
- Department of Radiology, University of Yamanashi, Yamanashi, Japan
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15
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Chassagnon G, Martini K, Giraud P, Revel MP. Radiological assessment after stereotactic body radiation of lung tumours. Cancer Radiother 2020; 24:379-387. [PMID: 32534799 DOI: 10.1016/j.canrad.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/17/2022]
Abstract
The increasing use of stereotactic body radiation therapy for lung tumours comes along with new post-therapeutic imaging findings that should be known by physicians involved in patient follow-up. Radiation-induced lung injury is much more frequent than after conventional radiation therapy, it can also be delayed and has a different radiological presentation. Radiation-induced lung injury after stereotactic body radiation therapy involves the lung parenchyma surrounding the target tumour and appears as a dynamic process continuing for years after completion of the treatment. Thus, the radiological pattern and the severity of radiation-induced lung injury are prone to changes during follow-up, which can make it difficult to differentiate from local recurrence. Contrary to radiation-induced lung injury, local recurrence after stereotactic body radiation therapy is rare. Other complications mainly depend on tumour location and include airway complications, rib fractures and organizing pneumonia. The aim of this article is to provide a wide overview of radiological changes occurring after SBRT for lung tumours. Awareness of changes following stereotactic body radiation therapy should help avoiding unnecessary interventions for pseudo tumoral presentations.
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Affiliation(s)
- G Chassagnon
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France.
| | - K Martini
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France
| | - P Giraud
- Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France; Service de radiologie, hôpital européen Georges-Pompidou, AP-HP, centre université de Paris, 20, rue Leblanc, 75015 Paris, France
| | - M-P Revel
- Service de radiologie, hôpital Cochin, AP-HP, centre université de Paris, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Université de Paris, 12, rue de l'École-de-Médecine, 75006 Paris, France
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16
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Frerker B, Hildebrandt G. <p>Distinguishing Radiation Pneumonitis from Local Tumour Recurrence Following SBRT for Lung Cancer</p>. REPORTS IN MEDICAL IMAGING 2020. [DOI: 10.2147/rmi.s176901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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17
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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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18
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Vail DM, LeBlanc AK, Jeraj R. Advanced Cancer Imaging Applied in the Comparative Setting. Front Oncol 2020; 10:84. [PMID: 32117739 PMCID: PMC7019008 DOI: 10.3389/fonc.2020.00084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 01/16/2020] [Indexed: 11/13/2022] Open
Abstract
The potential for companion (pet) species with spontaneously arising tumors to act as surrogates for preclinical development of advanced cancer imaging technologies has become more apparent in the last decade. The utility of the companion model specifically centers around issues related to body size (including spatial target/normal anatomic characteristics), physical size and spatial distribution of metastasis, tumor heterogeneity, the presence of an intact syngeneic immune system and a syngeneic tumor microenvironment shaped by the natural evolution of the cancer. Companion species size allows the use of similar equipment, hardware setup, software, and scan protocols which provide the opportunity for standardization and harmonization of imaging operating procedures and quality assurance across imaging protocols, imaging hardware, and the imaged species. Murine models generally do not replicate the size and spatial distribution of human metastatic cancer and these factors strongly influence image resolution and dosimetry. The following review will discuss several aspects of comparative cancer imaging in more detail while providing several illustrative examples of investigational approaches performed or currently under exploration at our institutions. Topics addressed include a discussion on interested consortia; image quality assurance and harmonization; image-based biomarker development and validation; contrast agent and radionuclide tracer development; advanced imaging to assess and predict response to cytotoxic and immunomodulatory anticancer agents; imaging of the tumor microenvironment; development of novel theranostic approaches; cell trafficking assessment via non-invasive imaging; and intraoperative imaging to inform surgical oncology decision making. Taken in totality, these comparative opportunities predict that safety, diagnostic and efficacy data generated in companion species with naturally developing and progressing cancers would better recapitulate the human cancer condition than that of artificial models in small rodent systems and ultimately accelerate the integration of novel imaging technologies into clinical practice. It is our hope that the examples presented should serve to provide those involved in cancer investigations who are unfamiliar with available comparative methodologies an understanding of the potential utility of this approach.
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Affiliation(s)
- David M Vail
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, United States.,Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States
| | - Amy K LeBlanc
- Comparative Oncology Program, Center for Cancer Research, National Cancer Institute, Bethesda, MD, United States
| | - Robert Jeraj
- Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, United States.,Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, United States
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19
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Gouveia AG, Zalay OC, Chua KL, Moraes FY. Response evaluation after stereotactic ablative radiotherapy for localised non-small-cell lung cancer: an equipoise of available resource and accuracy. Br J Radiol 2020; 93:20190647. [PMID: 31778312 DOI: 10.1259/bjr.20190647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
There is growing evidence supporting the use of stereotactic ablative radiotherapy (SABR) on the treatment of localised stage non-small-cell lung cancer (NSCLC). Distinctive imaging challenges are posed post-SABR treatment. Thus, it is imperative to provide guidance on assessing treatment response, especially for new adopters. This commentary is about filling a gap in response evaluation after SABR for localised NSCLC.
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Affiliation(s)
| | - Osbert C Zalay
- Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Kevin Lm Chua
- Division of Radiation Oncology, National Cancer Centre, Singapore, Singapore.,Oncology Academic Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Fabio Ynoe Moraes
- Department of Oncology - Division of Radiation Oncology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
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20
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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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21
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Abstract
OBJECTIVE The purpose of this article is to summarize the clinical utility of 18F-FDG PET/CT in the evaluation of lung cancer recurrence with an emphasis on typical anatomic and metabolic patterns of recurrence, expected posttherapeutic changes, and common pitfalls of FDG PET/CT. FDG PET/CT is useful in assessing therapeutic response and in determining the extent of recurrent disease and provides a guide for targeted biopsy. CONCLUSION FDG PET/CT plays a crucial role in the evaluation of therapeutic response in lung cancer and guides management.
