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Cortiula F, Hendriks LEL, Wijsman R, Houben R, Steens M, Debakker S, Canters R, Trovò M, Sijtsema NM, Niezink AGH, Unipan M, Urban S, Michelotti A, Dursun S, Bootsma G, Hattu D, Nuyttens JJ, Moretti E, Taasti VT, De Ruysscher D. Proton and photon radiotherapy in stage III NSCLC: Effects on hematological toxicity and adjuvant immune therapy. Radiother Oncol 2024; 190:110019. [PMID: 38000689 DOI: 10.1016/j.radonc.2023.110019] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND PURPOSE Concurrent chemo-radiotherapy (CCRT) followed by adjuvant durvalumab is standard-of-care for fit patients with unresectable stage III NSCLC. Intensity modulated proton therapy (IMPT) results in different doses to organs than intensity modulated photon therapy (IMRT). We investigated whether IMPT compared to IMRT reduce hematological toxicity and whether it affects durvalumab treatment. MATERIALS AND METHODS Prospectively collected series of consecutive patients with stage III NSCLC receiving CCRT between 06.16 and 12.22 (staged with FDG-PET-CT and brain imaging) were retrospectively analyzed. The primary endpoint was the incidence of lymphopenia grade ≥ 3 in IMPT vs IMRT treated patients. RESULTS 271 patients were enrolled (IMPT: n = 71, IMRT: n = 200) in four centers. All patients received platinum-based chemotherapy. Median age: 66 years, 58 % were male, 36 % had squamous NSCLC. The incidence of lymphopenia grade ≥ 3 during CCRT was 67 % and 47 % in the IMRT and IMPT group, respectively (OR 2.2, 95 % CI: 1.0-4.9, P = 0.03). The incidence of anemia grade ≥ 3 during CCRT was 26 % and 9 % in the IMRT and IMPT group respectively (OR = 4.9, 95 % CI: 1.9-12.6, P = 0.001). IMPT was associated with a lower rate of Performance Status (PS) ≥ 2 at day 21 and 42 after CCRT (13 % vs. 26 %, P = 0.04, and 24 % vs. 39 %, P = 0.02). Patients treated with IMPT had a higher probability of receiving adjuvant durvalumab (74 % vs. 52 %, OR 0.35, 95 % CI: 0.16-0.79, P = 0.01). CONCLUSION IMPT was associated with a lower incidence of severe lymphopenia and anemia, better PS after CCRT and a higher probability of receiving adjuvant durvalumab.
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Affiliation(s)
- Francesco Cortiula
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Medical Oncology, University Hospital of Udine, Udine, Italy.
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Robin Wijsman
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Michelle Steens
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Sarah Debakker
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Richard Canters
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marco Trovò
- Department of Radiation Oncology, University Hospital of Udine, Udine, Italy
| | - Nanna M Sijtsema
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne G H Niezink
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mirko Unipan
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Susanna Urban
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Anna Michelotti
- Department of Medical Oncology, University Hospital of Udine, Udine, Italy
| | - Safiye Dursun
- Department of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland Medical Centre, the Netherlands
| | - Djoya Hattu
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Joost J Nuyttens
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - Eugenia Moretti
- Medical Physics Unit, University Hospital of Udine, Udine, Italy
| | - Vicki T Taasti
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Reproduction, Maastricht University Medical Center+, Maastricht, the Netherlands
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Tohidinezhad F, Bontempi D, Zhang Z, Dingemans AM, Aerts J, Bootsma G, Vansteenkiste J, Hashemi S, Smit E, Gietema H, Aerts HJ, Dekker A, Hendriks LEL, Traverso A, De Ruysscher D. Computed tomography-based radiomics for the differential diagnosis of pneumonitis in stage IV non-small cell lung cancer patients treated with immune checkpoint inhibitors. Eur J Cancer 2023; 183:142-151. [PMID: 36857819 DOI: 10.1016/j.ejca.2023.01.027] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/29/2023] [Accepted: 01/29/2023] [Indexed: 02/11/2023]
Abstract
INTRODUCTION Immunotherapy-induced pneumonitis (IIP) is a serious side-effect which requires accurate diagnosis and management with high-dose corticosteroids. The differential diagnosis between IIP and other types of pneumonitis (OTP) remains challenging due to similar radiological patterns. This study was aimed to develop a prediction model to differentiate IIP from OTP in patients with stage IV non-small cell lung cancer (NSCLC) who developed pneumonitis during immunotherapy. METHODS Consecutive patients with metastatic NSCLC treated with immunotherapy in six centres in the Netherlands and Belgium from 2017 to 2020 were reviewed and cause-specific pneumonitis events were identified. Seven regions of interest (segmented lungs and spheroidal/cubical regions surrounding the inflammation) were