Stereotactic body radiotherapy for T3 and T4N0M0 non–small cell lung cancer

Eriguchi, Takahisa; Takeda, Atsuya; Sanuki, Naoko; Nishimura, Soraya; Takagawa, Yoshiaki; Enomoto, Tatsuji; Saeki, Noriyuki; Yashiro, Kae; Mizuno, Takahisa; Aoki, Yousuke; Oku, Yohei; Yokosuka, Tetsuya; Shigematsu, Naoyuki

doi:10.1093/jrr/rrw023

Cited by 13 publications

(5 citation statements)

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“…No proper comparison of SABR and segmentectomy functional consequences can be performed because of the lack of randomised trials. Several studies report PFT measured before and after SABR, but a comparison with surgical series is hazardous because of strong differences in patient characteristics ( patients in SABR studies are older and have more degraded lung function) and study design [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. The SABR PFT results suggest that the mean loss of lung function may be lower after SABR than after segmentectomy, but this needs to be confirmed.…”

Section: Future Prospectsmentioning

confidence: 99%

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Charloux

Quoix

2017

Eur Respir Rev

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@ERSpublicationsLung segmentectomy offers mild post-operative to small long-term functional benefits over lobectomy http://ow.ly/dcPQ30fuCU9Cite this article as: Charloux A, Quoix E. Lung segmentectomy: does it offer a real functional benefit over lobectomy ? Eur Respir Rev 2017; 26: 170079 [https://doi.org/10.1183/16000617.0079-2017.ABSTRACT Anatomical segmentectomy has been developed to offer better pulmonary function preservation than lobectomy, in stage IA lung cancer. Despite the retrospective nature of most of the studies and the lack of randomised studies, a substantial body of literature today allows us to evaluate to what extent lung function decreases after segmentectomy and whether segmentectomy offers a real functional benefit over lobectomy. From the available series, it emerges that the mean decrease in forced expiratory volume in 1 s (FEV1) is low, ranging from −9% to −24% of the initial value within 2 months and −3 to −13% 12 months after segmentectomy. This reduction in lung function is significantly lower than that induced by lobectomy, but saves only a few per cent of pre-operative FEV1. Moreover, the published results do not firmly establish the functional benefit of segmentectomy over lobectomy in patients with poor lung function. Some issues remain to be addressed, including whether video-assisted thoracic surgery (VATS) segmentectomy may preserve lung function better than VATS lobectomy in patients with poor lung function, especially within the early days after surgery, and whether this may translate to lowering the functional limit for surgery. Eventually, trials comparing stereotactic ablative body radiotherapy, radiofrequency ablation and segmentectomy functional consequences are warranted.

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Section: Future Prospectsmentioning

confidence: 99%

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Charloux

Quoix

2017

Eur Respir Rev

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“…Radiotherapy is an integral component for treatment of thoracic tumors and breast cancer, however, the high sensitivity of normal lung tissue to ionizing radiation (IR) leading to long term sequela such as development of pulmonary fibrosis constitutes a major dose limiting constraint for a curative treatment [ 1 ]. More recently, hypofractionated stereotactic body or ablative radiation therapy (SBRT, SABR) is increasingly used for e.g., early stage non-small cell lung cancer (NSCLC) and oligometastatic diseases [ 2 , 3 ]. SBRT is characterized by intensified deposition of radiation doses into one or few circumscribed regions in a single or few fractions [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Quantitative assessment of radiation dose and fractionation effects on normal tissue by utilizing a novel lung fibrosis index model

