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Zeng H, Tohidinezhad F, De Ruysscher DKM, Willems YCP, Degens JHRJ, van Kampen-van den Boogaart VEM, Pitz C, Cortiula F, Brandts L, Hendriks LEL, Traverso A. The Association of Gross Tumor Volume and Its Radiomics Features with Brain Metastases Development in Patients with Radically Treated Stage III Non-Small Cell Lung Cancer. Cancers (Basel) 2023; 15:cancers15113010. [PMID: 37296973 DOI: 10.3390/cancers15113010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To identify clinical risk factors, including gross tumor volume (GTV) and radiomics features, for developing brain metastases (BM) in patients with radically treated stage III non-small cell lung cancer (NSCLC). METHODS Clinical data and planning CT scans for thoracic radiotherapy were retrieved from patients with radically treated stage III NSCLC. Radiomics features were extracted from the GTV, primary lung tumor (GTVp), and involved lymph nodes (GTVn), separately. Competing risk analysis was used to develop models (clinical, radiomics, and combined model). LASSO regression was performed to select radiomics features and train models. Area under the receiver operating characteristic curves (AUC-ROC) and calibration were performed to assess the models' performance. RESULTS Three-hundred-ten patients were eligible and 52 (16.8%) developed BM. Three clinical variables (age, NSCLC subtype, and GTVn) and five radiomics features from each radiomics model were significantly associated with BM. Radiomic features measuring tumor heterogeneity were the most relevant. The AUCs and calibration curves of the models showed that the GTVn radiomics model had the best performance (AUC: 0.74; 95% CI: 0.71-0.86; sensitivity: 84%; specificity: 61%; positive predictive value [PPV]: 29%; negative predictive value [NPV]: 95%; accuracy: 65%). CONCLUSION Age, NSCLC subtype, and GTVn were significant risk factors for BM. GTVn radiomics features provided higher predictive value than GTVp and GTV for BM development. GTVp and GTVn should be separated in clinical and research practice.
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Affiliation(s)
- Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Fariba Tohidinezhad
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Dirk K M De Ruysscher
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Yves C P Willems
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
| | - Juliette H R J Degens
- Department of Respiratory Medicine, Zuyderland Medical Center, 6419 PC Heerlen, The Netherlands
| | | | - Cordula Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, 6043 CV Roermond, The Netherlands
| | - Francesco Cortiula
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
- Department of Medical Oncology, University Hospital of Udine, 33100 Udine, Italy
| | - Lloyd Brandts
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, Maastricht, GROW School for Oncology and Reproduction, Maastricht University Medical Center+, 6202 AZ Maastricht, The Netherlands
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht University Medical Centre+, 6229 ET Maastricht, The Netherlands
- School of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
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Keek SA, Kayan E, Chatterjee A, Belderbos JSA, Bootsma G, van den Borne B, Dingemans AMC, Gietema HA, Groen HJM, Herder J, Pitz C, Praag J, De Ruysscher D, Schoenmaekers J, Smit HJM, Stigt J, Westenend M, Zeng H, Woodruff HC, Lambin P, Hendriks L. Investigation of the added value of CT-based radiomics in predicting the development of brain metastases in patients with radically treated stage III NSCLC. Ther Adv Med Oncol 2022; 14:17588359221116605. [PMID: 36032350 PMCID: PMC9403451 DOI: 10.1177/17588359221116605] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/12/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction: Despite radical intent therapy for patients with stage III non-small-cell
lung cancer (NSCLC), cumulative incidence of brain metastases (BM) reaches
30%. Current risk stratification methods fail to accurately identify these
patients. As radiomics features have been shown to have predictive value,
this study aims to develop a model combining clinical risk factors with
radiomics features for BM development in patients with radically treated
stage III NSCLC. Methods: Retrospective analysis of two prospective multicentre studies. Inclusion
criteria: adequately staged [18F-fluorodeoxyglucose positron
emission tomography-computed tomography (18-FDG-PET-CT), contrast-enhanced
chest CT, contrast-enhanced brain magnetic resonance imaging/CT] and
radically treated stage III NSCLC, exclusion criteria: second primary within
2 years of NSCLC diagnosis and prior prophylactic cranial irradiation.
Primary endpoint was BM development any time during follow-up (FU). CT-based
radiomics features (N = 530) were extracted from the
primary lung tumour on 18-FDG-PET-CT images, and a list of clinical features
(N = 8) was collected. Univariate feature selection
based on the area under the curve (AUC) of the receiver operating
characteristic was performed to identify relevant features. Generalized
linear models were trained using the selected features, and multivariate
predictive performance was assessed through the AUC. Results: In total, 219 patients were eligible for analysis. Median FU was 59.4 months
for the training cohort and 67.3 months for the validation cohort; 21 (15%)
and 17 (22%) patients developed BM in the training and validation cohort,
respectively. Two relevant clinical features (age and adenocarcinoma
histology) and four relevant radiomics features were identified as
predictive. The clinical model yielded the highest AUC value of 0.71 (95%
CI: 0.58–0.84), better than radiomics or a combination of clinical
parameters and radiomics (both an AUC of 0.62, 95% CIs of 0.47–076 and
0.48–0.76, respectively). Conclusion: CT-based radiomics features of primary NSCLC in the current setup could not
improve on a model based on clinical predictors (age and adenocarcinoma
histology) of BM development in radically treated stage III NSCLC
patients.