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22
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Delgado Bolton RC, Calapaquí-Terán AK, Giammarile F, Rubello D. Role of 18F-FDG-PET/CT in establishing new clinical and therapeutic modalities in lung cancer. A short review. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Delgado Bolton RC, Calapaquí-Terán AK, Giammarile F, Rubello D. Role of 18F-FDG PET/CT in establishing new clinical and therapeutic modalities in lung cancer. A short review. Rev Esp Med Nucl Imagen Mol 2019; 38:229-233. [PMID: 31202725 DOI: 10.1016/j.remn.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/04/2019] [Accepted: 02/06/2019] [Indexed: 12/11/2022]
Abstract
Lung cancer is a fairly common malignancy. An early diagnosis and a reliable staging and re-staging with the aim to detect both local and distant relapse are of utmost importance in planning the therapeutic management. The imaging diagnostic work-up of patients with lung cancer usually includes conventional imaging (chest X-ray, contrast-enhanced CT, bone scan) and more recently 18F-FDG PET/CT. Great advances in the management of lung cancer are based on the information provided by 18F-FDG PET/CT, as it supplies both metabolic and anatomic information (better localisation). There is vast evidence in the literature demonstrating its utility in (a) characterising benign versus malignant solitary nodules, (b) staging and re-staging lung cancer, (c) guiding the type of therapy, (d) monitoring treatment response and (e) predicting outcome. In particular, given its specificity in differentiating 18F-FDG-avid relapse from post-surgical changes or post-radiation fibrosis (which do not take up 18F-FDG), PET/CT can detect recurrent disease after initial treatment and (being a whole-body technique) has demonstrated high accuracy in the detection of distant metastases or secondary tumours. In conclusion, 18F-FDG PET/CT can be considered a highly accurate and reliable method for staging and re-staging lung cancer, and is highly effective in guiding personalised therapies.
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Affiliation(s)
- Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine at the San Pedro University Hospital and Centre for Biomedical Research of La Rioja (CIBIR) in Logroño(La Rioja), Spain
| | - Adriana K Calapaquí-Terán
- Department of Pathology at the University Hospital Marqués de Valdecilla, Santander (Cantabria), Spain
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency (IAEA), Vienna, Austria
| | - Domenico Rubello
- Department of Imaging (Nuclear Medicine, Medical Physics, Radiology) and of Clinical Laboratory (Laboratory, Transfusional Centre, Microbiology, Pathology, Rovigo Hospital, Italy.
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Shi S, Ye L, Zhao Q, Hu Y, Huang Y, Chen G, Zeng Z, He J. Prognostic index score predicts outcome of patients with Stage I non-small cell lung cancer after stereotactic body radiation therapy. Jpn J Clin Oncol 2019; 49:367-372. [PMID: 30715411 DOI: 10.1093/jjco/hyy205] [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] [Received: 10/31/2018] [Revised: 11/20/2018] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Lung cancer is the most common causes of cancer death worldwide and patients with non-small-cell lung cancer (NSCLC) have various prognosis. We conducted this study to identify the prognostic predictors and establish a prognostic index score (PIS) for patients with Stage I NSCLC after stereotactic body radiation therapy (SBRT). METHODS A total of 131 consecutive patients with Stage I NSCLC who underwent SBRT in our institute were analyzed retrospectively. The Cox proportional hazards regression model was applied to identify the prognostic predictors. Time-dependent receiver operating characteristic analysis was performed to examine cutoff values for survival. The Kaplan-Meier method with log-rank test was used to compare survival curves. RESULTS Univariate analysis indicated that tumor location, maximum standardized uptake value (SUVmax), monocyte counts and platelet-to-lymphocyte ratio (PLR) were prognostic factors of overall survival (OS). SUVmax and PLR remained significant in multivariate analysis. Survival analysis indicated both high-SUVmax and PLR correlated with inferior OS and PFS. A PIS was constructed based on pretreatment SUVmax and PLR and a high PIS was also significantly associated with poor outcome. CONCLUSION The pretreatment SUVmax and PLR were independent prognostic factors of OS in patients with Stage I NSCLC after SBRT. PIS provides a convenient and accurate tool for predicting outcome of patients after SBRT.
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Affiliation(s)
- Shiming Shi
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Luxi Ye
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianqian Zhao
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yong Hu
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yan Huang
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Gang Chen
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhaochong Zeng
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jian He
- Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
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Yan SX, Qureshi MM, Dyer M, Truong MT, Mak KS. Stereotactic body radiation therapy with higher biologically effective dose is associated with improved survival in stage II non-small cell lung cancer. Lung Cancer 2019; 131:147-153. [PMID: 31027693 DOI: 10.1016/j.lungcan.2019.03.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 02/14/2019] [Accepted: 03/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The role of stereotactic body radiation therapy (SBRT) in treating stage II non-small cell lung cancer (NSCLC) remains unclear. This study evaluates SBRT dose prescription patterns and survival outcomes in Stage II NSCLC using the National Cancer Database (NCDB). MATERIALS AND METHODS Patients diagnosed with Stage II NSCLC and treated with SBRT between 2004-2013 were identified in NCDB. The biologically effective dose with α/β = 10 Gy (BED10) was calculated. Overall survival (OS) was analyzed using the Kaplan-Meier method and Cox regression models. RESULTS Of 56,543 patients with Stage II NSCLC, 451 (0.8%) received SBRT. There were 360 patients (79.8%) with node-negative and 91 patients (20.2%) with node-positive disease. The most common prescriptions were 10 Gy x 5 (35.9%) and 12 Gy x 4 (19.3%). The mean and median BED10 were 114.9 Gy and 105.6 Gy, respectively. With median follow-up of 19.3 months, overall median survival was 23.7 months. Median survival was 22.4 months for those treated with BED10 < 114.9 Gy versus 31.5 months for BED10 ≥ 114.9 Gy (p = 0.036). On multivariate analysis, BED10 as a continuous variable (hazard ratio [HR] 0.991, p = 0.009) and ≥ 114.9 Gy (HR 0.63, p = 0.015) were associated with improved survival in node-negative patients. BED10 as a continuous variable (HR 0.997, p = 0.465) and ≥ 114.9 Gy (HR 0.81, p = 0.546) were not significant factors for predicting survival in node-positive patients. CONCLUSION SBRT is infrequently utilized to treat Stage II NSCLC in the United States. Treatment with higher BED10 was associated with improved survival, and the benefit was limited to patients with node-negative disease.
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Affiliation(s)
- Sherry X Yan
- Boston Medical Center, One Boston Medical Center Pl., Boston, MA 02118, USA
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Michael Dyer
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA
| | - Kimberley S Mak
- Department of Radiation Oncology, Boston Medical Center, 830 Harrison Ave. Moakley LL, Boston, MA 02118, USA; Boston University School of Medicine, 72 E. Concord St., Boston, MA 02118, USA.