et al. 2017

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BackgroundNormal lung tissue tolerance constitutes a limiting factor in delivering the required dose of radiotherapy to cure thoracic and chest wall malignancies. Radiation-induced lung fibrosis (RILF) is considered a critical determinant for late normal tissue complications. While RILF mouse models are frequently approached e.g., as a single high dose thoracic irradiation to investigate lung fibrosis and candidate modulators, a systematic radiobiological characterization of RILF mouse model is urgently needed to compare relative biological effectiveness (RBE) of particle irradiation with protons, helium-, carbon and oxygen ions now available at HIT. We aimed to study the dose-response relationship and fractionation effect of photon irradiation in development of pulmonary fibrosis in C57BL/6 mouse.MethodsLung fibrosis was evaluated 24 weeks after single and fractionated whole thoracic irradiation by quantitative assessment of lung alterations using CT. The fibrosis index (FI) was determined based on 3D-segmentation of the lungs considering the two key fibrosis parameters affected by ionizing radiation i.e., a dose/fractionation dependent reduction of the total lung volume and increase of the mean lung density.ResultsThe effective dose required to induce 50% of the maximal possible fibrosis (ED 50) was 14.55 ± 0.34Gy and 27.7 ± 1.22Gy, for single and five- fractions irradiation, respectively. Applying a deterministic model an α/β = 4.49 ± 0.38 Gy for the late lung radiosensitivity was determined. Intriguingly, we found that a linear-quadratic model could be applied to in-vivo log transformed fibrosis (FI) vs. irradiation doses. The LQ model revealed an α/β for lung radiosensitivity of 4.4879 Gy for single fraction and 3.9474 for 5-fractions. Our FI based data were in good agreement with a meta-analysis of previous lung radiosensitivity data derived from different clinical endpoints and various mouse strains. The effect of fractionation on RILF development was further estimated by the biologically effective dose (BED) model with threshold BED (BED Tr) = 30.33 Gy and BED ED50 = 61.63 Gy, respectively.ConclusionThe systematic radiobiological characterization of RILF in the C57BL/6 mouse reported in this study marks an important step towards precise estimation of dose-response for development of lung fibrosis. These radiobiological parameters combined with a large repertoire of genetically engineered C57BL/6 mouse models, build a solid foundation for further biologically individualized risk assessment of RILF and functional RBE prediction on novel of particle qualities.Electronic supplementary materialThe online version of this article (10.1186/s13014-017-0912-y) contains supplementary material, which is available to authorized users.

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“…SBRT is a non-invasive treatment that can deliver a high dose of radiation in fewer fractions to thoracic or abdominal lesions, which can fully eradicate early-stage primary lung tumors and also can inactivate lung metastases or advanced localized disease. Therefore, it has exclusive advantages in the treatment of tumor peripheral dose change gradient large for pulmonary primary or pulmonary metastases (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric comparison of helical tomotherapy and conventional Linac-based X-knife stereotactic body radiation therapy for primary lung cancer or pulmonary metastases

Li¹,

Yang²,

Liu³

et al. 2018

J. Thorac. Dis.

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Background: To compare helical tomotherapy (HT) with X-knife stereotactic body radiation therapy (HT-SBRT/X-SBRT) for primary or metastatic lung cancer regarding planning target volume (PTV) coverage, such as homogeneity index (HI), conformity index (CI) and dose-volume histogram (DVH) of organs at risk (OARs). Methods:We retrospectively analyzed 21 patients receiving definitive radiation treatment for non-small cell lung cancer (NSCLC) or pulmonary metastases at our institution between March 2015 and October 2016.Tumors were irradiated with 4-10 Gy per fraction in 5-15 fractions. Plans were compared according to PTV coverage and OARs sparing.Results: Significant differences between HT and X-knife were observed for both HI (P=0.003) and CI (P<0.001). The V5 (P=0.001), V10 (P=0.009), V20 (P=0.001), the mean lung dose (P=0.005) of total lung and maximum dose of the spinal cord (P=0.010) were significantly lower in the X-SBRT group than the HT-SBRT group. There were no significant differences for the V30 (P=0.075) and the mean heart dose (P=0.584) between the two groups.Conclusions: X-SBRT was dosimetrically superior to HT-SBRT, when applied in these tumors' maximum diameters <5 cm. As HT resulted in increased low-dose volume, it is essential to optimize the patient selection in order to avoid severe radiation pneumonitis in HT-SBRT.

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Stereotactic body radiotherapy for T3 and T4N0M0 non–small cell lung cancer

Cited by 13 publications

References 30 publications

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Lung segmentectomy: does it offer a real functional benefit over lobectomy?

Quantitative assessment of radiation dose and fractionation effects on normal tissue by utilizing a novel lung fibrosis index model

Dosimetric comparison of helical tomotherapy and conventional Linac-based X-knife stereotactic body radiation therapy for primary lung cancer or pulmonary metastases

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