To study the impact of tumor doubling time and primary tumor specific growth rate (SGR) for non-oropharyngeal head and neck cancers (Non-OPC) on treatment outcomes after definitive radiation therapy (RT). Materials/Methods: A total of 39 non-OPC patients managed with radiation (RT) or chemoradiation (CRT) with measurable primary tumor on a diagnostic scan prior to CT simulation and with no interval treatment were analyzed. Diagnostic CT scan images of all patients were imported into a commercially available contouring system and fused with the radiation treatment planning scan using deformable registration. The diagnostic tumor and nodal volumes were contoured and compared to the planning scan volumes. A tumor doubling time was calculated from these two volumes. We included 30 patients in final analysis who had a quantifiable SGR, rest of them had an SGR of 0. Overall survival (OS), progression free survival (PFS), and local recurrence (LR) were evaluated according to the Kaplan Meier method and hazard ratios were estimated using Cox Regression. We stratified patients into low versus high tumor specific growth rate according to the median tumor SGR of 1.388 per day. Results: Of 39 patients, 36 patients had laryngeal and 3 had hypopharyngeal cancers. 24 were Stage III or IV (62%). Eleven patients got RT alone and 28 (72%) were treated with CRT. Median RT dose was 70Gy (range 60-79.2). The median time between acquisition of diagnostic and simulation CT scans was 22 days (range 7-170 days). Median SGR was 0.92%/day (range 0.04-7.3). Seven patients got recurrent disease locally (18%). The average doubling time for recurrent tumors was 2.1% per day (range 0-7.3). The median follow up was 2.4 years with a median overall survival of 3.8 years. OS at median follow up was 87% for the low tumor SGR versus 64% for the high tumor SGR group (P Z 0.053). There was a trend towards increased overall mortality among patients with high tumor SGR values (HR [95% CI] Z 3.40 [0.91-12.64], P Z 0.068). Similarly, PFS at median follow up was 87% for the low tumor SGR group versus 67% for the high tumor SGR group (P Z 0.053). There was a trend towards worse PFS among patients with high tumor SGR values (HR [95% CI] Z 2.63 [0.81-8.62], P Z 0.109). However, we noted no statistically significant difference in LR rates according to tumor SGR with 7% of low tumor SGR versus 23% of high tumor SGR patients experiencing LR at the median follow up (P Z 0.441) (HR [95% CI] Z 1.99 [0.33-11.95]), P Z 0.450). Conclusion: Tumor doubling time of more than 1.388% per day correlates to significant detrimental effect on tumor control in non-OPC cancers. Although limited in power by small sample size, our analysis supports a trend towards increased overall mortality and local recurrence risk among patients with high tumor specific growth rate. Means to reduce it include shortening of time interval between diagnostic and simulation scans.
Pancreatic adenocarcinoma is amongst the most lethal malignancies with dismal five-year survival rates. Surgical excision is the mainstay of therapy and unresectable disease is considered incurable. Herein, we describe a patient with unresectable, advanced stage pancreatic adenocarcinoma with a remarkable clinical course following definitive chemoradiotherapy.
volume (MTV), and total lesion glycolysis (TLG). Percent changes in these variables from before to during or after treatment were also analyzed. Both the absolute values and changes in these variables were added to a clinical model (which included age, sex, race, tumor size, histology, disease stage, smoking history, receipt of induction chemotherapy, radiation technique, and total delivered dose) to assess added prediction power. Endpoints were recurrence within the planning target volume (PTV) and times to distant metastasis, disease-free survival, and OS, assessed by Cox regression analysis. Results: Median time to recurrence within the PTV was 12 months; time to distant metastasis, 9 months; disease-free survival, 9 months; and OS, 24 months. On the pretreatment PET/CT scans, SUVmax (hazard ratio [HR] 0.938, 95% confidence interval [CI] 0.887-0.991, PZ0.023) and SUVpeak (HR 0.927, 95% CI 0.870-0.988, PZ0.019) of the primary tumor correlated with distant metastasis in univariate analysis but not after adjustment for clinical factors in multivariate analysis (SUVmax: HR 0.954, 95% CI, 0.899-1.012, PZ0.117; SUVpeak: HR 0.944, 95% CI 0.881-0.987, PZ0.106). On the mid-treatment scans, MTV and TLG of lymph nodes were associated with time to local recurrence in both univariate and multivariate analyses after adjustment for clinical factors (MTV: HR 1.027, 95% CI 1.008-1.046, PZ0.005; TLG: HR 1.008, 95% CI 1.003-1.012, P<0.001). On the post-treatment PET/CT scans, no variables for primary tumor or lymph nodes, whether absolute values or percent changes were associated with clinical outcomes. Conclusion: Our results suggest that MTV and TLG in lymph nodes during chemoradiation therapy predicted local recurrence after concurrent chemoradiation therapy for locally advanced NSCLC. This information may help clinicians to modify treatment accordingly.
18 months respectively. 6 pts (15%) had relapse close to irradiated field. Only one patient had relapse in field and close to treated field. Twenty pts (50%) had progression of distant metastases. Only grade 2 pneumonitis occurred in 2 pts. Two patients had a fistula of the esophagus and bronchus, which occurred in proximity of in field relapse. Conclusion: In our experience the use of Hypofractionated VMAT with high BED 10 values (72-100 Gy )for locally advanced NSCLC appears as effective treatment option with acceptable toxicity ,and High LC rates (89% at 1 year). It is necessary high accuracy in PTV delineation, because mostly we observed the marginal recurrences.Purpose/Objective(s): The optimal strategy and frequency for posttreatment surveillance imaging following stereotactic body radiation therapy (SBRT) for early stage non-small cell lung cancer (NSCLC) is unknown. We reviewed patients treated with SBRT with available computed tomography (CT) surveillance imaging performed at 3-month intervals over the first year following treatment, and assess imaging findings, resulting interventions, and estimate the impact of reduced intensity surveillance at 6 and 12-month intervals. Materials/Methods: Records of all patients treated with SBRT between 06/2005 and 01/2014 at our institution were reviewed. Eligible patients underwent SBRT for early stage NSCLC with curative intent and underwent surveillance CT at 3-month intervals over the first year, with 12 months follow-up. Of 117 patients, 28 underwent scans meeting eligibility criteria. Details on scan interpretation, subsequent imaging, biopsy, or cancer-directed therapy, recurrence, and survival were documented for each patient, and findings that would be missed with reduced intensity schedules were identified. Results: Baseline CT performed 3 months post-SBRT identified no new concerning findings. Scans performed at 6 months detected 2 solitary pulmonary nodules further evaluated with positron emission tomography (PET) and biopsy, and treated with SBRT (7%) as presumed second primary lung cancers. 1 patient with mediastinal adenopathy confirmed by PET to represent metastases received palliative chemotherapy. At 9 months, 2 new solitary lung nodules were identified, evaluated with PET and biopsy, and managed as new primary tumors with SBRT.
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