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Park J, Choi Y, Ahn KJ, Park SK, Cho H, Lee JY. Maximum standardized uptake value at pre-treatment PET in estimating lung cancer progression after stereotactic body radiotherapy. Radiat Oncol J 2019; 37:30-36. [PMID: 30947478 PMCID: PMC6453805 DOI: 10.3857/roj.2019.00010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/13/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). MATERIALS AND METHODS Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. RESULTS The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progressionfree survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). CONCLUSION SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.
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Affiliation(s)
- Jisun Park
- Department of Nuclear Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Yunseon Choi
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ki Jung Ahn
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sung Kwang Park
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Heunglae Cho
- Department of Radiation Oncology, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji Young Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Ding M, Zollinger W, Ebeling R, Heard D, Posey R. Using max standardized uptake value from positron emission tomography to assess tumor responses after lung stereotactic body radiotherapy for different prescriptions. J Appl Clin Med Phys 2018; 19:226-233. [PMID: 30216639 PMCID: PMC6236840 DOI: 10.1002/acm2.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/06/2018] [Accepted: 08/20/2018] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To retrospectively investigate tumor responses of lung SBRT patients for different prescriptions. To analyze the relation between optimal biologically equivalent dose (BED) and tumor responses. METHODS AND MATERIALS Tumor responses after lung SBRT were compared by examining 48 treatments used four prescriptions. This study used simplified tumor response criteria: (a) Complete Response (CR) - post max SUV (SUVpost ) after SBRT in the treated tumor region was almost the same as the SUVs in the surrounding regions; (b) Partial Response (PR) - SUVpost was smaller than previous max SUV (SUVpre ), but was greater than the SUVs in the surrounding regions; (c) No Response (NR) - SUVpost was the same as or greater than SUVpre . Some SUVpost reported as mild or favorable responses were classified as CR/PR. BED calculated using α/β of 10 Gy were analyzed with assessments of tumor responses for SBRT prescriptions. RESULTS For the prescriptions (9 Gy × 5, 10 Gy × 5, 11 Gy × 5, and 12 Gy × 4) historically recommended by RTOG, we observed that higher BED10 and lower tumor volume would achieve a higher complete response rate. The highest complete response rate was observed for smallest tumor volume (PTVave = 6.8 cc) with higher BED10 (105.6) of 12 Gy × 4 prescription. For 11 Gy × 5 prescription, the BED10 (115.5) was the highest, but its complete response rate (58%) was lower than 79% of 12 Gy × 4 prescription. We observed the PTVave of 11 Gy × 5 prescription was more than double of the PTVave of 12 Gy × 4 prescription. For the same lung SBRT prescription (BED10 > 100) earlier staging tumor had more favorable local control. CONCLUSION We demonstrated post max SUV read from PET/CT could efficiently and accurately assess tumor response after lung SBRT. Although SBRT with prescriptions resulting in a BED10 > 100 experienced favorable tumor responses for early staging cancer, escalation of BED10 to higher levels would be beneficial for lung cancer patients with later staging and larger volume tumors.
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Affiliation(s)
- Meisong Ding
- Department of Radiation OncologyTulane University Medical CenterNew OrleansLAUSA
| | | | | | - David Heard
- Northeast Louisiana Cancer CenterMonroeLAUSA
| | - Ryan Posey
- Northeast Louisiana Cancer CenterMonroeLAUSA
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Yang DM, Palma D, Louie A, Malthaner R, Fortin D, Rodrigues G, Yaremko B, Laba J, Gaede S, Warner A, Inculet R, Lee TY. Assessment of tumour response after stereotactic ablative radiation therapy for lung cancer: A prospective quantitative hybrid 18 F-fluorodeoxyglucose-positron emission tomography and CT perfusion study. J Med Imaging Radiat Oncol 2018; 63:94-101. [PMID: 30281918 DOI: 10.1111/1754-9485.12807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/25/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Stereotactic ablative radiotherapy (SABR) is a guideline-recommended treatment for inoperable stage I non-small cell lung cancer (NSCLC), but imaging assessment of response after SABR is difficult. The goal of this study was to evaluate imaging-based biomarkers of tumour response using dynamic 18 F-FDG-PET and CT perfusion (CTP). METHODS Thirty-one patients with early-stage NSCLC participated in this prospective correlative study. Each underwent dynamic 18 F-FDG-PET/CTP studies on a PET/CT scanner pre- and 8 weeks post-SABR. The dynamic 18 F-FDG-PET measured the tumour SUVmax , SUVmean and the following parameters: K1 , k2 , k3 , k4 and Ki , all using the Johnson-Wilson-Lee kinetic model. CTP quantitatively mapped BF, BV, MTT and PS in tumours and measured largest tumour diameter. Since free-breathing was allowed during CTP scanning, non-rigid image registration of CT images was applied to minimize misregistration before generating the CTP functional maps. Differences between pre- and post-SABR imaging-based parameters were compared. RESULTS Tumour size changed only slightly after SABR (median 26 mm pre-SABR vs. 23 mm post-SABR; P = 0.01). However, dynamic 18 F-FDG-PET and CTP study showed substantial and significant changes in SUVmax , SUVmean , k3 , k4 and Ki . Significant decreases were evident in SUVmax (median 6.1 vs. 2.6; P < 0.001), SUVmean (median 2.5 vs. 1.5; P < 0.001), k3 (relative decrease of 52%; P = 0.002), Ki (relative decrease of 27%; P = 0.03), whereas there was an increase in k4 (+367%; P < 0.001). CONCLUSIONS Hybrid 18 F-FDG-PET/CTP allowed the response of NSCLC to SABR to be assessed regarding metabolic and functional parameters. Future studies are needed, with correlation with long-term outcomes, to evaluate these findings as potential imaging biomarkers of response.