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Affiliation(s)
- Simon A Keek
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Esma Kayan
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Avishek Chatterjee
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - José S A Belderbos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland Hospital, Heerlen, The Netherlands
| | - Ben van den Borne
- Department of Pulmonary Diseases, Catharina Hospital, Eindhoven, The Netherlands
| | | | - Hester A Gietema
- Department of Radiology and Nuclear Medicine, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Judith Herder
- Department of Pulmonary Diseases, Meander Medical Center, Amersfoort, The Netherlands
| | - Cordula Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, Roermond, The Netherlands
| | - John Praag
- Department of Radiotherapy, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro), GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Janna Schoenmaekers
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hans J M Smit
- Department of Pulmonary Diseases, Rijnstate, Arnhem, The Netherlands
| | - Jos Stigt
- Department of Pulmonary Diseases, Isala Hospital, Zwolle, The Netherlands
| | - Marcel Westenend
- Department of Pulmonary Diseases, VieCuri, Venlo, The Netherlands
| | - Haiyan Zeng
- Department of Radiation Oncology (Maastro), GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Henry C Woodruff
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Philippe Lambin
- The D-Lab, Department of Precision Medicine, GROW - School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Lizza Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Reproduction, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
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Hendriks L, Keek S, Chatterjee A, Belderbos J, Bootsma G, van den Borne B, Dingemans AM, Gietema H, Groen H, Herder G, Pitz C, Praag J, De Ruysscher D, Schoenmaekers J, Smit H, Stigt J, Westenend M, Zeng H, Woodruff H, Lambin P. 127P Does radiomics have added value in predicting the development of brain metastases in patients with radically treated stage III non-small cell lung cancer (NSCLC)? Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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LeenderS M, Robeers R, Hendriks L, Van Loon J, Bootsma G, Wanders R, Pitz C, Reymen B, Houben R, Van Baardwijk A, Verhoeven K, Peeters S, De Ruysscher D. PO-1025: Prognostic factors for PFS and OS in radically treated patients with oligometastatic NSCLC. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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De Ruysscher D, van Baardwijk A, Wanders R, Hendriks LE, Reymen B, van Empt W, Öllers MC, Bootsma G, Pitz C, van Eijsden L, Dingemans AMC. Individualized accelerated isotoxic concurrent chemo-radiotherapy for stage III non-small cell lung cancer: 5-Year results of a prospective study. Radiother Oncol 2019; 135:141-146. [PMID: 31015160 DOI: 10.1016/j.radonc.2019.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 03/08/2019] [Accepted: 03/11/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stage III non-small cell lung cancer (NSCLC) still has a poor prognosis. Prior studies with individualized, accelerated, isotoxic dose escalation (INDAR) with 3D-CRT showed promising results, especially in patients not treated with concurrent chemo-radiotherapy. We investigated if INDAR delivered with IMRT would improve the overall survival (OS) of stage III NSCLC patients treated with concurrent chemotherapy and radiotherapy. PATIENTS AND METHODS Patients eligible for concurrent chemo-radiotherapy were entered in this prospective study. Radiotherapy was given to a dose of 45 Gy/30 fractions BID (1.5 Gy/fraction), followed by QD fractions of 2 Gy until a total dose determined by the normal tissue constraints. The primary endpoint was OS, secondary endpoints were loco-regional relapses and toxicity. RESULTS From May 4, 2009 until April 26, 2012, 185 patients were included. The mean tumor dose was 66.0 ± 12.8 Gy (36-73 Gy), delivered in a mean of 39.7 fractions in an overall treatment time of 38.2 days. The mean lung dose (MLD) was 17.3 Gy. The median OS was 19.8 months (95% CI 17.3-22.3) with a 5-year OS of 24.3%. Loco-regional failures as first site of recurrence occurred in 59/185 patients (31.8%). Isolated nodal failures (INF) were observed in 3/185 patients (1.6%). Dyspnea grade 3 was seen in 3.2% of patients and transient dysphagia grade 3 in 22%. CONCLUSIONS INDAR with IMRT concurrently with chemotherapy did not lead to a sign of an improved OS in unselected stage III NSCLC patients.
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Affiliation(s)
- Dirk De Ruysscher
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands.
