Stereotactic ablative radiotherapy (SABR) in early stage non-small cell lung cancer: Comparing survival outcomes in adenocarcinoma and squamous cell carcinoma

Abel, Stephen; Hasan, Shaakir; White, Richard; Schumacher, Lana; Finley, Gene Grant; Colonias, Athanasios; Wegner, Rodney E.

doi:10.1016/j.lungcan.2018.12.022

Cited by 32 publications

(26 citation statements)

References 28 publications

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“…This lack of significance, however, may be because of low patient numbers, in contrary another study of 15 110 patients with MIESLC showed a strong relationship between squamous histology and worse OS ( P < .0001). In that study, the median survival times for patients with squamous versus adenocarcinoma were 33 months versus 44 months 25 …”

Section: Discussionmentioning

confidence: 89%

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study

Sahin

Atalar

Sağlam

et al. 2020

Clinical Respiratory J

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Objective We identified factors influencing outcomes in patients with medically inoperable early stage lung cancer (MIESLC) treated with stereotactic ablative radiation therapy (SABR) at 14 centers in Turkey. Materials and Methods We retrospectively analyzed 431 patients with stage I‐II MIESLC treated with SABR from 2009 through 2017. Age; sex; performance score; imaging technique; tumor histology and size; disease stage radiation dose, fraction and biologically effective dose with an α/β ratio of 10 (BED10); tumor location and treatment center were evaluated for associations with overall survival (OS), local control (LC) and toxicity. Results Median follow‐up time was 27 months (range 1‐115); median SABR dose was 54 Gy (range 30‐70) given in a median three fractions (range 1‐10); median BED10 was 151 Gy (range 48‐180). Tumors were peripheral in 285 patients (66.1%), central in 69 (16%) and <1 cm from mediastinal structures in 77 (17.9%). Response was evaluated with PET/CT in most cases at a median 3 months after SABR. Response rates were: 48% complete, 36.7% partial, 7.9% stable and 7.4% progression. LC rates were 97.1% at 1 year, 92.6% at 2 years and 91.2% at 3 years; corresponding OS rates were 92.6%, 80.6% and 72.7%. On multivariate analysis, BED10 > 100 Gy (P = .011), adenocarcinoma (P = .025) and complete response on first evaluation (P = .007) predicted favorable LC. BED10 > 120 Gy (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.1‐3.2, P = .019) and tumor size (<2 cm HR 1.9, 95% CI 1.3‐3, P = .003) predicted favorable OS. No grade 4‐5 acute side effects were observed; late effects were grade ≤3 pneumonitis (18 [4.2%]), chest wall pain (11 [2.5%]) and rib fracture (1 [0.2%]). Conclusion SABR produced encouraging results, with satisfactory LC and OS and minimal toxicity. BED10 > 120 Gy was needed for better LC and OS for large, non‐adenocarcinoma tumors.

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Section: Discussionmentioning

confidence: 89%

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study

Sahin

Atalar

Sağlam

et al. 2020

Clinical Respiratory J

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“…Although no model performed highly and potentially prognostic clinical variables were not included in the multivariable model (i.e. histological sub-type, 26 or performance status 27 ), the purpose was comparison rather than development of a clinical prediction model. This provides confidence in using the generated volume as the tumor volume covariate in statistical modelling.…”

Section: Discussionmentioning

confidence: 99%

Automated gross tumor volume contour generation for large‐scale analysis of early‐stage lung cancer patients planned with 4D‐CT