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Affiliation(s)
- Dae-Myoung Yang
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - David Palma
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Alexander Louie
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Richard Malthaner
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Dalilah Fortin
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - George Rodrigues
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Brian Yaremko
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Joanna Laba
- Department of Oncology, Western University, London, Ontario, Canada.,Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Stewart Gaede
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Department of Oncology, Western University, London, Ontario, Canada.,Department of Engineering and Physics, Western University, London, Ontario, Canada
| | - Andrew Warner
- Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Richard Inculet
- Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, London, Ontario, Canada
| | - Ting-Yim Lee
- Department of Medical Biophysics, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
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Oikonomou A, Khalvati F, Tyrrell PN, Haider MA, Tarique U, Jimenez-Juan L, Tjong MC, Poon I, Eilaghi A, Ehrlich L, Cheung P. Radiomics analysis at PET/CT contributes to prognosis of recurrence and survival in lung cancer treated with stereotactic body radiotherapy. Sci Rep 2018; 8:4003. [PMID: 29507399 PMCID: PMC5838232 DOI: 10.1038/s41598-018-22357-y] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/19/2018] [Indexed: 02/08/2023] Open
Abstract
We sought to quantify contribution of radiomics and SUVmax at PET/CT to predict clinical outcome in lung cancer patients treated with stereotactic body radiotherapy (SBRT). 150 patients with 172 lung cancers, who underwent SBRT were retrospectively included. Radiomics were applied on PET/CT. Principal components (PC) for 42 CT and PET-derived features were examined to determine which ones accounted for most of variability. Survival analysis quantified ability of radiomics and SUVmax to predict outcome. PCs including homogeneity, size, maximum intensity, mean and median gray level, standard deviation, entropy, kurtosis, skewness, morphology and asymmetry were included in prediction models for regional control (RC) [PC4-HR:0.38, p = 0.02], distant control (DC) [PC4-HR:0.51, p = 0.02 and PC1-HR:1.12, p = 0.01], recurrence free probability (RFP) [PC1-HR:1.08, p = 0.04], disease specific survival (DSS) [PC2-HR:1.34, p = 0.03 and PC3-HR:0.64, p = 0.02] and overall survival (OS) [PC4-HR:0.45, p = 0.004 and PC3-HR:0.74, p = 0.02]. In combined analysis with SUVmax, PC1 lost predictive ability over SUVmax for RFP [HR:1.1, p = 0.04] and DC [HR:1.13, p = 0.002], while PC4 remained predictive of DC independent of SUVmax [HR:0.5, p = 0.02]. Radiomics remained the only predictors of OS, DSS and RC. Neither SUVmax nor radiomics predicted recurrence free survival. Radiomics on PET/CT provided complementary information for prediction of control and survival in SBRT-treated lung cancer patients.
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Affiliation(s)
- Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
| | - Farzad Khalvati
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Pascal N Tyrrell
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Masoom A Haider
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Usman Tarique
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Laura Jimenez-Juan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Michael C Tjong
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Armin Eilaghi
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Lisa Ehrlich
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Patrick Cheung
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Optimal imaging surveillance after stereotactic ablative radiation therapy for early-stage non-small cell lung cancer: Findings of an International Delphi Consensus Study. Pract Radiat Oncol 2018; 8:e71-e78. [DOI: 10.1016/j.prro.2017.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/12/2017] [Accepted: 10/22/2017] [Indexed: 12/17/2022]
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Pierson C, Grinchak T, Sokolovic C, Holland B, Parent T, Bowling M, Arastu H, Walker P, Ju A. Response criteria in solid tumors (PERCIST/RECIST) and SUV max in early-stage non-small cell lung cancer patients treated with stereotactic body radiotherapy. Radiat Oncol 2018; 13:34. [PMID: 29486779 PMCID: PMC5830069 DOI: 10.1186/s13014-018-0980-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 02/20/2018] [Indexed: 12/25/2022] Open
Abstract
Background The purpose of this study was to evaluate the prognostic impact of Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) and Response Evaluation Criteria in Solid Tumors (RECIST) and of pre- and post-treatment maximum Standard Uptake Value (SUVmax) in regards to survival and tumor control for patients treated for early-stage non-small cell lung cancer (ES-NSCLC) with stereotactic body radiotherapy (SBRT). Methods This is a retrospective review of patients with ES-NSCLC treated at our institution using SBRT. Lobar, locoregional, and distant failures were evaluated based on PERCIST/RECIST and clinical course. Univariate analysis of the Kaplan-Meier curves for overall survival (OS), progression free survival (PFS), lobar control (LC), locoregional control (LRC), and distant control (DC) was conducted using the log-rank test. Pre- and post-treatment SUVmax were evaluated using cutoffs of < 5 and ≥ 5, < 4 and ≥ 4, and < 3 and ≥ 3. ∆SUVmax was also evaluated at various cutoffs. Cox regression analysis was conducted to evaluate survival outcomes based on age, gender, pre-treatment gross tumor volume (GTV), longest tumor dimension on imaging, and Charlson Comorbidity Index (CCI). Results This study included 95 patients (53 female, 42 male), median age 75. Lung SBRT was delivered in 3–5 fractions to a total of 48–60 Gy, with a BEDα/β = 10Gy of at least 100 Gy. Median OS and PFS from the end of SBRT was 15.4 and 11.9 months, respectively. On univariate analysis, PERCIST/RECIST response correlated with PFS (p = 0.039), LC (p = 0.007), and LRC (p = 0.015) but not OS (p = 0.21) or DC (p = 0.94). Pre-treatment SUVmax and post-treatment SUVmax with cutoff values of < 5 and ≥ 5, < 4 and ≥ 4, and < 3 and ≥ 3 did not predict for OS, PFS, LC, LRC, or DC. ∆SUVmax did not predict for OS, PFS, LC, LRC, or DC. On multivariate analysis, pre-treatment GTV ≥ 30 cm3 was significantly associated with worse survival outcomes when accounting for other confounding variables. Conclusions PERCIST/RECIST response is associated with improved LC and PFS in patients treated for ES-NSCLC with SBRT. In contrast, pre- and post-treatment SUVmax is not predictive of disease control or survival.
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Affiliation(s)
- Cory Pierson
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Taras Grinchak
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | | | - Brandi Holland
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Teresa Parent
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Mark Bowling
- Department of Internal Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Hyder Arastu
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Paul Walker
- Department of Internal Medicine, 600 Moye Boulevard, Greenville, NC, 27834, USA
| | - Andrew Ju
- Leo W. Jenkins Cancer Center, 600 Moye Boulevard, Greenville, NC, 27834, USA.
