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Stereotactic Body Radiation Therapy for Biopsy-Proven Primary Non-Small-Cell Lung Cancer: Experience of Patients With Inoperable Cancer at a Single Brazilian Institution.

ABSTRACT: Purpose Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for patients with non-small-cell lung cancer (NSCLC). We report the clinical outcomes and toxicity for patients with inoperable primary NSCLC treated with SBRT. Methods Between 2007 and 2015, 102 consecutive lung lesions were treated with SBRT at our center, of which 59 primary NSCLC lesions (from 54 patients with inoperable disease) were retrospectively reviewed (43 lesions were excluded because of metastases or because there was no biopsy specimen). We report infield local control (LC) per SBRT target, regional or distant failure-free survival, and overall survival (OS) per patient, using Kaplan-Meier estimates. Serious toxicity was retrospectively scored using Common Terminology Criteria for Adverse Events, version 4. Results Most of the 54 patients were men (n = 41; 76%), median age was 75 years; stage IA (n = 36; 66%) and adenocarcinoma (n = 43; 80%) were the most common stage and histologic diagnosis, respectively. Five patients had two lung lesions. A median of three fractions (range, 3 to 5 fractions) and a total median dose of 54 Gy (range, 45 to 60 Gy) per lesion were prescribed. The median follow-up was 17.8 months (range, 4 to 56.4 months). The 2-year rates of LC, regional or distant failure-free survival, and OS were 89.1% (95% CI, 72.2% to 96%), 79% (95% CI, 59.8% to 89.8%), and 80% (95% CI, 64% to 89.8%), respectively. Grade 3 to 4 toxicities were observed in two patients (3%): grade 3 pneumonitis (n = 1) and grade 4 skin toxicity (n = 1). Conclusion SBRT results in high rates of 2-year LC, regional or distant failure-free survival, and OS with low rates of severe toxicity in patients with inoperable primary NSCLC disease.

SUBMITTER: Abreu CECV

PROVIDER: S-EPMC6223518 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Stereotactic Body Radiation Therapy for Biopsy-Proven Primary Non-Small-Cell Lung Cancer: Experience of Patients With Inoperable Cancer at a Single Brazilian Institution.

Abreu Carlos E C V CECV Moraes Fabio Y FY Miranda Fabiana A FA Siqueira Gabriela S M GSM Gadia Rafael R Haddad Cecilia K CK Carvalho Heloisa A HA

Journal of global oncology 20180701

Purpose Stereotactic body radiation therapy (SBRT) has emerged as a treatment option for patients with non-small-cell lung cancer (NSCLC). We report the clinical outcomes and toxicity for patients with inoperable primary NSCLC treated with SBRT. Methods Between 2007 and 2015, 102 consecutive lung lesions were treated with SBRT at our center, of which 59 primary NSCLC lesions (from 54 patients with inoperable disease) were retrospectively reviewed (43 lesions were excluded because of metastases o ...[more]

PMID: 30085881

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Project description:To examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non-small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes.We retrospectively reviewed the cases of consecutive patients with FDG-PET-staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models.Among 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P?0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02).Disease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.

Project description:PurposeDaily magnetic resonance (MR)-guided radiation has the potential to improve stereotactic body radiation therapy (SBRT) for tumors of the liver. Magnetic resonance imaging (MRI) introduces unique variables that are untested clinically: electron return effect, MRI geometric distortion, MRI to radiation therapy isocenter uncertainty, multileaf collimator position error, and uncertainties with voxel size and tracking. All could lead to increased toxicity and/or local recurrences with SBRT. In this multi-institutional study, we hypothesized that direct visualization provided by MR guidance could allow the use of small treatment volumes to spare normal tissues while maintaining clinical outcomes despite the aforementioned uncertainties in MR-guided treatment.Methods and materialsPatients with primary liver tumors or metastatic lesions treated with MR-guided liver SBRT were reviewed at 3 institutions. Toxicity was assessed using National Cancer Institute Common Terminology Criteria for Adverse Events Version 4. Freedom from local progression (FFLP) and overall survival were analyzed with the Kaplan-Meier method and χ2 test.ResultsThe study population consisted of 26 patients: 6 hepatocellular carcinomas, 2 cholangiocarcinomas, and 18 metastatic liver lesions (44% colorectal metastasis). The median follow-up was 21.2 months. The median dose delivered was 50 Gy at 10 Gy/fraction. No grade 4 or greater gastrointestinal toxicities were observed after treatment. The 1-year and 2-year overall survival in this cohort is 69% and 60%, respectively. At the median follow-up, FFLP for this cohort was 80.4%. FFLP for patients with hepatocellular carcinomas, colorectal metastasis, and all other lesions were 100%, 75%, and 83%, respectively.ConclusionsThis study describes the first clinical outcomes of MR-guided liver SBRT. Treatment was well tolerated by patients with excellent local control. This study lays the foundation for future dose escalation and adaptive treatment for liver-based primary malignancies and/or metastatic disease.

Project description:Background and Objective: It is unclear if stereotactic body radiation therapy (SBRT) or transarterial chemoembolization (TACE) is better for the treatment of inoperable early-stage hepatocellular carcinoma (HCC). This study aimed to retrospectively compare the efficacy of SBRT to TACE in patients with inoperable Barcelona Clinic Liver Cancer (BCLC)-A stage HCC. Materials and Methods: In this multi-institutional retrospective study, a total of 326 patients with inoperable BCLC-A stage HCC were enrolled. Totally, 167 patients initially received SBRT and 159 initially received TACE. Overall survival (OS), local control (LC), intrahepatic control (IC), and progression-free survival (PFS) were evaluated in univariable and propensity-score matched analyses. Results: There was a smaller median tumor size in the SBRT group than in the TACE group (3.4 cm vs. 7.2 cm, P < 0.001). After propensity score matching in the selection of 95 patient pairs, SBRT had better LC, IC, and PFS than TACE but showed comparable OS. The accumulative 1-, 3-, and 5-year OS rates were 85.7, 65.1, and 62.8% in the SBRT group and 83.6, 61.0, and 50.4% in the TACE group, respectively (P = 0.29). The accumulative 1-, 3-, and 5-year PFS were 63.4, 35.9, and 27.5% in the SBRT group and 53.5, 27.4, and 14.2% in the TACE group, respectively (P = 0.049). The accumulative 1-, 3-, and 5-year LC were 86.8, 62.5, and 56.9% in the SBRT group and 69.3, 53.3, and 36.6% in the TACE group, respectively (P = 0.0047). The accumulative 1-, 3-, and 5-year IC were 77.3, 45.9, and 42.4% in the SBRT group and 57.3, 34.1, and 17.7% in the TACE group, respectively (P = 0.003). On multivariate analysis, treatment (SBRT vs. TACE) was a significant covariate associated with local and intrahepatic control (HR = 1.59; 95% CI: 1.03-2.47; P = 0.04; HR = 1.61; 95% CI: 1.13-2.29; P = 0.009). Conclusions: SBRT was an alternative to TACE for inoperable BCLC-A stage HCC with better local and intrahepatic control. Controlled clinical trials are recommended to evaluate the actual effects of this novel regimen adequately.

Dataset Information

Stereotactic Body Radiation Therapy for Biopsy-Proven Primary Non-Small-Cell Lung Cancer: Experience of Patients With Inoperable Cancer at a Single Brazilian Institution.

Publications

Stereotactic Body Radiation Therapy for Biopsy-Proven Primary Non-Small-Cell Lung Cancer: Experience of Patients With Inoperable Cancer at a Single Brazilian Institution.

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