examined to extract the most predictive radiomic features from the chest computed tomography images obtained at pneumonitis manifestation. Models were internally tested regarding discrimination, calibration and decisional benefit. To evaluate the clinical application of the models, predicted labels were compared with the separate clinical and radiological judgements. RESULTS A total of 556 patients were reviewed; 31 patients (5.6%) developed IIP and 41 patients developed OTP (7.4%). The line of immunotherapy was the only predictive factor in the clinical model (2nd versus 1st odds ratio = 0.08, 95% confidence interval:0.01-0.77). The best radiomic model was achieved using a 75-mm spheroidal region of interest which showed an optimism-corrected area under the receiver operating characteristic curve of 0.83 (95% confidence interval:0.77-0.95) with negative and positive predictive values of 80% and 79%, respectively. Good calibration and net benefits were achieved for the radiomic model across the entire range of probabilities. A correct diagnosis was provided by the radiomic model in 10 out of 12 cases with non-conclusive radiological judgements. CONCLUSION Radiomic biomarkers applied to computed tomography imaging may support clinicians making the differential diagnosis of pneumonitis in patients with NSCLC receiving immunotherapy, especially when the radiologic assessment is non-conclusive.
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Affiliation(s)
- Fariba Tohidinezhad
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dennis Bontempi
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands; Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Zhen Zhang
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Anne-Marie Dingemans
- Department of Pulmonary Diseases, School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Joachim Aerts
- Department of Pulmonary Medicine, School of Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland Hospital, Heerlen, the Netherlands
| | - Johan Vansteenkiste
- Department of Respiratory Oncology, University Hospital KU Leuven, Leuven, Belgium
| | - Sayed Hashemi
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
| | - Egbert Smit
- Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Hester Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Hugo Jwl Aerts
- Artificial Intelligence in Medicine (AIM) Program, Mass General Brigham, Harvard Medical School, Boston, MA, USA; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands; Departments of Radiation Oncology and Radiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Andre Dekker
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Lizza E L Hendriks
- Department of Pulmonary Diseases, School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alberto Traverso
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), School for Oncology and Reproduction (GROW), Maastricht University Medical Center, Maastricht, the Netherlands.
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Voorn M, van Kampen-van den Boogaart V, Bootsma G, Bongers B, Franssen R, Hoogeboom T. 101P Evidence base for exercise prehabilitation suggests favourable outcomes for patients undergoing surgery for non-small cell lung cancer despite being of low therapeutic quality: A systematic review and meta-analysis. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00356-8] [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: 04/03/2023]
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Voorn M, Janssen-Heijnen M, Bongers B, Schröder C, van Kampen-van den Boogaart V, Bootsma G, Bastiaansen E. 102P A qualitative stakeholder analysis of beliefs, facilitators, and barriers for a feasible prehabilitation program before lung cancer surgery. J Thorac Oncol 2023. [DOI: 10.1016/s1556-0864(23)00357-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: 04/04/2023]
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Cortiula F, Hendriks L, Wijsman R, Debakker S, Steens M, Peeters S, Michelotti A, Sijtsema N, Urban S, Niezink A, Dursun S, Bootsma G, Canters R, Tohidinezhad F, Fasola G, Rinaldi I, Taasti V, Houben R, De Ruysscher D. 957P Proton-therapy and concurrent chemotherapy in stage III NSCLC: Effects on toxicity and immune therapy. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1083] [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: 11/01/2022] Open
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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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Li W, Bootsma G, Shultz D, Laperriere N, Millar B, Coolens C. PO-1717 Impact of Target Location on Intra-fraction Motion during Frameless Image Guided Gamma Knife SRS. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03681-7] [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: 10/18/2022]