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Wang HH, Zhang CZ, Zhang BL, Chen J, Zeng XL, Deng L, Meng MB. Sublobar resection is associated with improved outcomes over radiotherapy in the management of high-risk elderly patients with Stage I non-small cell lung cancer: a systematic review and meta-analysis. Oncotarget 2018; 8:6033-6042. [PMID: 28002808 PMCID: PMC5351610 DOI: 10.18632/oncotarget.14010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/12/2016] [Indexed: 02/05/2023] Open
Abstract
Background and Aim A matched-pair comparison was performed to compare the efficacy and safety of sublobar resection versus radiotherapy for high-risk elderly patients with Stage I non-small cell lung cancer (NSCLC). Patients and Methods We searched the Cochrane Library, MEDLINE, CENTRAL, EMBASE and manual searches. The meta-analysis was performed to compare overall survival, pattern of failure, and toxicity among the homogeneous studies. Subdivided analyses were also performed. Results Sixteen studies containing 11540 patients were included in the meta-analysis. Among these studies, 9 were propensity-score matched (PSM) cohort studies, and 7 were cohort studies. Sublobar resection, compared with radiotherapy (either conventional fraction radiation therapy or stereotactic body radiation therapy), significantly improved the overall survival regardless in both PSM and non-PSM analyses (all p < 0.05). However, the difference in the pattern of failure and toxicity were not significant (all p > 0.05). Conclusions Sublobar resection was associated with improved outcomes in high-risk elderly patients with Stage I NSCLC, which supports the need to compare both treatments in large prospective, randomized, controlled clinical trials.
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Affiliation(s)
- Huan-Huan Wang
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Chun-Ze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin 300121, China
| | - Bai-Lin Zhang
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jie Chen
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Xian-Liang Zeng
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
| | - Lei Deng
- Department of Thoracic Cancer and Huaxi Student Society of Oncology Research, West China Hospital, West China School of Medicine, Sichuan University, Sichuan Province 610041, China
| | - Mao-Bin Meng
- Department of Radiation Oncology, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China
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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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Hobbs CJ, Ko SJ, Paryani NN, Accurso JM, Olivier KR, Garces YI, Park SS, Hallemeier CL, Schild SE, Vora SA, Ashman JB, Rule WG, Bowers JR, Heckman MG, Diehl NN, Miller RC. Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non-Small Cell Lung Cancer: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2017; 2:40-48. [PMID: 30225431 PMCID: PMC6124323 DOI: 10.1016/j.mayocpiqo.2017.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective To examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non-small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes. Patients and Methods We retrospectively reviewed the cases of consecutive patients with FDG-PET-staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models. Results Among 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02). Conclusion Disease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.
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Key Words
- BED, biologically effective dose
- CT, computed tomography
- DFS, disease-free survival
- EBUS, endobronchial ultrasonography
- FDG-PET, 18F-fludeoxyglucose–positron emission tomography
- HR, hazard ratio
- ITV, internal target volume
- LC, local control
- NSCLC, non–small cell lung cancer
- OS, overall survival
- PET, positron emission tomography
- RTOG, Radiation Therapy Oncology Group
- SBRT, stereotactic body radiotherapy
- SUVmax, maximum standardized uptake value
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Affiliation(s)
- Corey J Hobbs
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | - Stephen J Ko
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
| | | | | | | | | | - Sean S Park
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Sujay A Vora
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | - William G Rule
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | - Johnny R Bowers
- Department of Radiation Oncology, Mayo Clinic Hospital, Phoenix, AZ
| | | | | | - Robert C Miller
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL
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Tyran M, Charrier N, Darreon J, Madroszyk A, Tallet A, Salem N. Early PET-CT After Stereotactic Radiotherapy for Stage 1 Non-small Cell Lung Carcinoma Is Predictive of Local Control. ACTA ACUST UNITED AC 2017; 32:121-124. [PMID: 29275308 DOI: 10.21873/invivo.11213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND/AIM Radiological evaluation after stereotactic-body-radiotherapy (SBRT) for non-small-cell lung carcinoma (NSCLC) is often difficult due to lung radiation-induced image modifications on computed tomographic (CT) scan. The aim of this study was to evaluate positron-emission tomography-computed tomography (PET-CT) using fluorodeoxyglucose after SBRT in primary lung cancer. PATIENTS AND METHODS Eighteen patients with histologically proven NSCLC were treated with SBRT. All had PET-CT evaluations before treatment, at 2 to 3 months and at 1 year post SBRT during the follow-up. RESULTS Early PET-CT in 12/18 patients who did not experience local failure did not show any progression. No conclusion could be drawn in four cases because early PET-CT was disturbed by inflammatory reaction. Early PET-CT was not predictive of late outcome for two patients, as it showed a significant response followed by disease progression on late evaluation. CONCLUSION Early PET response appears to correlate with local control at 1 year post SBRT.
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Affiliation(s)
- Marguerite Tyran
- Department of Radiation Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Nathalie Charrier
- Department of Nuclear Medicine, Paoli-Calmettes Institute, Marseille, France
| | - Julien Darreon
- Department of Radiation Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Anne Madroszyk
- Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Agnes Tallet
- Department of Radiation Oncology, Paoli-Calmettes Institute, Marseille, France
| | - Naji Salem
- Department of Radiation Oncology, Paoli-Calmettes Institute, Marseille, France
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Takeda K, Takanami K, Shirata Y, Yamamoto T, Takahashi N, Ito K, Takase K, Jingu K. Clinical utility of texture analysis of 18F-FDG PET/CT in patients with Stage I lung cancer treated with stereotactic body radiotherapy. JOURNAL OF RADIATION RESEARCH 2017; 58:862-869. [PMID: 29036692 PMCID: PMC5710655 DOI: 10.1093/jrr/rrx050] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/06/2017] [Indexed: 06/04/2023]
Abstract
We evaluated the reproducibility and predictive value of texture parameters and existing parameters of 18F-FDG PET/CT images in Stage I non-small-cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT). Twenty-six patients with Stage I NSCLC (T1-2N0M0) were retrospectively analyzed. All of the patients underwent an 18F-FDG PET/CT scan before treatment and were treated with SBRT. Each tumor was delineated using PET Edge (MIM Software Inc., Cleveland, OH), and texture parameters were calculated using open-source code CGITA. From 18F-FDG PET/CT images, three conventional parameters, including maximum standardized uptake value (SUV), metabolic tumor volume (MTV) and total lesion glycolysis (TLG), and four texture parameters, including entropy and dissimilarity (derived from a co-occurrence matrix) and high-intensity large-area emphasis (HILAE) and zone percentage (derived from a size-zone matrix) were analyzed. Reproducibility was evaluated using two independent delineations conducted by two observers. The ability to predict local control (LC), progression-free survival (PFS) and overall survival (OS) was tested for each parameter. All of the seven parameters except zone percentage showed good reproducibility, with intraclass correlation coefficient values >0.8. In univariate analysis, only HILAE was a significant predictor for LC. Histology, dose fractionation, and maximum SUV were associated with PFS, and histology and dose fractionation were associated with OS. We showed that texture parameters derived from 18F-FDG PET/CT were reproducible and potentially beneficial for predicting LC in Stage I lung cancer patients treated with SBRT.
