A Histologic Basis for the Efficacy of SBRT to the lung

Woody, N.M.; Stephans, Kevin L.; Andrews, Martin B.; Zhuang, Tingliang; Gopal, Priyanka; Xia, Peng; Farver, Carol; Raymond, Daniel P.; Peacock, Craig D.; Cicenia, Joseph; Reddy, Chandana A.; Videtic, Gregory M.M.; Abazeed, Mohamed E.

doi:10.1016/j.jtho.2016.11.002

Cited by 90 publications

(70 citation statements)

References 40 publications

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“…In a cohort of 740 patients treated for early lung cancer between 2003 and 2015, Woody et al . indicated that differences in histology should trigger modified dose schedules: 30% of the patients had no pathology, while 70% were diagnosed histologically, which is consistent with the higher biopsy rate compared to European series . Centrally located tumors were treated with 50 Gy in five fractions, whereas peripheral tumors received 60 Gy in three fractions.…”

Section: Discussionsupporting

confidence: 61%

“…Centrally located tumors were treated with 50 Gy in five fractions, whereas peripheral tumors received 60 Gy in three fractions. This treatment approach showed a significantly higher local failure rate in squamous cell carcinoma than in adenocarcinoma . The absence of microscopic proof may hamper optimal radiation treatment, thus histological proof should be sought whenever possible.…”

Section: Discussionmentioning

confidence: 99%

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Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

et al. 2019

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BackgroundApproximately 15% of lung cancer patients are diagnosed in early stages. Microscopic proof of disease cannot always be obtained because of comorbidity or reluctance to undergo invasive diagnostic procedures. In the current study, survival data of patients with and without pathology are compared.MethodsOne hundred and sixty three patients with NSCLC I–IIb (T3 N0) treated between 2002 and 2016 were eligible: 123 (75%) had pathological confirmation of disease, whereas 40 (25%) did not. In accordance with international guidelines, both groups received radiotherapy. Comorbidity was assessed with the Charlson Comorbidity Index (CCI).ResultsThe median follow‐up was 28.6 months (range: 0.3–162): 66 (40%) patients are still alive, while 97 (59%) patients died: 48 (29%) cancer‐related deaths and 49 (30%) from causes other than cancer. Median overall survival (OS) in patients without pathological confirmation was 58.6 months (range: 0.5–162), which did not differ from those with microscopic proof of disease (39.4 months, range: 0.3–147.5; logrank P = 0.481). Median cancer‐specific survival (CSS) also did not differ at 113.4 months (range: 0.5–162) in the non‐confirmation group (logrank P = 0.763) versus 51.5 months (range: 3.7–129.5) in patients with pathology. In Cox regression, a CCI of ≥ 3 was associated with poor OS (hazard ratio 2.0; range 1.2–3.4; P = 0.010) and CSS (hazard ratio 2.0; 1.0–4.0; P = 0.043).ConclusionOS and CSS in early lung cancer patients depend on comorbidity rather than on pathological confirmation of disease.

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Section: Discussionsupporting

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

et al. 2019

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“…For example, the mean dose to the GTV was still around 50 Gy with small variation with MC calculation due to the heterogeneous dose distribution. Since the purpose of this study is to investigate the differences in dose for patients with and without local control, the dose-response (which depends on other factors such as tumour 18 ) in this patient cohort is a subject of another study. The dosimetric parameters (D 95 /D 99 and D Mean of the PTV/GTV) investigated in this paper do not contain spatial information about the dose distribution.…”

Section: Discussionmentioning

confidence: 99%

Dosimetric differences between local failure and local controlled non‐small cell lung cancer patients treated with stereotactic body radiotherapy: A matched‐pair study

et al. 2018

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“…analysed the response of different histological subtypes of NSCLC treated with SBRT. On multivariate analysis, squamous histological subtype (HR 2.4, P = 0.008) was the strongest predictor of local failure, with a three year cumulative rate of local failure of 18.9% versus 8.7% for adenocarcinoma and 4.1% for not‐otherwise‐specified . Meanwhile, Mak et al .…”

Section: Factors Favoring Surgerymentioning

confidence: 99%

Which patients benefit most from stereotactic body radiotherapy or surgery in medically operable non‐small cell lung cancer? An in‐depth look at patient characteristics on both sides of the debate

Chua

2019

Thoracic Cancer

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The role of stereotactic body radiotherapy (SBRT) in early stage medically operable non‐small cell lung cancer is currently under debate. SBRT's advantage is its ability to provide high radiotherapy doses to a tumor in a short timeframe, without the risk of postoperative complications and mortality. Currently, in part due to limited prospective data comparing both treatments, international guidelines continue to recommend surgical resection as the gold standard for medically operable patients. However, not all patients possess uniform characteristics, and there is some evidence that certain subgroups of patients would benefit more from one form of treatment ‐ SBRT or surgery ‐ than the other. The aim of this review is to provide a brief summary of the evidence comparing SBRT to surgery, followed by a deeper discussion of the subgroups of patients who would benefit most from surgery: those with large tumors, centrally located tumors, increased risk of occult nodal metastases, increased risk of toxicity from radiotherapy and radioresistant histological tumor subtypes. Meanwhile, patients who could benefit most from SBRT might include elderly patients, those with reduced lung function or cardiac comorbidities, those with synchronous lung nodules, and those with specific tumor mutational status. We hope that this review will aid in the clinical decision‐making process regarding patient selection for either treatment.

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A Histologic Basis for the Efficacy of SBRT to the lung

Cited by 90 publications

References 40 publications

Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

Dosimetric differences between local failure and local controlled non‐small cell lung cancer patients treated with stereotactic body radiotherapy: A matched‐pair study

Which patients benefit most from stereotactic body radiotherapy or surgery in medically operable non‐small cell lung cancer? An in‐depth look at patient characteristics on both sides of the debate

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