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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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Cortiula F, De Ruysscher D, Dursun S, Steens M, Bootsma G, Canters R, Rinaldi I, Taasti V, Houben R, Reynders K, Peeters S, Angrisani A, Hattu D, Hendriks L. 113P Proton-therapy and concurrent chemotherapy in stage III NSCLC: Effects on durvalumab eligibility and safety profile. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.02.140] [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: 11/26/2022] Open
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Marcuse F, Hochstenbag M, De Baets MHV, Bootsma G, Maat APWM, Hoeijmakers JGJ, Keijzers M, Abdul Hamid M, De Ruysscher D, Maessen JG. Robotic thymectomy for thymomas: a retrospective follow-up study in the Netherlands. Ann Thorac Surg 2021; 114:1886-1894. [PMID: 34736927 DOI: 10.1016/j.athoracsur.2021.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Maastricht University Medical Center+ (MUMC+) is a Dutch center of expertise, appointed by the Netherlands Federation of University Medical Centres (NFU), for the treatment of thymomas. The aim of this study was to investigate the long-term oncological-, surgical-, and neurological outcomes of all patients who underwent a robotic thymectomy for a thymoma at the MUMC+. METHODS We retrospectively analyzed the clinical-pathological data of all consecutive patients with a thymoma who underwent robotic thymectomy using the DaVinci® Robotic System at the MUMC+ between April 2004 and December 2018. Follow-up data were collected from 60 referring Dutch hospitals. RESULTS In total, 398 robotic thymectomies were performed and 130 thymomas (32.7%) were found. Median follow-up time, procedure time and hospitalization were 46 months, 116 minutes and 3 days, respectively. In 8.4% of the patients a conversion was performed and in 20.8% a complication was registered. The majority of myasthenic patients with a thymoma went into remission, mostly within 12 to 24 months after thymectomy (81.0%). No statistical difference was found in the number of complications, conversions, incomplete resections or deaths between patients with myasthenia gravis and nonmyasthenic patients. Thirty-six patients (27.7%) underwent postoperative radiotherapy. The recurrence rate was 9.1% and the five-year thymoma-related survival rate was 96.6% . CONCLUSIONS Robotic thymectomy was found to be safe and feasible in early-stage thymomas, most advanced-stage thymomas and thymomatous myasthenia gravis. A national guideline could contribute to the improvement of the oncological follow-up of thymic epithelial tumors in the Netherlands.
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Affiliation(s)
- Florit Marcuse
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, Netherlands.
| | - Monique Hochstenbag
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marc H V De Baets
- School for Mental Health and Neuroscience, Maastricht University+, Maastricht, Netherlands; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Gerben Bootsma
- Department of Pulmonology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Janneke G J Hoeijmakers
- School for Mental Health and Neuroscience, Maastricht University+, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marlies Keijzers
- Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Myrurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
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Brouns A, Dursun S, Bootsma G, Dingemans AMC, Hendriks L. Reporting of Incidence and Outcome of Bone Metastases in Clinical Trials Enrolling Patients with Epidermal Growth Factor Receptor Mutated Lung Adenocarcinoma-A Systematic Review. Cancers (Basel) 2021; 13:3144. [PMID: 34201833 PMCID: PMC8267949 DOI: 10.3390/cancers13133144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/27/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 11/17/2022] Open
Abstract
Bone metastases, occurring in 30-60% of patients with non-small cell lung cancer (NSCLC), are associated with decreased survival, cancer-induced bone pain, and skeletal-related events (SREs). Those with an activating epidermal growth factor mutation (EGFR+) seem to be more prone to develop bone metastases. To gain more insight into bone metastases-related outcomes in EGFR+ NSCLC, we performed a systematic review on Pubmed (2006-2021). Main inclusion criteria: prospective, phase II/III trials evaluating EGFR-tyrosine kinase inhibitors, ≥10 EGFR+ patients included, data on bone metastases and/or bone-related outcomes available. Out of 663 articles, 21 (3176 EGFR+ patients) met the eligibility criteria; 4 phase III (one double blind), 17 phase II trials (three randomized) were included. In seven trials dedicated bone imaging was performed at baseline. Mean incidence of bone metastases at diagnosis was 42%; 3-33% had progression in the bone upon progression. Except for one trial, it was not specified whether the use of bone target agents was permitted, and in none of the trials, occurrence of SREs was reported. Despite the high incidence of bone metastases in EGFR+ adenocarcinoma, there is a lack of screening for, and reporting on bone metastases in clinical trials, as well as permitted bone-targeted agents and SREs.