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Affiliation(s)
- Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kentaro Takanami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yuko Shirata
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kengo Ito
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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37
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Cheng G, Huang H. Prognostic Value of 18F-Fluorodeoxyglucose PET/Computed Tomography in Non-Small-Cell Lung Cancer. PET Clin 2017; 13:59-72. [PMID: 29157386 DOI: 10.1016/j.cpet.2017.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related death with a poor prognosis. Numerous factors contribute to treatment outcome. 18F-fluorodeoxyglucose (FDG) uptake reflects tumor metabolic activity and is an important prognosticator in patients with NSCLC. Volume-based FDG-PET parameters reflect the metabolic status of a malignancy more accurately than maximum standardized uptake value and thus are better prognostic markers in lung cancer. FDG-avid tumor burden parameters may help clinicians to predict treatment outcomes before and during therapy so that treatment can be adjusted to achieve the best possible outcomes while avoiding side effects.
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Affiliation(s)
- Gang Cheng
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| | - He Huang
- Department of Nuclear Medicine, Luzhou People's Hospital, Luzhou, Sichuan Province, People's Republic of China
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38
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Jadvar H, Colletti PM, Delgado-Bolton R, Esposito G, Krause BJ, Iagaru AH, Nadel H, Quinn DI, Rohren E, Subramaniam RM, Zukotynski K, Kauffman J, Ahuja S, Griffeth L. Appropriate Use Criteria for 18F-FDG PET/CT in Restaging and Treatment Response Assessment of Malignant Disease. J Nucl Med 2017; 58:2026-2037. [DOI: 10.2967/jnumed.117.197988] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
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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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40
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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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Abstract
PURPOSE OF REVIEW The immunomodulatory effects of ionizing radiation have long been recognized; however, so far these have not been fully exploited in clinical practice. We review the rationale to combine radiation with immune checkpoint inhibitors, which are used in standard practice. RECENT FINDINGS Preclinical research suggests a synergy between radiotherapy and these immune checkpoint inhibitors. Whether or not this benefit translates into a clinical benefit is currently subject of ongoing research. SUMMARY It is highly rational to combine radiation with immune therapy as in preclinical models and in proof of concept trials in humans it clearly can increase the antitumor immunity when given together with other immune interventions.
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Antonoff MB, Correa AM, Sepesi B, Nguyen QN, Walsh GL, Swisher SG, Vaporciyan AA, Mehran RJ, Hofstetter WL, Rice DC. Salvage pulmonary resection after stereotactic body radiotherapy: A feasible and safe option for local failure in selected patients. J Thorac Cardiovasc Surg 2017; 154:689-699. [PMID: 28495066 DOI: 10.1016/j.jtcvs.2017.03.142] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 02/23/2017] [Accepted: 03/25/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE For inoperable patients with pulmonary malignancy, stereotactic body radiotherapy is a reasonable therapeutic option. Despite good early tumor control, local failure occurs in up to 10% of patients by 3 years. Because management of local recurrence after stereotactic body radiotherapy is unclear, we evaluated use of surgery as a salvage option. METHODS A retrospective review was conducted of consecutive patients from a single institution who underwent salvage resection of primary and metastatic pulmonary malignancies previously treated with stereotactic body radiotherapy. In addition, a literature search was conducted to identify previous reports of pulmonary resection for local stereotactic body radiotherapy failures, to allow cumulative analyses with previously published cases. RESULTS A total of 21 patients met inclusion criteria. The median time between stereotactic body radiotherapy and salvage surgery was 16.2 months (range, 6.4-71.5). Postoperative complications occurred in 7 patients (18.9%), in whom atrial arrhythmias and prolonged air leaks (>5 days) were most frequent (n = 2 each, 5.4%). There was no local recurrence after salvage surgery. Distant failure occurred in 5 of 21 patients (23.8%) at a median of 36.2 months, and median disease-free survival was 19.2 months. The 30- and 90-day mortality was 4.8% (1 patient). Cumulative analysis included 37 patients from 4 institutions and comprised 26 (78.8%) primary non-small cell lung cancers and 11 (29.7%) lung metastases. Median overall survival after salvage surgery was 46.9 months, and 3-year survival was 71.8%. CONCLUSIONS After local failure of stereotactic body radiotherapy, salvage resection remains a viable option for operable patients, with acceptable morbidity and survival. As use of stereotactic body radiotherapy continues to expand, further studies to evaluate the optimal management for local failure are needed.
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Affiliation(s)
- Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex.
| | - Arlene M Correa
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Boris Sepesi
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Quynh-Nhu Nguyen
- Department of Thoracic Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Garrett L Walsh
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Stephen G Swisher
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Ara A Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Reza J Mehran
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Wayne L Hofstetter
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
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Van Breussegem A, Hendriks JM, Lauwers P, Van Schil PE. Salvage surgery after high-dose radiotherapy. J Thorac Dis 2017; 9:S193-S200. [PMID: 28446984 DOI: 10.21037/jtd.2017.03.88] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Salvage surgery is a relatively new entity in thoracic surgery and oncology. Salvage resection after radiotherapy refers to surgery as only remaining therapeutic option in patients who were treated with high-dose stereotactic radiotherapy (SRT) for early-stage lung cancer or full-dose chemoradiation for locally advanced lung cancer. Indications include locally progressive tumors, recurrent local or locoregional disease, or specific complications after radiotherapy such as lung abscesses or infected, necrotic cavities. Small, retrospective series demonstrate that salvage surgery after high-dose radiotherapy is feasible and may yield good long-term results. A clear distinction should be made between salvage surgery after SRT for early-stage lung cancer and salvage procedures after full-dose chemoradiation for lung cancers with locoregional extension into the mediastinum. Salvage surgery after SRT may be rather straightforward and in specific cases even feasible by a minimally invasive approach. In contrast, surgery after a full dose of chemoradiation delivered several months or years earlier, can be quite challenging and the dissection of the pulmonary artery and mediastinal lymph nodes technically demanding. Due to the more central irradiation an intrapericardial dissection is often required. To prevent a bronchopleural fistula protection of the bronchial stump with well-vascularized flaps is recommended. Each individual patient in whom salvage surgery is considered, should be discussed thoroughly within a multidisciplinary board, detailed cardiopulmonary functional evaluation is required, and the operation should be performed by an experienced team including a thoracic surgeon, anaesthesiologist and intensive care physician. At the present time only retrospective series are available. Carefully designed prospective studies are necessary to more precisely define indications and results of salvage surgery not only after SRT for peripherally localized lesions but also following full-dose chemoradiation for locoregionally advanced disease.