| | - Angela van Baardwijk
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Rinus Wanders
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Lizza E Hendriks
- Maastricht University Medical Center, Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Bart Reymen
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Wouter van Empt
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Michel C Öllers
- Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Gerben Bootsma
- Zuyderland Hospital, Department of Pulmonology, Geleen, The Netherlands
| | - Cordula Pitz
- Laurentius Hospital, Department of Pulmonology, Roermond, The Netherlands
| | - Linda van Eijsden
- Sint Jans Gasthuis, Department of Pulmonology, Weert, The Netherlands
| | - Anne-Marie C Dingemans
- Maastricht University Medical Center, Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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De Ruysscher D, Wanders R, Hendriks L, Van Baardwijk A, Reymen B, Houben R, Bootsma G, Pitz C, Dingemans A. OA07.07 PFS and OS Beyond 5 years of NSCLC Patients with Synchronous Oligometastases Treated in a Prospective Phase II Trial (NCT 01282450). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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De Ruysscher D, Wanders R, Hendriks LE, van Baardwijk A, Reymen B, Houben R, Bootsma G, Pitz C, van Eijsden L, Dingemans AMC. Progression-Free Survival and Overall Survival Beyond 5 Years of NSCLC Patients With Synchronous Oligometastases Treated in a Prospective Phase II Trial (NCT 01282450). J Thorac Oncol 2018; 13:1958-1961. [PMID: 30253974 DOI: 10.1016/j.jtho.2018.07.098] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/20/2018] [Accepted: 07/24/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Two randomized studies have shown an increased progression-free survival (PFS) by adding a radical local treatment to systemic therapy in responding patients with oligometastatic NSCLC, but long-term data are lacking. We updated the results of our previous phase II trial with a minimal follow-up exceeding 7 years. METHODS This is a prospective single-arm phase II trial. The main inclusion criteria were pathologically proven NSCLC stage IV with less than five metastases at primary diagnosis, amendable for radical local treatment (surgery or radiotherapy). No previous response to systemic treatment was needed. RESULTS Forty patients were enrolled, 39 of whom were evaluable (18 men, 21 women); mean age was 62.1 ± 9.2 years (range, 44 to 81 years). Twenty-nine (74%) had N2 or N3 disease; 17 (44%) brain, 7 (18%) bone, and 4 (10%) adrenal gland metastases. Thirty-five (87%) had a single metastatic lesion. Thirty-seven (95%) of the patients received chemotherapy as part of their primary treatment. Median overall survival (OS) was 13.5 months (95% confidence interval: 7.6-19.4 months); 1-, 2-, 3-, 5-, and 6- year OS was 56.4%, 23.3%,12.8%, 10.3%, 7.7%, and 5.1%, respectively. Median PFS was 12.1 months (95% confidence interval: 9.6-14.3 months); 1-, 2-, 3-, 5-, and 6- year OS was 51.3%, 13.6%, %,12.8%, 7.7%, 7.7%, and 2.5%, respectively. Only three patients (7.7%) had a local recurrence. CONCLUSIONS In patients who were not selected according to response to systemic treatment, the PFS at 5 years was 8%. Entering patients in trials combining local therapy with novel systemic agents (e.g., immunotherapy) remains mandatory.
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Affiliation(s)
- Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | | - Lizza E Hendriks
- Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | | | - Gerben Bootsma
- Department of Pulmonology, Zuyderland Hospital, Geleen, The Netherlands
| | - Cordula Pitz
- Department of Pulmonology, Laurentius Hospital, Roermond, The Netherlands
| | - Linda van Eijsden
- Department of Pulmonology, Sint Jans Gasthuis, Weert, The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Hendriks LEL, Smit EF, Vosse BAH, Mellema WW, Heideman DAM, Bootsma GP, Westenend M, Pitz C, de Vries GJ, Houben R, Grünberg K, Bendek M, Speel EJM, Dingemans AMC. EGFR mutated non-small cell lung cancer patients: more prone to development of bone and brain metastases? Lung Cancer 2014; 84:86-91. [PMID: 24529684 DOI: 10.1016/j.lungcan.2014.01.006] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 01/12/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Both bone and brain are frequent sites of metastasis in non-small cell lung cancer (NSCLC). Conflicting data exist whether EGFR mutant (+) patients are more prone to develop brain metastases or have a better outcome with brain metastases compared to EGFR/KRAS wildtype (WT) or KRAS+ patients. For bone metastases this has not been studied. METHODS In this retrospective case-control study all EGFR+ (exons 19 and 21) patients diagnosed at two pathology departments were selected (2004/2008 to 2012). For every EGFR+ patient a consecutive KRAS+ and WT patient with metastatic NSCLC (mNSCLC) was identified. Patients with another malignancy within 2 years of mNSCLC diagnosis were excluded. Data regarding age, gender, performance score, histology, treatment, bone/brain metastases diagnosis, skeletal related events (SRE) and subsequent survival were collected. RESULTS 189 patients were included: 62 EGFR+, 65 KRAS+, 62 WT. 32%, 35% and 40%, respectively, had brain metastases (p=0.645). Mean time to brain metastases was 20.8 [± 12.0], 10.8 [± 9.8], 16.4 [± 10.2] months (EGFR+-KRAS+, p = 0.020, EGFR+-WT, p = 0.321). Median post brain metastases survival was 12.1 [5.0-19.1], 7.6 [1.2-14.0], 10.7 [1.5-19.8] months (p = 0.674). 60%, 52% and 50% had metastatic bone disease (p=0.528). Mean time to development of metastatic bone disease was 13.4 [± 10.6], 23.3 [± 19.4], 16.4 [± 9.6] months (p = 0.201). Median post metastatic bone disease survival was 15.0 [10.6-20.3], 9.0 [5.2-12.9], 3.2 [0.0-6.9] months (p = 0.010). Time to 1st SRE was not significantly different. CONCLUSIONS Incidence of brain and bone metastases was not different between EGFR+, KRAS+ and WT patients. Post brain metastases survival, time from mNSCLC diagnosis to metastatic bone disease and 1st SRE did not differ either. Post metastatic bone disease survival was significantly longer in EGFR+ patients. Although prevention of SRE's is important for all patients, the latter finding calls for a separate study for SRE preventing agents in EGFR+ patients.