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Affiliation(s)
- Anita Brouns
- Department of Pulmonary Diseases, Zuyderland, 6162 BG Geleen, The Netherlands; (A.B.); (G.B.)
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
| | - Safiye Dursun
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
| | - Gerben Bootsma
- Department of Pulmonary Diseases, Zuyderland, 6162 BG Geleen, The Netherlands; (A.B.); (G.B.)
| | - Anne-Marie C. Dingemans
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
- Department of Respiratory Medicine, Erasmus MC Cancer Institute, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Lizza Hendriks
- Maastricht University Medical Center+, Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, 6229 HX Maastricht, The Netherlands; (S.D.); (A.-M.C.D.)
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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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13
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Li W, Bootsma G, Cho Y, Laperriere N, Shultz D, Coolens C. Assessment of Intra-fraction Motion during Frameless Stereotactic Radiosurgery. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.808] [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: 10/23/2022]
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Degens J, De Ruysscher D, Houben R, Kietselaer B, Bootsma G, Hendriks L, Huijbers E, Schols A, Dingemans AMC. Are patients with stage III non-small cell lung cancer treated with chemoradiotherapy at risk for cardiac events? Results from a retrospective cohort study. BMJ Open 2020; 10:e036492. [PMID: 32988942 PMCID: PMC7523207 DOI: 10.1136/bmjopen-2019-036492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Dyspnoea is one of the symptoms frequently encountered after treatment with chemoradiotherapy (CRT) in stage III non-small cell lung cancer (NSCLC). Long-term data on mild to moderately severe cardiac events as underlying cause of dyspnoea in patients with stage III NSCLC are lacking. Therefore, the incidence of new cardiac events, with a common terminology criteria for adverse events (CTCAE) score of ≥2 within 5 years after diagnosis, were analysed. DESIGN Retrospective multicentre cohort study of patients with stage III NSCLC treated with CRT from 2006 to 2013. The medical files of the treated patients were reviewed. OUTCOME MEASURES The primary endpoint of the study was the incidence of new cardiac events with a CTCAE score of ≥2 within 5 years after diagnosis. Secondary endpoint was to identify risk factors associated with the development of a cardiac event. RESULTS Four hundred and sixty patients were included in the study. Of all patients, 150 (32.6%) developed a new cardiac event. In patients with a known cardiac history (n=138), 44.2% developed an event. The most common cardiac events were arrhythmia (14.6%), heart failure (7.6%) and symptomatic coronary artery disease (6.8%). Pre-existent cardiac comorbidity (HR 1.96; p<0.01) and WHO-performance score ≥2 (HR 2.71; p<0.01) were significantly associated with developing a cardiac event. The majority of patients did not have pre-existent cardiac comorbidity (n=322). Elevated WHO/International Society of Hypertension score was not identified as a significant predictor for cardiac events. CONCLUSION One-third of patients with stage III NSCLC treated in daily clinical practice develop a new cardiac event within 5 years after CRT. All physicians confronted with patients with NSCLC should take cardiac comorbidity as a serious possible explanation for dyspnoea after treatment with CRT.
