Impact of Pretreatment Tumor Growth Rate on Outcome of Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy

Atallah, Soha; Cho, J.; Allibhai, Z.; Taremi, Mojgan; Giuliani, Meredith; Le, Lisa W.; Brade, Anthony; Sun, Alexander; Bezjak, Andrea; Hope, Andrew

doi:10.1016/j.ijrobp.2014.03.003

Cited by 24 publications

(18 citation statements)

References 17 publications

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“…These data strongly support the idea that tumor size is a key predictor of outcome in NSCLC patients treated with SBRT. 13 Bhatt et al 32 observed that T-stage was associated with tumor shrinkage during SBRT treatment, with T1 tumors showing greater decrease than T2 tumors. These data imply that patients with larger tumors might benefit from dose escalation (if normal tissue constraints allow).…”

Section: Discussionmentioning

confidence: 99%

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Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Kim

Balagurunathan

et al. 2017

Medical Physics

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Purpose To investigate whether imaging features from pre-treatment planning CT scans are associated with overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS) after stereotactic body radiotherapy (SBRT) among non-small-cell lung cancer (NSCLC) patients. Patients and methods A total of 92 patients (median age: 73 years) with stage I or IIA NSCLC were qualified for this study. A total dose of 50 Gy in 5 fractions was the standard treatment. Besides clinical characteristics, 24 “semantic” image features were manually scored based on a point scale (up to 5) and 219 computer-derived “radiomic” features were extracted based on whole tumor segmentation. Statistical analysis was performed using Cox proportional hazards model and Harrell’s C-index, and the robustness of final prognostic model was assessed using ten-fold cross validation by dichotomizing patients according to the survival or recurrence status at 24 months. Results Two-year OS, RFS and LR-RFS were 69.95%, 41.3% and 51.85%, respectively. There was an improvement of Harrell’s C-index when adding imaging features to a clinical model. The model for OS contained the Eastern Cooperative Oncology Group (ECOG) performance status (Hazard Ratio [HR] = 2.78, 95% Confidence Interval [CI]: 1.37 – 5.65), pleural retraction (HR = 0.27, 95% CI: 0.08 – 0.92), F2 (short axis × longest diameter, HR = 1.72, 95% CI: 1.21 – 2.44) and F186 (Hist-Energy-L1, HR = 1.27, 95% CI: 1.00 - 1.61); The prognostic model for RFS contained vessel attachment (HR = 2.13, 95% CI: 1.24 – 3.64) and F2 (HR = 1.69, 95% CI: 1.33 – 2.15); and the model for LR-RFS contained the ECOG performance status (HR = 2.01, 95% CI: 1.12 – 3.60) and F2 (HR = 1.67, 95% CI: 1.29 – 2.18). Conclusions Imaging features derived from planning CT demonstrate prognostic value for recurrence following SBRT treatment, and might be helpful in patient stratification.

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Section: Discussionmentioning

confidence: 99%

“…Prior studies on staging PET-CT images [9][10][11][12] have been inconclusive. A few studies of pretreatment CT [13][14][15] showed that tumor growth rate and pleural attachment were associated with survival or recurrence.…”

Section: Introductionmentioning

confidence: 99%

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Kim

Balagurunathan

et al. 2017

Medical Physics

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“…In addition, estimation of the natural growth rate of untreated tumour needs at least two tumour volume estimations prior to therapy, e.g., V d and V i . Furthermore, natural tumour growth rate is correlated with kinetic index [12] and patient survival [13,14] and is also valuable for evaluating therapeutic efficacy [1,2,6,[15][16][17][18][19][20][21]. Due to limited availability of diagnostic imaging, an examination close to treatment initiation is in general not possible, and indirect methods for estimation of V i must therefore be developed using, e.g., mathematical models.…”

Section: Discussionmentioning

confidence: 99%

Estimation of tumour volume at therapy initiation by back-extrapolating the post-therapy regression curve of tumour volume

Mehrara

Forssell-Aronsson

2018

Appl Cancer Res

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Background: Tumour volume at therapy initiation, V i , is rarely available in cancer patients, and the last pre-treatment tumour volume available is from previous diagnostic imaging (V d ). Therapeutic efficacy is thus evaluated by comparing tumour volume after treatment with V d , instead of V i , which results in underestimation of treatment efficacy. V i , together with V d , can also be used for estimation of the natural growth rate of tumour valuable for, e.g., screening programs, prognostication and individualised treatment planning such as chemotherapy scheduling. The aim of this work was to study the feasibility of estimating V i by back-extrapolating the post-therapy regression of tumour volume, based on data from animal model. Methods: Nude mice bearing human neuroendocrine GOT1 tumour cell line were treated with 177 Lu-DOTA-TATE. Tumour volumes were measured regularly after therapy and V i was estimated by back-extrapolation of (a) linear and (b) exponential regression lines of the two earliest post-therapy tumour volumes and (c) the long-term exponential regression of tumour volume. The estimated V i values (V est ) were compared with the measured volume of tumour at therapy initiation. Results: The linear regression of the two earliest post-therapy tumour volumes gave the best estimate for V i (V est = 0.91 V i , p < 0.00001), compared with the exponential regression models either on short-term (V est = 2.30 V i , p < 0.01), or long-term (V est = 0.93 V i , non-significant) follow up of tumour volume after therapy. Conclusion: Back-extrapolation of the early linear regression of tumour volume after therapy gave the best estimate for tumour volume at time of therapy initiation. This estimate can be used as baseline for treatment efficacy evaluation or for estimation of the natural growth rate of tumour (together with the measured tumour volume at pre-treatment diagnostic imaging).

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“…We searched PubMed using (lung cancer) AND ((stereotactic body radiotherapy) OR (stereotactic ablative radiotherapy)) AND ((volume*) OR (enlarged) OR (growth) OR (progressed) OR (progression)) as keywords to find relevant studies. Among 1083 studies, we found that tumor growth before radiotherapy planning (RTP) in lung cancer patients treated with SBRT had been reported . There were also studies reporting potential tumor growth during SBRT .…”

Section: Discussionmentioning

confidence: 99%

What if a tumor is significantly enlarged just before stereotactic body radiation therapy? A case report and review of the literature

et al. 2016

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Stereotactic body radiation therapy (SBRT) plays an important role in early stage non‐small cell lung cancer. Tumor growth before radiotherapy planning (RTP) or during SBRT has been reported in lung cancer patients; however, little is known of growth during the period in‐between (i.e. after RTP but before SBRT). An 83‐year‐old man referred to our hospital and diagnosed with medically inoperable non‐small cell lung cancer was noted to have significant tumor progression on day 1 of cone beam computed tomography just before the planned SBRT delivery. Because of uncertainty of the underlying etiology and unfamiliarity with this phenomenon, we made a clinical decision to arrange re‐simulation and revise our treatment to conventional fractionated radiotherapy (CFRT). After an initial response, distant metastases occurred eight months after CFRT. The patient received best supportive care and was under hospice care at the last follow‐up (27 months after CFRT). We report a case with significant tumor growth just before planned SBRT. Optimal management in this scenario requires further investigation.

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Impact of Pretreatment Tumor Growth Rate on Outcome of Early-Stage Lung Cancer Treated With Stereotactic Body Radiation Therapy

Cited by 24 publications

References 17 publications

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Estimation of tumour volume at therapy initiation by back-extrapolating the post-therapy regression curve of tumour volume

What if a tumor is significantly enlarged just before stereotactic body radiation therapy? A case report and review of the literature

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