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Affiliation(s)
- Annemie Van Breussegem
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Jeroen M Hendriks
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Patrick Lauwers
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium
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Hanna GG, Illidge T. Radiotherapy and Immunotherapy Combinations in Non-small Cell Lung Cancer: A Promising Future? Clin Oncol (R Coll Radiol) 2016; 28:726-731. [PMID: 27519157 DOI: 10.1016/j.clon.2016.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/18/2016] [Accepted: 07/28/2016] [Indexed: 12/12/2022]
Abstract
The goal of re-programming the host immune system to target malignancy with durable anti-tumour clinical responses has been speculated for decades. In the last decade such speculation has been transformed into reality with unprecedented and durable responses to immune checkpoint inhibitors seen in solid tumours. This mini-review considers the mechanism of action of immune modulating agents and the potential for combination with radiotherapy in the treatment of non-small cell lung cancer.
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Affiliation(s)
- G G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK.
| | - T Illidge
- Institute of Cancer Sciences, Manchester Cancer Research Centre, Manchester Academic Health Sciences Centre, University of Manchester, The Christie Hospital, Manchester, UK
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Takahashi N, Yamamoto T, Matsushita H, Sugawara T, Kubozono M, Umezawa R, Ishikawa Y, Kozumi M, Katagiri Y, Tasaka S, Takeda K, Takeda K, Dobashi S, Jingu K. Metabolic tumor volume on FDG-PET/CT is a possible prognostic factor for Stage I lung cancer patients treated with stereotactic body radiation therapy: a retrospective clinical study. JOURNAL OF RADIATION RESEARCH 2016; 57:655-661. [PMID: 27422935 PMCID: PMC5137288 DOI: 10.1093/jrr/rrw048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/30/2015] [Accepted: 03/24/2016] [Indexed: 05/08/2023]
Abstract
The aim of this study was to determine whether metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are associated with outcomes in Stage I lung cancer patients treated with stereotactic body radiation therapy (SBRT). Thirty-eight patients underwent [18F] fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) within 60 days before SBRT at our institution between January 2001 and December 2011. The maximum standardized uptake value (SUVmax), MTV2, MTV4, MTV6, TLG40%, TLG50% and TLG60% were calculated. Prognostic factors for overall survival (OS) and local control (LC) were analyzed using Cox's proportional hazards model, and survival curves were calculated using the Kaplan-Meier method. Receiver operating characteristics (ROC) curves of PET parameters for OS and LC were calculated. The median follow-up period for survivors was 37.7 months. Three-year OS and LC rates were 56.4% and 70.5%, respectively, and 5-year OS and LC rates were 36.8% and 70.5%, respectively. In univariate analyses, tumor diameter (P = 0.019), single dose ≥10 Gy (P = 0.017), MTV2 (P = 0.030) and MTV4 (P = 0.048) were significant predictors for OS. Tumor diameter (P < 0.001), single dose ≥10 Gy (P = 0.007), SUVmax (P = 0.035), MTV2 (P < 0.001), MTV4 (P = 0.003), MTV6 (P = 0.017), TLG40% (P < 0.001), TLG50% (P = 0.001) and TLG60% (P = 0.003) were significant predictors for LC. SUVmax was not a significant predictor for OS. We made the ROC curves at PET parameters, and the largest area under the curve value for OS was MTV2 and for LC was TLG40% Tumor diameter, single dose ≥10 Gy, MTV2 and MTV4 are prognostic factors for OS and LC rates and MTV2 is a better prognostic factor for OS than other PET parameters.
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Affiliation(s)
- Noriyoshi Takahashi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Takaya Yamamoto
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Haruo Matsushita
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Toshiyuki Sugawara
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Masaki Kubozono
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Rei Umezawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yojiro Ishikawa
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Maiko Kozumi
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yu Katagiri
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Syun Tasaka
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Kazuya Takeda
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Ken Takeda
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Suguru Dobashi
- Department of Radiological Technology, School of Health Sciences, Faculty of Medicine, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Keiichi Jingu
- Department of Radiation Oncology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Ghaye B, Wanet M, El Hajjam M. Imaging after radiation therapy of thoracic tumors. Diagn Interv Imaging 2016; 97:1037-1052. [PMID: 27567554 DOI: 10.1016/j.diii.2016.06.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 12/25/2022]
Abstract
Radiation-induced lung disease (RILD) is frequent after therapeutic irradiation of thoracic malignancies. Many technique-, treatment-, tumor- and patient-related factors influence the degree of injury sustained by the lung after irradiation. Based on the time interval after the completion of the treatment RILD presents as early and late features characterized by inflammatory and fibrotic changes, respectively. They are usually confined to the radiation port. Though the typical pattern of RILD is easily recognized after conventional two-dimensional radiation therapy (RT), RILD may present with atypical patterns after more recent types of three- or four-dimensional RT treatment. Three atypical patterns are reported: the modified conventional, the mass-like and the scar-like patterns. Knowledge of the various features and patterns of RILD is important for correct diagnosis and appropriate treatment. RILD should be differentiated from recurrent tumoral disease, infection and radiation-induced tumors. Due to RILD, the follow-up after RT may be difficult as response evaluation criteria in solid tumours (RECIST) criteria may be unreliable to assess tumor control particularly after stereotactic ablation RT (SABR). Long-term follow-up should be based on clinical examination and morphological and/or functional investigations including CT, PET-CT, pulmonary functional tests, MRI and PET-MRI.