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Affiliation(s)
- Juliette Degens
- Departement of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - D De Ruysscher
- Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, MAASTRO, Maastricht, the Netherlands
| | - Ruud Houben
- Department of Radiation Oncology, MAASTRO, Maastricht, the Netherlands
| | - Bastiaan Kietselaer
- Department of Cardiology, Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
| | - Gerben Bootsma
- Department of Respiratory Medicine, Zuyderland Medical Centre Heerlen, Heerlen, the Netherlands
| | - Lizza Hendriks
- Department of Respiratory Medicine, GROW School for Oncology and Developmental Biology, Maastricht Universitair Medisch Centrum+, Maastricht, the Netherlands
| | - Ellen Huijbers
- General Practitioner, focus on Cardio-Vascular Risk Management, DOH Zorggroep, Eindhoven, the Netherlands
| | - Annemie Schols
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Anne-Marie C Dingemans
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
- Department of Respiratory Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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Burgers S, de Gooijer C, Cornelissen R, Aerts J, Biesma B, Heemst R, Youssef-El Soud M, Groen H, Staal-van den Brekel A, Bootsma G, Schijen JHEM, Baas P, Giovannetti E, de Vries J, Hogenboom F, de Wit D, Mahn- Schaefers M, Lalezari F, van de Noort V, Stigt J. Switch maintenance gemcitabine after first-line chemotherapy in patients with malignant mesothelioma: A multicenter open label phase II trial (NVALT19). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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16
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Hendriks LE, Bootsma G, Mourlanette J, Henon C, Mezquita L, Ferrara R, Audigier-Valette C, Mazieres J, Lefebvre C, Duchemann B, Cousin S, le Pechoux C, Botticella A, De Ruysscher D, Dingemans AMC, Besse B. Survival of patients with non-small cell lung cancer having leptomeningeal metastases treated with immune checkpoint inhibitors. Eur J Cancer 2019; 116:182-189. [DOI: 10.1016/j.ejca.2019.05.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/04/2019] [Accepted: 05/12/2019] [Indexed: 11/24/2022]
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17
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Schoenmaekers J, Hofman P, Bootsma G, Westenend M, de Booij M, Schreurs W, Houben R, De Ruysscher D, Dingemans AM, Hendriks LEL. Screening for brain metastases in patients with stage III non-small-cell lung cancer, magnetic resonance imaging or computed tomography? A prospective study. Eur J Cancer 2019; 115:88-96. [PMID: 31129385 DOI: 10.1016/j.ejca.2019.04.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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: 12/13/2018] [Revised: 03/19/2019] [Accepted: 04/05/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Non-small-cell lung cancer (NSCLC) guidelines advise to screen stage III NSCLC patients for brain metastases (BMs), preferably by magnetic resonance imaging (MRI) or when contraindicated or not accessible a dedicated contrast enhanced-computed tomography (dCE-CT), which can be incorporated in the staging 18Fluodeoxoglucose-positron emission tomography (18FDG-PET-CE-CT). In daily practice, often a dCE-CT is performed instead of a MRI. The aim of the current study is to evaluate the additive value of MRI after dCE-CT, incorporated in the 18FDG-PET-CE-CT. PATIENTS AND METHODS It is an observational prospective multicentre study (NTR3628). Inclusion criteria included stage III NSCLC patients with a dCE-CT of the brain incorporated in the 18FDG-PET and an additional MRI of the brain. Primary end-point is percentage of patients with BM on MRI without suspect lesions on dCE-CT. Secondary end-points are percentage of patients with BM on dCE-CT and percentage of patients with BM ≤ 1 year of a negative staging MRI. RESULTS Sixteen (7%) patients with extracranial stage III had BM on dCE-CT and were excluded. One hundred forty-nine patients were enrolled. 7/149 (4.7%) had BM on MRI without suspect lesions on dCE-CT. One hundred eighteen patients had a follow-up of at least 1 year (four with BM on baseline MRI); eight of the remaining 114 (7%) patients developed BM ≤ 1 year after a negative staging brain MRI. CONCLUSION Although in 7% of otherwise stage III NSCLC patients, BMs were detected on staging dCE-CT, MRI brain detected BMs in an additional 4.7%, which we consider clinically relevant. Within 1 year after a negative staging MRI, 7% developed BM.