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Affiliation(s)
- L E L Hendriks
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | - E F Smit
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - B A H Vosse
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - W W Mellema
- Department of Pulmonary Diseases, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - D A M Heideman
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - G P Bootsma
- Department of Pulmonary Diseases, Atrium Medical Center, H. Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - M Westenend
- Department of Pulmonary Diseases, VieCuri, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - C Pitz
- Department of Pulmonary Diseases, Laurentius Hospital, Mgr. Driessenstraat 6, 6043 CV Roermond, The Netherlands
| | - G J de Vries
- Department of Pulmonary Diseases, Orbis Medical Center, PO Box 5500, 6130 MB Sittard, The Netherlands
| | - R Houben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 3035, 6202 NA Maastricht, The Netherlands
| | - K Grünberg
- Department of Pathology, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands
| | - M Bendek
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - E-J M Speel
- Department of Pathology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
| | - A-M C Dingemans
- Department of Pulmonary Diseases, Maastricht University Medical Center+, PO Box 5800, 6202 AZ Maastricht, The Netherlands
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Reymen B, van Baardwijk A, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Long-term survival of stage T4N0-1 and single station IIIA-N2 NSCLC patients treated with definitive chemo-radiotherapy using individualised isotoxic accelerated radiotherapy (INDAR). Radiother Oncol 2014; 110:482-7. [PMID: 24444527 DOI: 10.1016/j.radonc.2013.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 12/10/2013] [Accepted: 12/18/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) stage T4N0-1 or single nodal station IIIA-N2 are two stage III sub-groups for which the outcome of non-surgical therapy is not well known. We investigated the results of individualised isotoxic accelerated radiotherapy (INDAR) and chemotherapy in this setting. METHODS Analysis of NSCLC patients included in 2 prospective trials (NCT00573040 and NCT00572325) stage T4N0-1 or IIIA-N2 with 1 pathologic nodal station, treated with chemo-radiotherapy (CRT) using INDAR with concurrent or sequential platinum-based chemotherapy. Overall survival (OS) was updated and calculated from date of diagnosis (Kaplan-Meier). Toxicity was scored following CTCAEv3.0. To allow comparison with other articles the subgroups were also analysed separately for toxicity, progression free and overall survival. RESULTS 83 patients (42 T4N0-1 and 41 IIIA-N2) were identified: the median radiotherapy dose was 65Gy. Thirty-seven percent of patients received sequential CRT and 63% received concurrent CRT. At a median follow-up of 48 months the median OS for T4N0-1 patients was 34 months with 55% 2-year survival and 25% 5-year survival. For stage IIIA-N2 at a median follow-up of 50 months the median OS was 26 months with 2- and 5-year survival rates of 53% and 24%, respectively. CONCLUSION Chemo-radiation using INDAR yields promising survival results in patients with single-station stage IIIA-N2 or T4N0-1 NSCLC.
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Affiliation(s)
- Bart Reymen
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
| | | | - Rinus Wanders
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Jacques Borger
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonology, University Medical Centre Maastricht, GROW-School for Oncology and Developmental Biology, The Netherlands
| | - Gerben Bootsma
- Department of Pulmonology, Atrium Medical Centre, Heerlen, The Netherlands
| | - Cordula Pitz
- Department of Pulmonology, Laurentius Hospital, Roermond, The Netherlands
| | - Ragnar Lunde
- Department of Pulmonology, St. Jansgasthuis, Weert, The Netherlands
| | - Wiel Geraedts
- Department of Pulmonology, Orbis Medical Centre, Sittard, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), The Netherlands; University Hospital Leuven/KU Leuven, Belgium
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Reymen B, Van Loon J, van Baardwijk A, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Total Gross Tumor Volume Is an Independent Prognostic Factor in Patients Treated With Selective Nodal Irradiation for Stage I to III Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2012.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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van Baardwijk A, Reymen B, Wanders S, Borger J, Ollers M, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Lunde R, Peters F, Lambin P, De Ruysscher D. Mature results of a phase II trial on individualised accelerated radiotherapy based on normal tissue constraints in concurrent chemo-radiation for stage III non-small cell lung cancer. Eur J Cancer 2012; 48:2339-46. [PMID: 22608261 DOI: 10.1016/j.ejca.2012.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 03/26/2012] [Accepted: 04/09/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND Sequential chemotherapy and individualised accelerated radiotherapy (INDAR) has been shown to be effective in non-small cell lung cancer (NSCLC), allowing delivering of high biological doses. We therefore performed a phase II trial (clinicaltrials.gov; NCT00572325) investigating the same strategy in concurrent chemo-radiation in stage III NSCLC. METHODS 137 stage III patients fit for concurrent chemo-radiation (PS 0-2; FEV(1) and DLCO ≥ 30%) were included from April 2006 till December 2009. An individualised prescribed dose based on normal tissue dose constraints was applied: mean lung dose (MLD) 19 Gy, spinal cord 54 Gy, brachial plexus 66 Gy, central structures 74 Gy. A total dose between 51 and 69 Gy was delivered in 1.5 Gy BID up to 45 Gy, followed by 2 Gy QD. Radiotherapy was started at the 2nd or 3rd course of chemotherapy. Primary end-point was overall survival (OS) and secondary end-point toxicity common terminology criteria for adverse events v3.0 (CTCAEv3.0). FINDINGS The median tumour volume was 76.4 ± 94.1 cc; 49.6% of patients had N2 and 32.1% N3 disease. The median dose was 65.0 ± 6.0 Gy delivered in 35 ± 5.7 days. Six patients (4.4%) did not complete radiotherapy. With a median follow-up of 30.9 months, the median OS was 25.0 months (2-year OS 52.4%). Severe acute toxicity (≥ G3, 35.8%) consisted mainly of G3 dysphagia during radiotherapy (25.5%). Severe late toxicity (≥ G3) was observed in 10 patients (7.3%). INTERPRETATION INDAR in concurrent chemo-radiation based on normal tissue constraints is feasible, even in patients with large tumour volumes and multi-level N2-3 disease, with acceptable severe late toxicity and promising 2-year survival.