et al. 2020

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Purpose: Patients with early-stage lung cancer undergoing stereotactic ablative radiotherapy receive four-dimensional computed tomography (4D-CT) for treatment planning. Often, an internal gross target volume (iGTV), which approximates the motion envelope of a tumor over the breathing cycle, is delineated without defining a gross tumor volume (GTV). However, the GTV volume and shape are important parameters for prognostic and dose modelling, and there is interest in radiomic features extracted from the GTV and surrounding tissue. We demonstrate and validate a method to generate the GTV from an iGTV contour to aid retrospective analysis on routine data. Method: It is possible to reconstruct the geometry of a tumor with knowledge of tumor motion and the motion envelope formed during respiration. To demonstrate this, the tumor motion path was estimated with local rigid registration, and the iGTV positioned incrementally at stations along the reverse path. It is shown that the tumor volume is the largest set common to the intersection of the iGTV at these positions, hence can be derived. This was implemented for 521 lung lesions on 4D-CT. Eleven patients with a GTV delineation performed by a radiation oncologist on a reference phase (50%) were used for validation. The generated GTV was compared to that delineated by the expert using distance-to-agreement (DTA), volume, and distance between centres of mass. An overall success rate was determined by detecting registration inaccuracy and performing a quality check on the routine iGTV. For successfully generated contours, GTV volume was compared to iGTV volume in a prognostic model for overall survival. Results: For the validation dataset, DTA mean (0.79-1.55 mm) and standard deviation (0.68-1.51 mm) were comparable to expected observer variation. Difference in volume was < 5 cm 3 , and average difference in position was 1.21 mm. Deviations in shape and position were mainly caused by observer differences in iGTV and GTV interpretation as opposed to algorithm performance. For the complete dataset, an acceptable contour was generated for 94% of patients using statistical and visual assessment to detect failures. Generated GTV volumes improved prognostic model performance over iGTV volumes. Conclusion: A method to generate a GTV from an iGTV and 4D-CT dataset was developed. This method facilitates data analysis of patients with early-stage lung cancer treated in the routine setting, that is, data mining, prognostic modeling, and radiomics. Generation failure detection removes the need for visual assessment of all contours, reducing a time-consuming aspect of big-data analysis. Favorable prognostic performance of generated GTV volumes over iGTV ones demonstrates opportunities to use this methodology for future study.

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“…CT examination can be used to accurately observe the mass of NSCLC and to assess whether there is enlargement of lymph nodes and metastasis (20). With the development of imaging genomics, the NSCLC tissues can be quantitatively analyzed, so that the images can be converted into researchable data to reveal the intrinsic relation between tumor imaging features and molecular markers, which is of positive significance in predicting related gene mutations, and can offer strong support to targeted therapy of NSCLC (21). In this study, there was overexpression of MTA1 in tumor tissues in elderly NSCLC patients with spicule sign, pleural indentation sign and lymph node metastasis sign in CT images, indicating that patients with high expression of MTA1 are more prone to spicule sign, pleural indentation sign and lymph node metastasis sign.…”

Section: Discussionmentioning

confidence: 99%

Associations of MTA1 expression with CT features, pathology and prognosis of elderly patients with non-small cell lung cancer

Han

Feng

et al. 2020

Oncol Lett

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Associations of metastasis-associated protein 1 (MTA1) expression with computed tomography (CT) features, pathology and prognosis of elderly patients with non-small cell lung cancer (NSCLC), and its clinical significance were explored. A total of 98 elderly patients with NSCLC were selected and underwent CT examination. The expression of MTA1 in carcinoma tissues and para-carcinoma normal tissues was detected via immunohistochemistry, and its associations with CT features, pathology and prognosis were analyzed. The results manifested that the expression of MTA1 in carcinoma tissues was significantly higher than that in para-carcinoma normal tissues, and it was associated with the degree of differentiation, stage and lymph node metastasis (P<0.05). Besides, the high expression of MTA1 was also related to the spicule sign, pleural indentation and lymph node metastasis (P<0.05) as well as the CT perfusion parameter capillary permeability (PMB) (P<0.05), but not to blood volume (BV), blood flow (BF) or time to peak (TTP). Moreover, the patients with high expression of MTA1 had significantly shorter survival time and a remarkably lower 5-year survival rate than those with low expression of MTA1 (P<0.05). In conclusion, MTA1 plays a certain role in the occurrence and development of NSCLC in elderly patients and has an association with their prognosis, which can provide references for the treatment and prognosis of NSCLC, with important clinical significance.

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Stereotactic ablative radiotherapy (SABR) in early stage non-small cell lung cancer: Comparing survival outcomes in adenocarcinoma and squamous cell carcinoma

Cited by 32 publications

References 28 publications

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study

Prognostic factors in medically inoperable early stage lung cancer patients treated with stereotactic ablative radiation therapy (SABR): Turkish Radiation Oncology Society Multicentric Study

Automated gross tumor volume contour generation for large‐scale analysis of early‐stage lung cancer patients planned with 4D‐CT

Associations of MTA1 expression with CT features, pathology and prognosis of elderly patients with non-small cell lung cancer

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