Relationship between Dose Prescription Methods and Local Control Rate in Stereotactic Body Radiotherapy for Early Stage Non-Small-Cell Lung Cancer: Systematic Review and Meta-Analysis

Eriguchi, Takahisa; Takeda, Atsuya; Nemoto, Takafumi; Tsurugai, Yuichiro; Sanuki, Naoko; Tateishi, Yudai; Kibe, Yuichi; Akiba, Takeshi; Inoue, Mari; Nagashima, Kengo; Horita, Nobuyuki

doi:10.3390/cancers14153815

Cited by 11 publications

(14 citation statements)

References 67 publications

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“…Through systematic review and meta regression analysis based on Probit model, this study found that there was no significant dose effect relationship between nominal BED 10 or peripheral BED 10 and 3 years local control rate, but there was a significant dose effect relationship between PTV central BED 10 or PTV average BED 10 and local control rate. This result is similar to that of Eriguchi et al [ 5 ]. Through systematic review and meta-analysis, they determined that the correlation between central BED 10 of PTV and tumor local control is stronger than that between peripheral BED 10 and local control.…”

Section: Discussionsupporting

confidence: 93%

“…SBRT has also achieved encouraging outcomes in patients with operable early NSCLC [ 3 , 4 ]. The total physical dose varies greatly due to different fractionation [ 5 , 6 ]. Even if the fractionation and the nominal prescription dose are the same, there is significant difference for near maximum dose or the average dose in the planning target volume due to the absence of the uniform standard for the selection of prescription dose isodose line [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…In SBRT of early stage NSCLC, higher maximum dose in target volume can not only improve local control rate, but also reduce cancer specific death and promote overall survival (OS), without increasing toxicity [ 8 ]. Several studies have attempted to determine the most relevant dose parameters for tumor local control in SBRT of NSCLC, and tried to recommend the prescription dose [ 5 , 6 ]. However, it is regrettable that the optimal dose prescription is still unclear.…”

Section: Introductionmentioning

confidence: 99%

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Dose–effect relationship of stereotactic body radiotherapy in non-small cell lung cancer patients

Jiang

Mingwei

et al. 2022

Radiat Oncol

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Objective To establish the dose effect relationship between the dose parameters of stereotactic body radiation therapy (SBRT) for early non-small cell lung cancer (NSCLC) and the local tumor control rate. Materials and methods A comprehensive literature search was conducted using PubMed, the Web of Science and the Cochrane databases to determine the articles treated with SBRT in early-stage NSCLC. Original studies with complete prescription dose information, tumor local control rate and other important parameters were screened and reported. Probit model in XLSTAT 2016 was used for regression analysis, and P < 0.05 was set as a statistically significant level. Results After literature screening, 22 eligible studies were included in probit model regression analysis, involving 1861 patients. There is no significant dose effect relationship between nominal BED10 and peripheral BED10 versus 3 years local control probability. There were significant dose effect relationships between the center BED10 and the average BED10 versus the 3 years local control probability, with P values are 0.001 and < 0.0001, respectively. According to the results of this model, the 3 years local control rate of 90.5% (87.5–92.1%) and 89.5% (86.7–91.0%) can be expected at the center BED10 of 180 Gy or the average BED10 of 140 Gy, prospectively. Conclusions For NSCLC treated with SBRT, more attention should be paid to the central dose and average dose of PTV. A set of clear definition in the dose prescription should be established to ensure the effectiveness and comparability of treatment.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dose–effect relationship of stereotactic body radiotherapy in non-small cell lung cancer patients

Jiang

Mingwei

et al. 2022

Radiat Oncol

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“…Similarly, a recent metaanalysis investigating the relationship between LC rates and SBRT dose prescription for early-stage NSCLC found that the central BED, calculated from near the maximum dose of the PTV, was significantly correlated with 3-year LC rates, with a central BED of 150 Gy resulting in an LC rate of 90%. 5 Another recent retrospective study also reported improved LC rates with a maxBED > 125 Gy. 6 In our study, we investigated a maxBED of 120 Gy as the threshold for LC comparison because it was the median value among patients.…”

Section: Discussionmentioning

confidence: 91%

“…2,3 Furthermore, some have suggested that a hotter center or an escalated maximum dose with the PTV could result in better tumor control rates and survival outcomes. [4][5][6] However, the supporting data are limited, and the differences in prescription patterns make any findings difficult to interpret and apply.…”

mentioning

confidence: 99%

Impact of Maximum Point Dose Within the Planning Target Volume on Local Control of Nonsmall Cell Lung Cancer Treated With Stereotactic Body Radiotherapy