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Affiliation(s)
- Angela van Baardwijk
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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De Ruysscher D, van Baardwijk A, Steevens J, Botterweck A, Bosmans G, Reymen B, Wanders R, Borger J, Dingemans AMC, Bootsma G, Pitz C, Lunde R, Geraedts W, Oellers M, Dekker A, Lambin P. Individualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: A prospective population-based study. Radiother Oncol 2012; 102:228-33. [DOI: 10.1016/j.radonc.2011.10.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/19/2011] [Accepted: 10/20/2011] [Indexed: 12/25/2022]
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Wanders R, Steevens J, Botterweck A, Dingemans AMC, Reymen B, Baardwijk AV, Borger J, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Treatment with curative intent of stage III non-small cell lung cancer patients of 75years: A prospective population-based study. Eur J Cancer 2011; 47:2691-7. [DOI: 10.1016/j.ejca.2011.06.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 06/01/2011] [Accepted: 06/07/2011] [Indexed: 10/18/2022]
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van Baardwijk A, Reymen B, Wanders R, Dingemans A, Bootsma G, Pitz C, Lunde R, Geraedts W, Lambin P, De Ruysscher D. Mature Results of a Phase II Trial on Individualized Radiation Dose-escalation Based on Normal Tissue Constraints in Concurrent Chemo-radiation for Stage III Non-small Cell Lung Cancer (NSCLC). Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Van Baardwijk A, Wanders R, Reymen B, Borger J, Dingemans A, Bootsma G, Pitz C, Geraedts W, Lambin P, De Ruysscher D. First Results of a Phase II Trial Investigating Individualized Dose-escalation Based on Normal Tissue Constraints in Concurrent Chemo-radiation for Locally Advanced Non-small Cell Lung Cancer (NSCLC) (NCT00572325). Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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van Loon J, Grutters JPC, Wanders R, Boersma L, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Simons J, Brans B, Snoep G, Hochstenbag M, Lambin P, De Ruysscher D. 18FDG-PET-CT in the follow-up of non-small cell lung cancer patients after radical radiotherapy with or without chemotherapy: an economic evaluation. Eur J Cancer 2010; 46:110-9. [PMID: 19944595 DOI: 10.1016/j.ejca.2009.10.028] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 10/29/2009] [Indexed: 01/10/2023]
Abstract
BACKGROUND The optimal follow-up strategy of non-small cell lung cancer (NSCLC) patients after curative intent therapy is still not established. In a recent prospective study with 100 patients, we showed that a FDG-PET-CT 3 months after radiotherapy (RT) could identify progression amenable for curative treatment in 2% (95% confidence interval (CI): 1-7%) of patients, who were all asymptomatic. Here, we report on the economic evaluation of this study. PATIENTS AND METHODS A decision-analytic Markov model was developed in which the long-term cost-effectiveness of 3 follow-up strategies was modelled with different imaging methods 3 months after therapy: a PET-CT scan; a chest CT scan; and conventional follow-up with a chest X-ray. A probabilistic sensitivity analysis was performed to account for uncertainty. Because the results of the prospective study indicated that the advantage seems to be confined to asymptomatic patients, we additionally examined a strategy where a PET-CT was applied only in the subgroup of asymptomatic patients. Cost-effectiveness of the different follow-up strategies was expressed in incremental cost-effectiveness ratios (ICERs), calculating the incremental costs per quality adjusted life year (QALY) gained. RESULTS Both PET-CT- and CT-based follow-up were more costly but also more effective than conventional follow-up. CT-based follow-up was only slightly more effective than conventional follow-up, resulting in an incremental cost-effectiveness ratio (ICER) of euro 264.033 per QALY gained. For PET-CT-based follow-up, the ICER was euro 69.086 per QALY gained compared to conventional follow-up. The strategy in which a PET-CT was only performed in the asymptomatic subgroup resulted in an ICER of euro 42.265 per QALY gained as opposed to conventional follow-up. With this strategy, given a ceiling ratio of euro 80.000, PET-CT-based follow-up had the highest probability of being cost-effective (73%). CONCLUSIONS This economic evaluation shows that a PET-CT scan 3 months after (chemo)radiotherapy with curative intent is a potentially cost-effective follow-up method, and is more cost-effective than CT alone. Applying a PET-CT scan only in asymptomatic patients is probably as effective and more cost-effective. It is worthwhile to perform additional research to reduce uncertainty regarding the decision concerning imaging in the follow-up of NSCLC.
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Affiliation(s)
- Judith van Loon
- Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, Maastricht University Medical Centre(+), Maastricht, The Netherlands.