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Affiliation(s)
- Janna Schoenmaekers
- Dept. of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Paul Hofman
- Dept. of Radiology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Gerben Bootsma
- Dept. of Pulmonary Diseases, Zuyderland Hospital Heerlen, Heerlen, the Netherlands
| | - Marcel Westenend
- Dept. of Pulmonary Diseases, VieCuri Hospital, Venlo, the Netherlands
| | - Machiel de Booij
- Dept. of Radiology, Zuyderland Hospital Heerlen, Heerlen, the Netherlands
| | - Wendy Schreurs
- Dept. of Nuclear Medicine, Zuyderland Hospital Heerlen, Heerlen, the Netherlands
| | - Ruud Houben
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Dirk De Ruysscher
- Dept. of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Anne-Marie Dingemans
- Dept. of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Lizza E L Hendriks
- Dept. of Pulmonary Diseases, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, the Netherlands.
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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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Schoenmaekers J, Hendriks L, Dingemans AM, De Ruysscher D, Bootsma G, Schreurs W, Westenend M, Houben R, Hofman P, De Booij M. Screening for brain metastases (BM) in patients (pts) with stage III non-small cell lung cancer (NSCLC), magnetic resonance imaging (MRI) or dedicated contrast-enhanced computed tomography (dCE-CT)? A prospective observational study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy291.002] [Citation(s) in RCA: 1] [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: 11/14/2022] Open
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20
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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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21
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Degens J, De Ruysscher D, Kietselaer B, Bootsma G, Schols A, Dingemans AM. Cardiac events in stage III non-small cell lung cancer (NSCLC) treated in daily clinical practice: Is it time for cardiovascular screening and follow-up? Ann Oncol 2018. [DOI: 10.1093/annonc/mdy291.001] [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: 11/13/2022] Open
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22
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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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De Paepe A, Vermaelen KY, Cornelissen R, Germonpre PR, Janssens A, Lambrechts M, Bootsma G, Van Meerbeeck JP, Surmont V. Cetuximab plus platinum-based chemotherapy in patients with malignant pleural mesothelioma: A single arm phase II trial. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e20030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20030 Background: Cetuximab is a chimeric monoclonal antibody targeting the epidermal growth factor receptor (EGFR). Previous studies suggested that cetuximab enhances chemotherapy activity in the presence of EGFR overexpression, which is present in a majority of MPM specimens. We investigated the activity and safety of the combination of platinum-based chemotherapy and cetuximab in EGFR immunohistochemical positive (IHC+) MPM patients (pts). Methods: This is an open, single arm multicenter phase II study according to a Simon 2-step design with progression-free survival (PFS) rate at 18 weeks as primary endpoint. PFS rate at 18 weeks in MPM pts with cisplatin-pemetrexed is 0.67. We hypothesized that the combination of cetuximab and chemotherapy would increase the PFS rate with 30% to 0.87 (alpha = 0.05, power 90%). 18 chemotherapy-naïve pts with epithelioid MPM and PS 0-1, EGFR IHC+ (assessed by DAKO kit with at least 1% of cells showing staining), were included in step 1 of in the study. If ≥14 were alive and free of progression at 18 weeks, sample size was to be increased to 43 pts. Treatment consisted of cisplatin (75 mg/m², day 1 of each 3-week cycle) or carboplatin AUC 5 (day 1 of each 3-week cycle) and pemetrexed (500mg/m2, day 1 of each 3-week cycle) and cetuximab (loading dose of 400 mg/m² followed by 250 mg/m² weekly) during chemotherapy until disease progression. Chemotherapy was given up to 6 cycles. Secondary end points were overall survival (OS), toxicity and response rate. Results: We enrolled 18 eligible pts between June 2010 and June 2013; 89% males, median age 68 years (range 57-80), 83% PS 1. Median number of cycles was 4 (range 2-6). Median number of weekly administrations of cetuximab was 25 (range 8-51). 13 pts were alive and without progression at 18 weeks, median PFS was 24 weeks (95% CI 18.5-29.5), median OS 49 weeks (95% CI 38.6-59.4). 44% (8/18) of patients obtained a partial response. The treatment was well tolerated; the most common adverse event was skin rash (89%), mainly grade 1-2. Conclusions: As platinum-based chemotherapy in combination with cetuximab in pts with epithelioid MPM did not reach the predefined threshold, the study was not continued. No new safety signal was observed. Clinical trial information: NCT00996567.
