Stereotactic body radiotherapy improves the survival of patients with oligometastatic non‐small cell lung cancer

Ouyang, Wen; Yu, Jing; Shuake, Nuerjiang; Li, Zhijun; Wang, Dajiang; Wang, Xiaoyong; Zhang, Junhong

doi:10.1002/cam4.2366

Cited by 23 publications

(14 citation statements)

References 43 publications

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“…However, it was also reported that clinical and therapeutic characteristics such as KPS score, local therapy for BM, radiotherapy for primary lesion [18], subsequent treatment of Osimertinib [19], and diagnosed as oligometastasis [20] could influence OS. To eliminate the impact of potential confounders, and to further confirm metachronous BM was an independent prognostic factor of poorer OS, we performed multivariable Cox regression analysis to investigate the potential prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

Metachronous Brain Metastasis in patients with EGFR-mutant NSCLC indicates a worse prognosis

Ouyang

Zhou

et al. 2020

J. Cancer

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Purpose: NSCLC patients with EGFR mutation were associated with high incidence of brain metastasis (BM). BM could be grouped by the time of occurrence, including synchronous BM at initial diagnosis and metachronous BM during disease course. The primary aim of the study was to investigate the survival of patients with metachronous BM. Methods: A total of 99 EGFR-mutant advanced NSCLC patients in our institute between 2012 and 2018 were grouped into synchronous BM and metachronous BM. Comparisons of OS were performed based on BM status. The independent prognostic factors of OS were investigated, and extracranial and intracranial PFS were further analyzed. Results: Patients with metachronous BM (mOS: 22.1 months) had poorer outcomes than synchronous BM (mOS: 30.3 months) (P=0.016). Moreover, multivariate analysis indicated that BM status (P=0.015), local therapy for BM (P=0.013) and subsequent treatment of Osimertinib (P=0.008) impact significantly on OS. Significantly, the proportion of local therapy for BM had no difference between patients with synchronous and metachronous BM. And patients with metachronous BM harbored a more favorable prognostic factor (higher proportion of subsequent Osimertinib treatment), but also harbored a poorer prognostic factor (metachronous BM), which confirmed BM status was the most significant prognostic factor of OS. At last, results of extracranial and intracranial PFS indicated that patients with metachronous BM tended to have a higher risk of intracranial disease progression. Conclusions: Patients developing metachronous BM during EGFR-TKIs treatment have worse outcomes than synchronous BM. Our findings suggested that the patients with metachronous BM should receive more aggressive treatments.

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Section: Discussionmentioning

confidence: 99%

Metachronous Brain Metastasis in patients with EGFR-mutant NSCLC indicates a worse prognosis

Ouyang

Zhou

et al. 2020

J. Cancer

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“…Comparisons of tumor volume, SUV max , TGIR, tumor necrosis rate, apoptosis rate, and Ki-67 + expression rate among groups and at different time points (mean ± S)Decreasing group (p > 0.05). The most obvious difference in apoptosis rates was observed on day 7 after radiation (t = 3.91, 2.93; p < 0.05).Figures 3,4; …”

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confidence: 89%

“…The radiotherapy model for malignancy has transformed from conventional fraction radiotherapy (CFRT) to hypofractionated radiotherapy, which is now considered to be a new and highly effective mode of radiation therapy [1,2]. Stereotactic body radiotherapy (SBRT) and stereotactic radiosurgery are common procedures in hypofractionated radiotherapy, especially SBRT, which is widely performed for lung cancer, colorectal cancer, liver cancer, and prostate cancer, and shows considerable improvement in the radiotherapeutic outcomes [3][4][5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Relationship between the invasion of lymphocytes and cytokines in the tumor microenvironment and the interval after single brachytherapy hypofractionated radiotherapy and conventional fractionation radiotherapy in non-small cell lung Cancer