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van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AMC, Bootsma G, Geraedts W, Pitz C, Lunde R, Lambin P, De Ruysscher D. Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 2010; 28:1380-6. [PMID: 20142596 DOI: 10.1200/jco.2009.24.7221] [Citation(s) in RCA: 144] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We previously showed that individualized radiation dose escalation based on normal tissue constraints would allow safe administration of high radiation doses with low complication rate. Here, we report the mature results of a prospective, single-arm study that used this individualized tolerable dose approach. PATIENTS AND METHODS In total, 166 patients with stage III or medically inoperable stage I to II non-small-cell lung cancer, WHO performance status 0 to 2, a forced expiratory volume at 1 second and diffusing capacity of lungs for carbon monoxide >or= 30% were included. Patients were irradiated using an individualized prescribed total tumor dose (TTD) based on normal tissue dose constraints (mean lung dose, 19 Gy; maximal spinal cord dose, 54 Gy) up to a maximal TTD of 79.2 Gy in 1.8 Gy fractions twice daily. Only sequential chemoradiation was administered. The primary end point was overall survival (OS), and the secondary end point was toxicity according to Common Terminology Criteria of Adverse Events (CTCAE) v3.0. RESULTS The median prescribed TTD was 64.8 Gy (standard deviation, +/- 11.4 Gy) delivered in 25 +/- 5.8 days. With a median follow-up of 31.6 months, the median OS was 21.0 months with a 1-year OS of 68.7% and a 2-year OS of 45.0%. Multivariable analysis showed that only a large gross tumor volume significantly decreased OS (P < .001). Both acute (grade 3, 21.1%; grade 4, 2.4%) and late toxicity (grade 3, 4.2%; grade 4, 1.8%) were acceptable. CONCLUSION Individualized prescribed radical radiotherapy based on normal tissue constraints with sequential chemoradiation shows survival rates that come close to results of concurrent chemoradiation schedules, with acceptable acute and late toxicity. A prospective randomized study is warranted to further investigate its efficacy.
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Affiliation(s)
- Angela van Baardwijk
- Department of RadiationOncology (MAASTRO), GROWResearch Institute, Maastricht UniversityMedical Center, Maastricht.
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De Ruysscher D, Dehing C, Yu S, Wanders R, Öllers M, Dingemans AMC, Bootsma G, Hochstenbag M, Geraedts W, Pitz C, Simons J, Boersma L, Borger J, Dekker A, Lambin P. Dyspnea evolution after high-dose radiotherapy in patients with non-small cell lung cancer. Radiother Oncol 2009; 91:353-9. [DOI: 10.1016/j.radonc.2008.10.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 10/10/2008] [Accepted: 10/12/2008] [Indexed: 11/27/2022]
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Aerts HJWL, van Baardwijk AAW, Petit SF, Offermann C, Loon JV, Houben R, Dingemans AMC, Wanders R, Boersma L, Borger J, Bootsma G, Geraedts W, Pitz C, Simons J, Wouters BG, Oellers M, Lambin P, Bosmans G, Dekker ALAJ, De Ruysscher D. Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy (18)Fluorodeoxyglucose-PET-CT scan. Radiother Oncol 2009; 91:386-92. [PMID: 19329207 DOI: 10.1016/j.radonc.2009.03.006] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Revised: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Non-small cell lung cancer (NSCLC) tumours are mostly heterogeneous. We hypothesized that areas within the tumour with a high pre-radiation (18)F-deoxyglucose (FDG) uptake, could identify residual metabolic-active areas, ultimately enabling selective-boosting of tumour sub-volumes. MATERIAL AND METHODS Fifty-five patients with inoperable stage I-III NSCLC treated with chemo-radiation or with radiotherapy alone were included. For each patient one pre-radiotherapy and one post-radiotherapy FDG-PET-CT scans were available. Twenty-two patients showing persistent FDG uptake in the primary tumour after radiotherapy were analyzed. Overlap fractions (OFs) were calculated between standardized uptake value (SUV) threshold-based auto-delineations on the pre- and post-radiotherapy scan. RESULTS Patients with residual metabolic-active areas within the tumour had a significantly worse survival compared to individuals with a complete metabolic response (p=0.002). The residual metabolic-active areas within the tumour largely corresponded (OF>70%) with the 50%SUV high FDG uptake area of the pre-radiotherapy scan. The hotspot within the residual area (90%SUV) was completely within the GTV (OF=100%), and had a high overlap with the pre-radiotherapy 50%SUV threshold (OF>84%). CONCLUSIONS The location of residual metabolic-active areas within the primary tumour after therapy corresponded with the original high FDG uptake areas pre-radiotherapy. Therefore, a single pre-treatment FDG-PET-CT scan allows for the identification of residual metabolic-active areas.
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Affiliation(s)
- Hugo J W L Aerts
- Department of Radiation Oncology (MAASTRO), Grow-School for Oncology and Developmental Biology, Maastricht University, The Netherlands.
