Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Frakulli, R.; Salvi, Fabrizio; Balestrini, Damiano; Palombarini, M.; Cammelli, S.; Morganti, Alessio Giuseppe; Zompatori, Maurizio; Frezza, G.P.

doi:10.21037/tlcr.2017.10.01

Cited by 14 publications

(8 citation statements)

References 18 publications

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“…Following radiation-induced lung injury using CT scan remains a challenge in the clinic. 21 In preclinical models, micro-CT imaging has been shown to be a sensitive technique for the assessment of late lung toxicity 22 but appeared insufficient to follow mitigation effects ensured by nintedanib administration. 23 The ability to follow lung damage by CT imaging remains an important noninvasive parameter to be taken into account in the choice of preclinical models of radiation-induced lung damage.…”

Section: Discussionmentioning

confidence: 99%

Preclinical Model of Stereotactic Ablative Lung Irradiation Using Arc Delivery in the Mouse: Effect of Beam Size Changes and Dose Effect at Constant Collimation

Bertho

Santos

Buard

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Stereotactic body radiation therapy is a therapeutic option offered to high surgical risk patients with lung cancer. Focal lung irradiation in mice is a new preclinical model to help understand the development of lung damage in this context. Here we developed a mouse model of lung stereotactic therapy using arc delivery and monitored the development of lung damage while varying the beam size and dose delivered. Methods and Materials: C57BL/6JRj mice were exposed to 90 Gy focal irradiation on the left lung using 1-mm diameter, 3 Â 3 mm 2 , 7 Â 7 mm 2 , or 10 Â 10 mm 2 beam collimation for beam size effect and using 3 Â 3 mm 2 beam collimation delivering 20 to 120 Gy for dose effect. Long-term lung damage was monitored with microecomputed tomography imaging with anatomopathologic and gene expression measurements in the injured patch and the ipsilateral and contralateral lungs. Results: Both 1-mm diameter and 3 Â 3 mm 2 beam collimation allow long-term studies, but only 3-mm beam collimation generates lung fibrosis when delivering 90 Gy. Dose-effect studies with constant 3-mm beam collimation revealed a dose of 60 Gy as the minimum to obtain lung fibrosis 6 months postexposure. Lung fibrosis development was associated with club cell depletion and increased type II pneumocyte numbers. Lung injury developed with ipsilateral and contralateral consequences such as parenchymal thickening and gene expression modifications. Conclusions: Arc therapy allows long-term studies and dose escalation without lethality. In our dose-delivery conditions, dose-effect studies revealed that 3 Â 3 mm 2 beam collimation to a minimum single dose of 60 Gy enables preclinical models

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Section: Discussionmentioning

confidence: 99%

Preclinical Model of Stereotactic Ablative Lung Irradiation Using Arc Delivery in the Mouse: Effect of Beam Size Changes and Dose Effect at Constant Collimation

Bertho

Santos

Buard

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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“…14 This may also be confounded by the difficulty to accurately identify radiological evidence of local recurrence in the SBRT field compared with the ablation zone, which may account for underreporting or delayed reporting of local recurrence. 15 Recent evidence shows a higher pathological complete response rate reported for lung ablation (reported at 90.9%) 16,17 compared with SBRT (which was reported at 60%). 18 Taken together, the clinical significance of reported higher local recurrence rate in ablation remains unclear.…”

mentioning

confidence: 97%

Microwave Ablation in Primary Lung Malignancies

Moussa

Ziv

Solomon

et al. 2019

Semin intervent Radiol

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Lung cancer is the leading cause of cancer-related mortality worldwide. Eighty-five percent of cases correspond to non-small cell lung cancer (NSCLC) and pivotal nonsurgical options for early-stage disease include percutaneous ablation and stereotactic body radiation therapy (SBRT). Microwave Ablation (MWA) is a locoregional treatment option that has many advantages over radiofrequency ablation and has been able to overcome the limitations of this technique in the treatment of early-stage NSCLC. In this review article, we highlight the current evidence supporting the use of MWA in patients with early-stage NSCLC and discuss the technical considerations of the procedure, including optimal patient selection and planning strategies, as well as the potential complications and reported outcomes. Finally, we mention future trends involving ablation in NSCLC, including its role in combination with SBRT in central tumors, management of post-SBRT local recurrence, and its potential as an adjuvant treatment option for patients with resistance to systemic therapy or in combination with checkpoint inhibitors.

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“…Recurrence is the main cause of the death of patients with NSCLC, even for patients with clinical stage IA (10,11). Studies reveal that recurrence occurs mainly because NSCLC shows the features of "skip metastasis" and "micrometastasis" (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer

Luo¹,

Chen²,

Zeng³

2020

Transl Cancer Res TCR

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Background: Lymph node metastasis occurs although clinical stage IA is a relatively early stage for patients with non-small cell lung cancer (NSCLC). This study aimed to explore the influencing factors of lymph node metastasis. Methods: A total of 200 patients diagnosed with clinical stage IA NSCLC preoperatively from July 2014 to July 2016 were examined. Every patient underwent lobectomy and systematic lymph node dissection. Their clinicopathological characteristics and status of lymph node metastasis are analyzed. Results:The rates of both N1 and N2 lymph node metastasis increase with the increase in the tumor diameter. The N1 lymph node metastasis rate is 0%, 2.82%, and 9.52%, while the N2 lymph node metastasis rate is 0%, 4.23%, and 25.40% for pure ground-glass nodules, mixed ground-glass nodules (solid component <50%), and mixed ground-glass nodules (solid component >50%), respectively. The difference is statistically significant (P=0.000). Patients with squamous cell carcinoma have a relatively higher N1 lymph node metastasis rate comparing with patients with adenocarcinoma (P<0.05). Tumors locate in the inner half lobe (close to hilus) are prone to metastasize to lymph nodes (P=0.018). Multiple regression analysis shows that tumor diameter, solid component rate, and tumor location are relevant factors for lymph node metastasis. Conclusions:In patients with NSCLC, who have tumors smaller than 1 cm, pure ground-glass nodules, or tumors locate in the lateral half lobe, lymph node metastasis is rare and selective lymphadenectomy is considerable.

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Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Cited by 14 publications

References 18 publications

Preclinical Model of Stereotactic Ablative Lung Irradiation Using Arc Delivery in the Mouse: Effect of Beam Size Changes and Dose Effect at Constant Collimation

Preclinical Model of Stereotactic Ablative Lung Irradiation Using Arc Delivery in the Mouse: Effect of Beam Size Changes and Dose Effect at Constant Collimation

Microwave Ablation in Primary Lung Malignancies

Analysis of lymph node metastasis in 200 patients with non-small cell lung cancer

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