et al. 2020

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Background The effect of brachytherapy on lymphocytes and cytokines in the tumor microenvironment is unclear. This study aimed to analyze the relationship between the invasion of lymphocytes and cytokines in the tumor microenvironment and the interval after single brachytherapy hypofractionated radiotherapy (SBHFRT) and conventional fractionation radiotherapy (CFRT) in non-small cell lung cancer (NSCLC). Methods Lewis tumor-bearing mice were randomly divided into control, CFRT, and SBHFRT groups. On days 7 and 14 after radiation, the expression levels of CD86+, CD4+, CD8+, and Foxp3+ cells, and levels of Ki-67+ protein were detected by immunohistochemistry, and the tumor necrosis rate was calculated. Following this, the levels of interleukin-10 (IL-10), IL-12, and interferon-γ (IFN-γ) were detected by enzyme-linked immunosorbent assay. The apoptosis rate was evaluated via flow cytometry. The tumor volume and tumor growth inhibition rate (TGIR) were calculated on day 14. Tumor metabolism was assessed via 18F-FDG micropositron emission tomography/computer tomography. Results The tumor volume reduced by 22.0% and TGIR increased by 92.2% (p < 0.05) in the SBHFRT group. Further, on days 7 and 14 after radiation, tumor metabolism, Ki-67+ and Foxp3+ expression levels, and IL-10 levels were lower, and tumor necrosis and apoptosis rates; CD86+, CD4+, and CD8+ expression levels; and IL-12 and IFN-γ levels were higher in the SBHFRT group than in the CFRT group, particularly on day 7. Conclusion SBHFRT could lead to more accumulation of dendritic cells, anti-tumor lymphocytes, and cytokines, and further reduce the aggregation of immunosuppressive lymphocytes and cytokines in the tumor microenvironment compared with CFRT, and the difference was the most obvious on day 7 after radiation. The clinical significance of the findings remains to be further verified.

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“…Hypo-fractionated radiotherapy (HFRT) includes stereotactic body radiation therapy (SBRT) and hypo-fractionated brachytherapy, both of which deliver a high biologically effective dose (BED) to the tumor while minimizing toxicity to the normal tissues. Therefore, HFRT can prompt superior local control and improved survival ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Positron Emission Tomography-Based Short-Term Efficacy Evaluation and Prediction in Patients With Non-Small Cell Lung Cancer Treated With Hypo-Fractionated Radiotherapy

et al. 2021

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BackgroundPositron emission tomography is known to provide more accurate estimates than computed tomography when staging non–small cell lung cancer. The aims of this prospective study were to contrast the short-term efficacy of the two imaging methods while evaluating the effects of hypo-fractionated radiotherapy in non-small cell lung cancer, and to establish a short-term efficacy prediction model based on the radiomics features of positron emission tomography.MethodsThis nonrandomized-controlled trial was conducted from March 2015 to June 2019. Thirty-one lesions of 30 patients underwent the delineation of the regions of interest on positron emission tomography and computed tomography 1 month before, and 3 months after hypo-fractionated radiotherapy. Each patient was evaluated for the differences in local objective response rate between the two images. The Kaplan Meier method was used to analyze the local objective response and subsequent survival duration of the two imaging methods. The 3D Slicer was used to extract the radiomics features based on positron emission tomography. Least absolute shrinkage and selection operator regression was used to eliminate redundant features, and logistic regression analysis was used to develop the curative-effect-predicting model, which was displayed through a radiomics nomogram. Receiver operating characteristic curve and decision curve were used to evaluate the accuracy and clinical usefulness of the prediction model.ResultsPositron emission tomography-based local objective response rate was significantly higher than that based on computed tomography [70.97% (22/31) and 12.90% (4/31), respectively (p<0.001)]. The mean survival time of responders and non-responders assessed by positron emission tomography was 28.6 months vs. 11.4 months (p=0.29), whereas that assessed by computed tomography was 24.5 months vs. 26 months (p=0.66), respectively. Three radiomics features were screened to establish a personalized prediction nomogram with high area under curve (0.94, 95% CI 0.85–0.99, p<0.001). The decision curve showed a high clinical value of the radiomics nomogram.ConclusionsWe recommend positron emission tomography for evaluating the short-term efficacy of hypo-fractionated radiotherapy in non-small cell lung cancer, and that the radiomics nomogram could be an important technique for the prediction of short-term efficacy, which might enable an improved and precise treatment.Registration number/URLChiCTR1900027768/http://www.chictr.org.cn/showprojen.aspx?proj=46057

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Stereotactic body radiotherapy improves the survival of patients with oligometastatic non‐small cell lung cancer

Cited by 23 publications

References 43 publications

Metachronous Brain Metastasis in patients with EGFR-mutant NSCLC indicates a worse prognosis

Metachronous Brain Metastasis in patients with EGFR-mutant NSCLC indicates a worse prognosis

Relationship between the invasion of lymphocytes and cytokines in the tumor microenvironment and the interval after single brachytherapy hypofractionated radiotherapy and conventional fractionation radiotherapy in non-small cell lung Cancer

Positron Emission Tomography-Based Short-Term Efficacy Evaluation and Prediction in Patients With Non-Small Cell Lung Cancer Treated With Hypo-Fractionated Radiotherapy

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