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De Ruysscher D, Botterweck A, Dirx M, Pijls-Johannesma M, Wanders R, Hochstenbag M, Dingemans AMC, Bootsma G, Geraedts W, Simons J, Pitz C, Lambin P. Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study. Ann Oncol 2009; 20:98-102. [DOI: 10.1093/annonc/mdn559] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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De Ruysscher D, Wanders R, van Haren E, Hochstenbag M, Geraedts W, Pitz C, Simons J, Boersma L, Verschueren T, Minken A, Bentzen SM, Lambin P. HI-CHART: a phase I/II study on the feasibility of high-dose continuous hyperfractionated accelerated radiotherapy in patients with inoperable non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2007; 71:132-8. [PMID: 18037581 DOI: 10.1016/j.ijrobp.2007.09.048] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2007] [Revised: 09/10/2007] [Accepted: 09/12/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the feasibility of high-dose continuous hyperfractionated accelerated radiotherapy in patients with inoperable non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS In a prospective, Phase I/II study, according to the risk for radiation pneumonitis, three risk groups were defined: V(20) <25%, V(20) 25-37%, and V(20) >37%. The dose was administered in three steps from 61.2 Gy/34 fractions/23 days to 64.8 Gy/36 fractions/24 days to 68.40 Gy/38 fractions/25 days (1.8 Gy b.i.d. with 8-h interval), using a three-dimensional conformal technique. Only the mediastinal lymph node areas that were positive on the pretreatment (18)F-deoxy-D-glucose positron emission tomography scan were included in the target volume. The primary endpoint was toxicity. RESULTS A total of 48 Stage I-IIIB patients were included. In all risk groups, 68.40 Gy/38 fractions/25 days could be administered. Maximal toxicity according to the risk groups was as follows: V(20) <25% (n = 35): 1 Grade 4 (G4) lung and 1 G3 reversible esophageal toxicity; V(20) 35-37% (n = 12): 1 G5 lung and 1 G3 reversible esophageal toxicity. For the whole group, local tumor recurrence occurred in 25% (95% confidence interval 14%-40%) of the patients, with 1 of 48 (2.1%; upper one-sided 95% confidence limit 9.5%) having an isolated nodal recurrence. The median actuarial overall survival was 20 months, with a 2-year survival rate of 36%. CONCLUSIONS High-dose continuous hyperfractionated accelerated radiotherapy up to a dose of 68.40 Gy/38 fractions/25 days (a biologic equivalent of approximately 80 Gy when delivered in conventional fractionation) in patients with inoperable NSCLC and a V(20) up to 37% is feasible.
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Affiliation(s)
- Dirk De Ruysscher
- Department of Radiation Oncology, University Hospital Maastricht, GROW, Maastricht, The Netherlands.
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Dehing-Oberije C, De Ruysscher D, van der Weide H, Hochstenbag M, Bootsma G, Geraedts W, Pitz C, Simons J, Teule J, Rahmy A, Thimister P, Steck H, Lambin P. Tumor volume combined with number of positive lymph node stations is a more important prognostic factor than TNM stage for survival of non-small-cell lung cancer patients treated with (chemo)radiotherapy. Int J Radiat Oncol Biol Phys 2007; 70:1039-44. [PMID: 17889446 DOI: 10.1016/j.ijrobp.2007.07.2323] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 07/10/2007] [Accepted: 07/12/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE The current tumor, node, metastasis system needs refinement to improve its ability to predict survival of patients with non-small-cell lung cancer (NSCLC) treated with (chemo)radiation. In this study, we investigated the prognostic value of tumor volume and N status, assessed by using fluorodeoxyglucose-positron emission tomography (PET). PATIENTS AND METHODS Clinical data from 270 consecutive patients with inoperable NSCLC Stages I-IIIB treated radically with (chemo)radiation were collected retrospectively. Diagnostic imaging was performed using either integrated PET-computed tomography or computed tomography and PET separately. The Kaplan-Meier method, as well as Cox regression, was used to analyze data. RESULTS Univariate survival analysis showed that number of positive lymph node stations (PLNSs), as well as N stage on PET, was associated significantly with survival. The final multivariate Cox model consisted of number of PLNSs, gross tumor volume (i.e., volume of the primary tumor plus lymph nodes), sex, World Health Organization performance status, and equivalent radiation dose corrected for time; N stage was no longer significant. CONCLUSIONS Number of PLNSs, assessed by means of fluorodeoxyglucose-PET, was a significant factor for survival of patients with inoperable NSCLC treated with (chemo)radiation. Risk stratification for this group of patients should be based on gross tumor volume, number of PLNSs, sex, World Health Organization performance status, and equivalent radiation dose corrected for time.
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Affiliation(s)
- Cary Dehing-Oberije
- Department of Radiotherapy, University Hospital Maastricht, University Maastricht, The Netherlands.