Braschi,

Morris,

Yeung

et al. 2023

American Journal of Clinical Oncology

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Objective: No consensus exists on the maximum dose delivered to the planning target volume (PTV) in the delivery of stereotactic body radiotherapy (SBRT) for primary lung cancer. We investigated whether higher biologically effective doses (BED) within the PTV were associated with improved tumor control. Methods: We reviewed patients with early-stage, node-negative nonsmall cell lung cancer who received curative-intent SBRT between 2005 and 2018. We calculated the maximum BED (maxBED) within the PTV for all patients, analyzing outcomes using the cumulative incidence method and Fine-Gray test statistics to assess prognostic impact. Results: We analyzed 171 patients (median age, 70.2; range, 43 to 90 y) with 181 lung nodules. Median follow-up was 2.7 years (range, 0.1 to 12 y) for all patients and 4.2 years (range, 0.2 to 8.4 y) for living patients. Median maximum tumor diameter was 1.9 cm (range, 0.7 to 5.6 cm). Patients received a prescription of 48 or 50 Gy in 4 or 5 fractions, respectively, except for one who received 60 Gy in 5 fractions. Median maxBED was 120 Gy (range, 101 to 171 Gy). There was no difference in the 3-year local control (LC) rate among patients treated with a maxBED<120 Gy versus ≥120 Gy (P=0.83). Conclusion: No significant differences in LC were observed between patients with early-stage nonsmall cell lung cancer treated with SBRT in 4 or 5 fractions with a maxBED≥120 Gy. However, a higher maxBED trended toward improved LC rates, suggesting a maxBED threshold greater than 120 Gy may be needed to improve LC rates.

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Multicentric development and evaluation of [18F]FDG PET/CT and CT radiomic models to predict regional and/or distant recurrence in early-stage non-small cell lung cancer treated by stereotactic body radiation therapy

Lucia,

Louis,

Cousin

et al. 2023

Eur J Nucl Med Mol Imaging

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Purpose To develop machine learning models to predict regional and/or distant recurrence in patients with early-stage non-small cell lung cancer (ES-NSCLC) after stereotactic body radiation therapy (SBRT) using [ 18 F]FDG PET/CT and CT radiomics combined with clinical and dosimetric parameters. Methods We retrospectively collected 464 patients (60% for training and 40% for testing) from University Hospital of Liège and 63 patients from University Hospital of Brest (external testing set) with ES-NSCLC treated with SBRT between 2010 and 2020 and who had undergone pretreatment [ 18 F]FDG PET/CT and planning CT. Radiomic features were extracted using the PyRadiomics toolbox®. The ComBat harmonization method was applied to reduce the batch effect between centers. Clinical, radiomic, and combined models were trained and tested using a neural network approach to predict regional and/ or distant recurrence. Results In the training (n = 273) and testing sets (n = 191 and n = 63), the clinical model achieved moderate performances to predict regional and/or distant recurrence with C-statistics from 0.53 to 0.59 (95% CI, 0.41, 0.67). The radiomic (origi-nal_firstorder_Entropy, original_gldm_LowGrayLevelEmphasis and original_glcm_DifferenceAverage) model achieved higher predictive ability in the training set and kept the same performance in the testing sets, with C-statistics from 0.70 to 0.78 (95% CI, 0.63, 0.88) while the combined model performs moderately well with C-statistics from 0.50 to 0.62 (95% CI, 0.37, 0.69). Conclusion Radiomic features extracted from pre-SBRT analog and digital [ 18 F]FDG PET/CT outperform clinical parameters in the prediction of regional and/or distant recurrence and to discuss an adjuvant systemic treatment in ES-NSCLC. Prospective validation of our models should now be carried out.

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Relationship between Dose Prescription Methods and Local Control Rate in Stereotactic Body Radiotherapy for Early Stage Non-Small-Cell Lung Cancer: Systematic Review and Meta-Analysis

Cited by 11 publications

References 67 publications

Dose–effect relationship of stereotactic body radiotherapy in non-small cell lung cancer patients

Dose–effect relationship of stereotactic body radiotherapy in non-small cell lung cancer patients

Impact of Maximum Point Dose Within the Planning Target Volume on Local Control of Nonsmall Cell Lung Cancer Treated With Stereotactic Body Radiotherapy

Multicentric development and evaluation of [18F]FDG PET/CT and CT radiomic models to predict regional and/or distant recurrence in early-stage non-small cell lung cancer treated by stereotactic body radiation therapy

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