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Affiliation(s)
- B Ghaye
- Service de radiologie, secteur cardiothoracique, cliniques universitaires St-Luc, université catholique de Louvain, avenue Hippocrate 10, 1200 Bruxelles, Belgium.
| | - M Wanet
- Service de radiothérapie, oncologique, CHU UCL Namur, site clinique et maternité Sainte-Elisabeth, 5000 Namur, Belgium
| | - M El Hajjam
- Service de radiologie, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France
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Ablative dose proton beam therapy for stage I and recurrent non-small cell lung carcinomas : Ablative dose PBT for NSCLC. Strahlenther Onkol 2016; 192:649-57. [PMID: 27282279 DOI: 10.1007/s00066-016-0985-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 04/21/2016] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the efficacy and safety of ablative dose hypofractionated proton beam therapy (PBT) for patients with stage I and recurrent non-small cell lung carcinoma (NSCLC). PATIENTS AND METHODS A total of 55 patients with stage I (n = 42) and recurrent (n = 13) NSCLC underwent hypofractionated PBT and were retrospectively reviewed. A total dose of 50-72 CGE (cobalt gray equivalent) in 5-12 fractions was delivered. RESULTS The median follow-up duration was 29 months (range 4-95 months). There were 24 deaths (43.6%) during the follow-up period: 11 died of disease progression and 13 from other causes. Kaplan-Meier overall survival rate (OS) at 3 years was 54.9% and the median OS was 48.6 months (range 4-95 months). Local progression was observed in 7 patients and the median time to local progression was 9.3 months (range 5-14 months). Cumulative actuarial local control rate (LCR), lymph node metastasis-free survival, and distant metastasis-free survival rates at 3 years were 85.4, 78.4, and 76.5%, respectively. Larger tumor diameter was significantly associated with poorer LCR (3-year: 94% for ≤3 cm vs. 65% for >3 cm, p = 0.006) on univariate analysis and also an independent prognostic factor for LCR (HR 6.9, 95% CI = 1.3-37.8, p = 0.026) on multivariate analysis. No grade 3 or 4 treatment-related toxicities developed. One grade 5 treatment-related adverse event occurred in a patient with symptomatic idiopathic pulmonary fibrosis. CONCLUSIONS Ablative dose hypofractionated PBT was safe and promising for stage I and recurrent NSCLC.
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Follow-up of patients after stereotactic radiation for lung cancer: a primer for the nonradiation oncologist. J Thorac Oncol 2016; 10:412-9. [PMID: 25695219 DOI: 10.1097/jto.0000000000000435] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The use of stereotactic ablative radiotherapy (SABR) as primary treatment for early stage non-small-cell lung cancer, or for ablation of metastases, has increased rapidly in the past decade. With local recurrence rates reported at approximately 10%, and a patient population that is becoming increasingly fit and amenable to salvage treatment, appropriate multidisciplinary follow-up care is critical. Appropriate follow-up will allow for detection and management of radiation-related toxicity, early detection of recurrent disease and differentiation of recurrence from radiation-induced lung injury. METHODS This narrative review summarizes issues surrounding follow-up of patients treated with SABR in the context of a multidisciplinary perspective. We summarize treatment-related toxicities including radiation pneumonitis, chest wall pain, rib fracture, and fatal toxicity, and highlight the challenges of early and accurate detection of local recurrence, while avoiding unnecessary biopsy or treatment of benign radiation-induced fibrotic lung damage. RESULTS Follow-up recommendations based on the current evidence and available guidelines are summarized. Imaging follow-up recommendations include serial computed tomography (CT) imaging at 3-6 months posttreatment for the initial year, then every 6-12 months for an additional 3 years, and annually thereafter. With suspicion of progressive disease, recommendations include a multidisciplinary team discussion, the use of high-risk CT features for accurate detection of local recurrence, and positron emission tomography/CT SUV max cutoffs to prompt further investigation. Biopsy and/or surgical or nonsurgical salvage therapy can be considered if safe and when investigations are nonreassuring. CONCLUSIONS The appropriate follow-up of patients after SABR requires collaborative input from nearly all members of the thoracic multidisciplinary team, and evidence is available to guide treatment decisions. Further research is required to develop better predictors of toxicity and recurrence.
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Lovinfosse P, Janvary ZL, Coucke P, Jodogne S, Bernard C, Hatt M, Visvikis D, Jansen N, Duysinx B, Hustinx R. FDG PET/CT texture analysis for predicting the outcome of lung cancer treated by stereotactic body radiation therapy. Eur J Nucl Med Mol Imaging 2016; 43:1453-60. [PMID: 26830299 DOI: 10.1007/s00259-016-3314-8] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/08/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION With (18)F-FDG PET/CT, tumor uptake intensity and heterogeneity have been associated with outcome in several cancers. This study aimed at investigating whether (18)F-FDG uptake intensity, volume or heterogeneity could predict the outcome in patients with non-small cell lung cancers (NSCLC) treated by stereotactic body radiation therapy (SBRT). METHODS Sixty-three patients with NSCLC treated by SBRT underwent a (18)F-FDG PET/CT before treatment. Maximum and mean standard uptake value (SUVmax and SUVmean), metabolic tumoral volume (MTV), total lesion glycolysis (TLG), as well as 13 global, local and regional textural features were analysed. The predictive value of these parameters, along with clinical features, was assessed using univariate and multivariate analysis for overall survival (OS), disease-specific survival (DSS) and disease-free survival (DFS). Cutoff values were obtained using logistic regression analysis, and survivals were compared using Kaplan-Meier analysis. RESULTS The median follow-up period was 27.1 months for the entire cohort and 32.1 months for the surviving patients. At the end of the study, 25 patients had local and/or distant recurrence including 12 who died because of the cancer progression. None of the clinical variables was predictive of the outcome, except age, which was associated with DFS (HR 1.1, P = 0.002). None of the (18)F-FDG PET/CT or clinical parameters, except gender, were associated with OS. The univariate analysis showed that only dissimilarity (D) was associated with DSS (HR = 0.822, P = 0.037), and that several metabolic measurements were associated with DFS. In multivariate analysis, only dissimilarity was significantly associated with DSS (HR = 0.822, P = 0.037) and with DFS (HR = 0.834, P < 0.01). CONCLUSION The textural feature dissimilarity measured on the baseline (18)F-FDG PET/CT appears to be a strong independent predictor of the outcome in patients with NSCLC treated by SBRT. This may help selecting patients who may benefit from closer monitoring and therapeutic optimization.
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Affiliation(s)
- Pierre Lovinfosse
- Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium.
| | - Zsolt Levente Janvary
- Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium
| | - Philippe Coucke
- Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium
| | | | - Claire Bernard
- Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium
| | | | | | - Nicolas Jansen
- Department of Medical Physics, Division of Radiation Oncology, CHU and University of Liège, Liège, Belgium
| | | | - Roland Hustinx
- Department of Medical Physics, Division of Nuclear Medicine and Oncological Imaging, CHU University of Liège, B35 Domaine Universitaire du Sart Tilman, 4000, Liege, Belgium
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Prognostic Value of Semiautomatic CT Volumetry in Patients With Stage I Non–Small Cell Lung Cancer Treated With Stereotactic Body Radiation Therapy. J Comput Assist Tomogr 2016; 40:343-50. [DOI: 10.1097/rct.0000000000000368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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