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van Loon J, De Ruysscher D, Hochstenbag M, Bootsma G, Geraedts W, Pitz C, Simons J, Dekker A, Wanders S, Lambin P. 919 POSTER FDG-PET based planning of limited stage small-cell lung cancer changes radiotherapy fields: a planning study. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)70558-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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van Baardwijk A, Wanders R, Boersma L, Dingemans AM, Bootsma G, Geraedts W, Pitz C, Simons J, Lambin P, De Ruysscher D. P3-046: Personalized High-Dose Continuous Hyperfractionated Accelerated Radiotherapy (HI-CHART) of non-small cell lung cancer (NSCLC) based on normal tissue constraints: a prospective clinical trial. J Thorac Oncol 2007. [DOI: 10.1097/01.jto.0000283803.40306.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Ruysscher D, Dehing C, Bremer RH, Bentzen SM, Koppe F, Pijls-Johannesma M, Harzée L, Minken A, Wanders R, Hochstenbag M, Dingemans AM, Boersma L, van Haren E, Geraedts W, Pitz C, Simons J, Wouters B, Rosier JF, Lambin P. Maximal neutropenia during chemotherapy and radiotherapy is significantly associated with the development of acute radiation-induced dysphagia in lung cancer patients. Ann Oncol 2007; 18:909-16. [PMID: 17322546 DOI: 10.1093/annonc/mdm005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Acute dysphagia is a distressing dose-limiting toxicity after concurrent chemoradiation or high-dose radiotherapy for lung cancer. We therefore identified factors associated with the occurrence of acute dysphagia in lung cancer patients receiving radiotherapy alone or combined with chemotherapy. PATIENTS AND METHODS Radiotherapy, chemotherapy and patient characteristics were analyzed using ordinal regression analysis as possible predictors for acute dysphagia (CTCAE 3.0) in 328 lung cancer patients treated with curative intent. RESULTS The most significant association was seen between the maximal grade of neutropenia during chemoradiation and dysphagia, with an odds ratio increasing from 1.49 [95% confidence interval (CI) 0.63-3.54, P = 0.362] for grade 1-2 neutropenia to 19.7 (95% CI 4.66-83.52, P < 0.001) for patients with grade 4 neutropenia. Twice-daily schedule, mean esophageal dose and administration of chemotherapy were significant predictive factors. By combining these factors, a high-performance predictive model was made. On an individual patient level, 64% of patients were correctly classified and only 1.2% of patients were misclassified by more than one grade. CONCLUSIONS The maximal neutrophil toxicity during concurrent chemotherapy and radiotherapy is strongly associated with the development of acute dysphagia. A multivariate predictive model was developed.
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Affiliation(s)
- D De Ruysscher
- Department of Radiotherapy, MAASTRO clinic, GROW, University Hospital Maastricht, Maastricht, The Netherlands.
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De Ruysscher D, Bremer RH, Koppe F, Wanders S, van Haren E, Hochstenbag M, Geeraedts W, Pitz C, Simons J, ten Velde G, Dohmen J, Snoep G, Boersma L, Verschueren T, van Baardwijk A, Dehing C, Pijls M, Minken A, Lambin P. Omission of elective node irradiation on basis of CT-scans in patients with limited disease small cell lung cancer: a phase II trial. Radiother Oncol 2006; 80:307-12. [PMID: 16949169 DOI: 10.1016/j.radonc.2006.07.029] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 07/11/2006] [Accepted: 07/20/2006] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the patterns of recurrence when elective node irradiation was omitted in patients with limited disease small cell lung cancer (LD-SCLC). METHODS A prospective phase II study was undertaken in 27 patients with LD-SCLC without detectable distant metastases on CT scan. Chest radiotherapy to a dose of 45 Gy in 30 fractions in 3 weeks (1.5 Gy BID with 6 - 8 h interval) was delivered concurrently with carboplatin and etoposide chemotherapy. Chest radiation started after a mean time of 17.7 days +/- 9.7 days (SD) (range: 0-33 days) after the beginning of chemotherapy. Only the primary tumour and the positive nodal areas on the pre-treatment CT scan were irradiated. A total of five chemotherapy cycles were administered, followed by prophylactic cranial irradiation (PCI) in patients without disease progression. Isolated nodal failure was defined as recurrence in the regional nodes outside of the clinical target volume, in the absence of in-field failure. RESULTS After a median time of 18 months post-radiotherapy, 7 patients (26%, 95% CI 19.5-42.5%) developed a local recurrence. Three patients (crude rate 11%, 95% CI 2.4-29%), developed an isolated nodal failure, all of them in the ipsilateral supraclavicular fossa. The median actuarial overall survival was 21 months (95% CI 15.3-26.7), and the median actuarial progression free survival was 16 months (95% CI 6.5-25.5). Eight patients developed an acute, reversible grade 3 (CTC 3.0) radiation oesophagitis (30%, 95% CI 14-50%). CONCLUSIONS Because of the small sample size, no definitive conclusions can be drawn. However, the omission of elective nodal irradiation on the basis of CT scans in patients with LD-SCLC resulted in a higher than expected rate of isolated nodal failures in the ipsilateral supraclavicular fossa. The incidence of acute, reversible oesophagitis was in the same range as reported with elective nodal fields. The safety of selective nodal irradiation in NSCLC should not be extrapolated to patients with LD-SCLC until more data are available. In the mean time, elective nodal irradiation should only be omitted in clinical trials.
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De Ruysscher D, Wanders S, van Haren E, Hochstenbag M, Pitz C, Geraedts W, Simons J, Snoep G, ten Velde G, Lambin P. P-757 Omission of elective mediastinal node irradiation on basis ofCT-scans in patients with limited disease small cell lung cancer results in low isolated nodal failures: A phase II trial. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81250-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pitz C, Brutel de la Riviere A, van Beek F, Schlosser N, Hofman P, Dik H, Kersbergen J, Biesma B, Schramel F. Phase II study of induction chemotherapy in patients with stage IIIB NSCLC. Lung Cancer 2000. [DOI: 10.1016/s0169-5002(00)80292-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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