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Hendriks L, Brouns A, Amini M, Uyterlinde W, Wijsman R, Bussink J, Biesma B, Oei SB, Stigt J, Bootsma G, Belderbos J, De Ruysscher D, Van Den Heuvel M, Dingemans AM. P2.02-021 Extracranial Progression (ePD) after Chemoradiotherapy (CRT) for Stage III NSCLC: Does the Chemotherapy Regimen Matter? J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1168] [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: 10/20/2022]
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25
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Reymen B, Oberije C, Van Loon J, Van Baardwijk A, Wanders S, Troost E, Hoebers F, Zindler J, Dingemans A, Bootsma G, Lunde R, Geraedts W, De Ruysscher D, Lambin P. PD-0426: A clinical model predicting severe esophagitis in individual SCLC patients treated with chemo-radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40422-0] [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: 10/23/2022]
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26
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Brocken P, van der Heijden EHFM, Oud KTM, Bootsma G, Groen HJM, Donders ART, Dekhuijzen PNR, Prins JB. Distress in suspected lung cancer patients following rapid and standard diagnostic programs: a prospective observational study. Psychooncology 2014; 24:433-41. [DOI: 10.1002/pon.3660] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/14/2014] [Accepted: 08/01/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Pepijn Brocken
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | | | - Karen T. M. Oud
- Dept. of Pulmonary Diseases; Gelderse Vallei Medical Centre; Ede The Netherlands
| | - Gerben Bootsma
- Dept. of Pulmonary Diseases; Atrium Medical Centre; Heerlen The Netherlands
| | - Harry J. M. Groen
- Dept. of Pulmonary Diseases; University Medical Centre Groningen and University of Groningen; Groningen The Netherlands
| | - A. Rogier T. Donders
- Dept. of Epidemiology, Biostatistics and Health Technology Assessment; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - P. N. Richard Dekhuijzen
- Dept. of Pulmonary Diseases; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | - Judith B. Prins
- Dept. of Medical Psychology; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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Chung C, Li W, Bootsma G, Cho Y, von Schultz O, Carlsson P, Jaffray D. Clinical Evaluation of a Novel Thermoplastic Mask System With Intrafraction Motion Monitoring Using IR Tracking and Cone Beam CT for Gamma Knife Radiosurgery. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.2430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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28
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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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Troquay S, von Meyenfeldt E, Vissers Y, Bootsma G, Siebenga J. P-141CHEST X-RAY PRIOR TO DISCHARGE AFTER VIDEO-ASSISTED THORACIC ANATOMICAL PULMONARY RESECTION. FRIEND OR FOE? Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt288.141] [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: 11/14/2022] Open
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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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De Ruysscher D, van Elmpt W, Wanders R, van Baardwijk A, Dingemans A, Reymen B, Bootsma G, Lambin P, Sonke J, Belderbos J. Acute Toxicity of Full-Dose Cisplatin-Etoposide Concurrently with High-Dose Hypofractionated Chest Radiotherapy for Stage III Non-Small Cell Lung Cancer: Subset Analysis of Non-Randomised Patients in the Pet-Boost Phase II Trial (NCT01024829). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33767-4] [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: 11/24/2022] Open
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Bootsma G, Verhaegen F, Jaffray D. SU-F-BRCD-04: Efficient Scatter Distribution Estimation and Correction in CBCT Using Concurrent Monte Carlo Fitting. Med Phys 2012; 39:3856. [PMID: 28517527 DOI: 10.1118/1.4735742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE X-ray scatter is a known source of image artifacts, contrast reduction, and CT number inaccuracy in cone-beam CT (CBCT). We present and demonstrate the performance of a novel scatter correction method based on an algorithm that simultaneously combines multiple Monte Carlo (MC) CBCT scatter simulations through the use of a fitting function. METHODS AND MATERIALS The scatter estimation system consists of concurrently run MC CBCT scatter projection simulations that are a sub-sample of the projection angles used in the reconstruction projection set, P, to be corrected. The photons generated by each MC simulation are simultaneously aggregated in an algorithm which computes the scatter detector response, S(i,j,k), for each down-sampled projection location (i,j) and angle (k). S(i,j,k) is fit to a function, FS, and if FS is determined to have a specified goodness of fit value the simulations are terminated. FS is subtracted from P which is subsequently used to create a scatter corrected reconstruction. The scatter correction method was applied to simulated phantoms using a frequency limited sum of sines and cosines as the fitting function. Image quality in the corrected reconstruction was evaluated using metrics looking at contrast, noise, and artifact reduction. RESULTS Fitting the scatter distribution to a limited sum of sine and cosine functions, using a low-pass filtered Fast Fourier transform, provides a computationally efficient and accurate fit. Scatter distribution estimates for a 360 image projection set were computed in under one minute. The scatter correction algorithm increased the contrast-to-noise ratio by 46%, reduced the shading artifact by 87%, and decreased the skin line artifact by 79% in reconstructions of a simulated pelvis phantom. CONCLUSION The algorithm provides an efficient method for estimating and removing the scatter distribution in from CBCT projection images. The results on simulated data show a significant increase in image quality.
