The Impact of Tumor Size on Outcomes After Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Non-Small Cell Lung Cancer

Allibhai, Z.; Taremi, Mojgan; Bezjak, Andrea; Brade, Anthony; Hope, Andrew; Sun, Alexander; Cho, J.

doi:10.1016/j.ijrobp.2013.08.020

Cited by 114 publications

(77 citation statements)

References 18 publications

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“…Prognosis as determined through the APM following SABR was also found to be highly dependent on tumor size, a finding consistent with previous SABR and surgical studies (24)(25)(26)(27). In the APM, the RPA determined a tumor diameter cutpoint of 20 mm.…”

Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 84%

Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model

Louie

Haasbeek

Mokhles

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Section: A C C E P T E D Accepted Manuscriptsupporting

confidence: 84%

Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model

Louie

Haasbeek

Mokhles

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“….45 mm, there were no statistically significant relationships between the large tumour size vs increased toxicity (any patient who developed G3 toxicity or needs to stop the treatment) or between tumour size vs decreased LC. However, our data confirmed that the dominant pattern of relapse in these large tumours is not connected with local failure, as was similarly reported by other authors in both SBRT 24 and hypofractionated studies. 13 However, large tumours were associated with poorer rates of OS, TTP, RF and TTM.…”

Section: Discussionsupporting

confidence: 92%

Hypofractionated 3D radiotherapy for inoperable T1-3 N0-1 non-small-cell lung cancer

Mollà

Saez

Ramos

et al. 2016

BJR

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Objective: This study assessed the toxicity and clinical outcomes of three-dimensional (3D) hypofractionated radiotherapy (HFRT) for medically inoperable T1-3 N0-1 non-small-cell lung cancer (NSCLC). Methods: 34 patients with inoperable early-stage NSCLC were treated from August 2008 to April 2013. Prior to enrolment, patients were required to be evaluated by an experienced thoracic surgeon to determine the "operability". All received 57 Gy in 19 fractions followed by escalated doses of 3-Gy fractions, up to a total dose of 66 Gy using a 3D conformal technique. Toxicities were measured using the Common Terminology Criteria for Adverse Effects v. 4.0. Results: The median follow-up was 33 months (7-74 months). Toxicity grades $3 were not observed. Local control (LC) was 80.4% at 2 years, whereas regional control (RC) was 78%. The overall survival (OS), time to progression (TTP) and time to distant metastasis (TTM) at 2 years were 60%, 59% and 80%, respectively. For patients with T1-2 N0 and a tumour size ,45 mm (n 5 19), rates of OS, TTP and TTM at 2 years were 71%, 75% and 94%, respectively. LC and RC at 2 years were 85% and 94%, respectively. Conclusion: HFRT using 3.0-Gy fractions amounting to a total dose of 66 Gy is the recommended dose. A Phase 2 trial is warranted in order to assess the safety and efficacy of this fractionation scheme. Advances in knowledge: HFRT results in a favourable outcome in early-stage lung cancer without the usual restrictions in tumour size and/or location associated with previous treatment methods. No special equipment is required, therefore permitting its application in any centre.

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“…In addition to SUV max , larger GTV was also significantly associated with LR in our analysis. We chose to assess tumor size by GTV because it is a robust measure that has been demonstrated to better correlate with patient outcomes after SBRT than cross-sectional measurements [8]. Other studies using less prognostic size measures, such as greatest tumor diameter or T stage, have the potential to overestimate the prognostic importance of SUV max .…”

Section: Discussionmentioning

confidence: 99%

“…SUV max is a measure of tumor glucose metabolism and is correlated with prognostic features such as proliferation index and differentiation status [5-7]. While tumor size alone has long been recognized as prognostic in the setting of early-stage NSCLC [8], SUV max may be a more robust prognostic feature, as it incorporates information about metabolic activity and potentially the biology of the tumor. Indeed, SUV max has emerged as a promising prognostic marker in NSCLC, with a meta-analysis of surgically treated NSCLC patients demonstrating SUV max to be prognostic for overall survival [9, 10].…”

Section: Introductionmentioning

confidence: 99%

FDG-PET maximum standardized uptake value is prognostic for recurrence and survival after stereotactic body radiotherapy for non-small cell lung cancer

Wu¹,

Zhang²,

Foster³

et al. 2015

Lung Cancer

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Objectives Glucose metabolic activity measured by [18F]-fluoro-2-deoxy-glucose positron emission tomography (FDG-PET) has shown prognostic value in multiple malignancies, but results are often confounded by the inclusion of patients with various disease stages and undergoing various therapies. This study was designed to evaluate the prognostic value of tumor FDG uptake quantified by maximum standardized uptake value (SUVmax) in a large group of early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) using consistent treatment techniques. Materials and Methods 219 lesions in 211 patients treated with definitive SBRT for stage I NSCLC were analyzed after a median follow-up of 25.2 months. Cox regression was used to determine associations between SUVmax and overall survival (OS), disease-specific survival (DSS), and freedom from local recurrence (FFLR) or distant metastasis (FFDM). Results SUVmax >3.0 was associated with worse OS (p<0.001), FFLR (p=0.003) and FFDM (p=0.003). On multivariate analysis, OS was associated with SUVmax (HR 1.89, p=0.03), gross tumor volume (GTV) (HR 1.94, p=0.005) and Karnofsky performance status (KPS) (HR 0.51, p=0.008). DSS was associated only with SUVmax (HR 2.58, p=0.04). Both LR (HR 11.47, p=0.02) and DM (HR 3.75, p=0.006) were also associated with higher SUVmax. Conclusion In a large patient population, SUVmax >3.0 was associated with worse survival and a greater propensity for local recurrence and distant metastasis after SBRT for NSCLC.

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The Impact of Tumor Size on Outcomes After Stereotactic Body Radiation Therapy for Medically Inoperable Early-Stage Non-Small Cell Lung Cancer

Cited by 114 publications

References 18 publications

Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model

Predicting Overall Survival After Stereotactic Ablative Radiation Therapy in Early-Stage Lung Cancer: Development and External Validation of the Amsterdam Prognostic Model

Hypofractionated 3D radiotherapy for inoperable T1-3 N0-1 non-small-cell lung cancer

FDG-PET maximum standardized uptake value is prognostic for recurrence and survival after stereotactic body radiotherapy for non-small cell lung cancer

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