Comparison of Single- and Five-fraction Regimens of Stereotactic Body Radiation Therapy for Peripheral Early-stage Non–small-cell Lung Cancer: A Two-institution Propensity-matched Analysis

Cummings, Michael; Jun, Sung; Hermann, Gregory M.; Serra, Lucas M.; Syed, Yusef A.; Malhotra, H; Chen, Yuhchyau; Milano, Michael T.; Gomez-Suescun, Jorge A.; Singh, Deepinder; Singh, Anurag K.

doi:10.1016/j.cllc.2018.07.006

Cited by 17 publications

(18 citation statements)

References 22 publications

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“…This is consistent with other retrospective analyses[41]. Most recently, we expanded the two-institution analysis to include 163 patients comparing single-fraction vs five-fraction SBRT and again found no difference in survival outcomes or local control[42].…”

Section: Discussionsupporting

confidence: 86%

Stereotactic body radiation therapy for non-small cell lung cancer: A review

Prezzano

Jun

Hermann

et al. 2019

WJCO

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Stereotactic body radiation therapy (SBRT) is the treatment of choice for medically inoperable patients with early stage non-small cell lung cancer (NSCLC). A literature search primarily based on PubMed electronic databases was completed in July 2018. Inclusion and exclusion criteria were determined prior to the search, and only prospective clinical trials were included. Nineteen trials from 2005 to 2018 met the inclusion criteria, reporting the outcomes of 1434 patients with central and peripheral early stage NSCLC. Patient eligibility, prescription dose and delivery, and follow up duration varied widely. Three-years overall survival ranged from 43% to 95% with loco-regional control of up to 98% at 3 years. Up to 33% of patients failed distantly after SBRT at 3 years. SBRT was generally well tolerated with 10%-30% grade 3-4 toxicities and a few treatment-related deaths. No differences in outcomes were observed between conventionally fractionated radiation therapy and SBRT, central and peripheral lung tumors, or inoperable and operable patients. SBRT remains a reasonable treatment option for medically inoperable and select operable patients with early stage NSCLC. SBRT has shown excellent local and regional control with toxicity rates equivalent to surgery. Decreasing fractionation schedules have been consistently shown to be both safe and effective. Distant failure is common, and chemotherapy may be considered for select patients. However, the survival benefit of additional interventions, such as chemotherapy, for early stage NSCLC treated with SBRT remains unclear.

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Section: Discussionsupporting

confidence: 86%

Stereotactic body radiation therapy for non-small cell lung cancer: A review

Prezzano

Jun

Hermann

et al. 2019

WJCO

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“…Cummings et al . 22 compared 65 patients affected by early stage NSCLC who were treated with SBRT 30 Gy single dose, with 98 patients who were treated with SBRT 50 Gy in 5 fractions. The results of the propensity-matched analysis showed again no differences in 2-year LC (92% versus 82%, p = 0.38; for single dose and five-fractions, respectively, and in the 2-year OS (68% versus 74%, p = 0.18).…”

Section: Discussionmentioning

confidence: 99%

Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors

Nicosia

Reverberi

Agolli

et al. 2019

Sci Rep

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Stereotactic body radiotherapy (SBRT) is a standard treatment for inoperable early-stage NSCLC, with local control rates comparable to surgical series. Promising results have been achieved utilizing a high single-dose schedule. The aim of our study was to evaluate long-term local control and toxicity in a series of patients treated with SBRT delivered in a single dose of 30 Gy. 44 patients affected by early stage NSCLC were treated with SBRT delivered in a single dose of 30 Gy. Survival and prognostic factors were retrospectively evaluated. Median follow-up was 34 months (range 3–81). Three- and 5-year local progression-free survival (LPFS) were 87.8% and 87.8% respectively (median 30 months; range 6–81 months), 3- and 5-year OS and CSS were 64.9% and 36.9%, 80.9% and 65.5%, respectively. Two (4.6%) cases of grade 3 pneumonitis occurred. At the univariate analysis lesion diameter ≤ 25 mm was predictive of better 5-year LPFS (95.8% versus 56.3%; p = 0.003) and 5-year PFS (69.8% versus 27.8%; p = 0.002). The results of our study indicated a high local control, survival and tolerability after a long-term follow-up with the use of SBRT 30 Gy single dose. Further prospective studies could better define the role of this regimen.

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“…Single fraction to 30–34 Gy has been shown to equivalent to 3 and 4 fractions in randomized multi-institutional trials [54]. Also, single fraction has been shown to be equivalent to 5 fractions in a multi-institutional case-matched review [55]. Patients with more advanced stage III lung cancers are still treated with fractionated radiation therapy (60 Gy in 30 fractions) and in this group heart dose is associated with overall survival [56].…”

Section: Discussionmentioning

confidence: 99%

Effects of a novel peptide Ac-SDKP in radiation-induced coronary endothelial damage and resting myocardial blood flow

Sharma¹,

Sonkawade

Baird

et al. 2018

Cardio-Oncology

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Background: Cancer survivors treated with thoracic ionizing radiation are at higher risk of premature death due to myocardial ischemia. No therapy is currently available to prevent or mitigate these effects. We tested the hypothesis that an endogenous tetrapeptide N-acetyl-Ser-Asp-Lys-Pro (Ac-SDKP) counteracts radiation-induced coronary vascular fibrosis and endothelial cell loss and preserves myocardial blood flow. Methods: We examined a rat model with external-beam-radiation exposure to the cardiac silhouette. We treated a subgroup of irradiated rats with subcutaneous Ac-SDKP for 18-weeks. We performed cardiac MRI with Gadolinium contrast to examine resting myocardial blood flow content. Upon sacrifice, we examined coronary endothelialcell-density, fibrosis, apoptosis and endothelial tight-junction proteins (TJP). In vitro, we examined Ac-SDKP uptake by the endothelial cells and tested its effects on radiation-induced reactive oxygen species (ROS) generation. In vivo, we injected labeled Ac-SDKP intravenously and examined its endothelial localization after 4-h. Results: We found that radiation exposure led to reduced resting myocardial blood flow content. There was concomitant endothelial cell loss and coronary fibrosis. Smaller vessels and capillaries showed more severe changes than larger vessels. Real-time PCR and confocal microscopy showed radiation-induced loss of TJ proteins including-claudin-1 and junctional adhesion molecule-2 (JAM-2). Ac-SDKP normalized myocardial blood flow content, inhibited endothelial cell loss, reduced coronary fibrosis and restored TJ-assembly. In vitro, Ac-SDKP localized to endothelial cells and inhibited radiation-induced endothelial ROS generation. In vivo, labeled Ac-SDKP was visualized into the endothelium 4-h after the intravenous injection. Conclusions: We concluded that Ac-SDKP has protective effects against radiation-induced reduction of myocardial blood flow. Such protective effects are likely mediated by neutralization of ROS-mediated injury, preservation of endothelial integrity and inhibition of fibrosis. This demonstrates a strong therapeutic potential of Ac-SDKP to counteract radiotherapy-induced coronary disease.

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Comparison of Single- and Five-fraction Regimens of Stereotactic Body Radiation Therapy for Peripheral Early-stage Non–small-cell Lung Cancer: A Two-institution Propensity-matched Analysis

Cited by 17 publications

References 22 publications

Stereotactic body radiation therapy for non-small cell lung cancer: A review

Stereotactic body radiation therapy for non-small cell lung cancer: A review

Long term results of single high dose Stereotactic Body Radiotherapy in the treatment of primary lung tumors

Effects of a novel peptide Ac-SDKP in radiation-induced coronary endothelial damage and resting myocardial blood flow

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