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Affiliation(s)
- G Bootsma
- University of Toronto, Toronto, ON.,Maastro Clinic, Maastricht.,Princess Margaret Hospital, Toronto, ON
| | - F Verhaegen
- University of Toronto, Toronto, ON.,Maastro Clinic, Maastricht.,Princess Margaret Hospital, Toronto, ON
| | - D Jaffray
- University of Toronto, Toronto, ON.,Maastro Clinic, Maastricht.,Princess Margaret Hospital, Toronto, ON
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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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Dingemans A, Bootsma G, van Baardwijk A, Reijmen B, Wanders R, Hochstenbag M, van Belle A, Houben R, Lambin P, de Ruysscher D. 9034 POSTER Determination of Standard Dose Cetuximab Together With Concurrent Individualised, Isotoxic Accelerated Radiotherapy (RT) and Cisplatin-vinorelbine for Patients (pts) With Stage III Non-small Cell Lung Cancer (NSCLC): a Phase I Study (NCT00522886). Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72346-2] [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: 10/17/2022]
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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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Bootsma G, Verhaegen F, Jaffray D. TH-D-201B-05: Monte Carlo Simulations of the Effects of Bowtie Filtration on X-Ray Scatter in Cone-Beam CT. Med Phys 2010. [DOI: 10.1118/1.3469564] [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: 11/07/2022] Open
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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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Cho Y, Bootsma G, Ruschin M, MacFadden D, Hodaie M, Ménard C, Jaffray D. Evaluating Stress-related Uncertainties in Stereotactic Frame-based Localization for Gamma Knife Radiosurgery. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1577] [Citation(s) in RCA: 2] [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: 10/20/2022]
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Bootsma G, Verhaegen F, Jaffray D. SU-FF-I-111: Exploration of the Scatter Distribution in Cone-Beam CT Using Monte Carlo Techniques. Med Phys 2009. [DOI: 10.1118/1.3181232] [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: 11/07/2022] Open
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Nayebi N, Cho Y, Bootsma G, Li W, Ruschin M, Jaffray D. SU-FF-T-532: Immobilization Accuracy of a Novel Re-Locatable Head Frame Investigated with a Real-Time Optical Tracking System. Med Phys 2009. [DOI: 10.1118/1.3182030] [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: 11/07/2022] Open
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46
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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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47
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Siddique S, Bartolac SJ, Bootsma G, Mail N, Fiume E, Jaffray D. SU-FF-I-162: Depth of Field in Radiography. Med Phys 2009. [DOI: 10.1118/1.3181283] [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: 11/07/2022] Open
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Ruysscher DD, Dehing C, Dingemans AMC, Bootsma G, Lambin P. In response to the “Letter to the Editor” by Borst et al.: Dyspnea evaluation after high-dose radiotherapy in patients with NSCLC. Radiother Oncol 2009. [DOI: 10.1016/j.radonc.2009.02.001] [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: 10/21/2022]
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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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