Follow-Up of Patients after Stereotactic Radiation for Lung Cancer: A Primer for the Nonradiation Oncologist

Huang, Kelei; Palma, David A.

doi:10.1097/jto.0000000000000435

Cited by 53 publications

(52 citation statements)

References 70 publications

(78 reference statements)

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“…The optimal time recommendation of PET/CT examination after SBRT has not yet been established, also if it is advisable to perform a PET scan not before than 6 months due to the possible interference of the inflammatory changes in the lungs which follow high-dose irradiation. However, in presence of high suspicion of recurrence at CT, SUVmax ≥5.0 after SBRT or greater than the original pretreatment SUVmax appear suggestive of recurrent disease and a biopsy is recommended if salvage surgery is possible (10,18). On the contrary, in a study similar to ours, Hayashi and coworkers evaluated CT patterns of 81 patients with early stage NSCLC who underwent SBRT (main delivered dose was 48 Gy in 4 fractions, 8-11 conformal static field).…”

Section: S3mentioning

confidence: 90%

“…More frequent CT imaging was obtained in cases of suspected recurrence. 18 F-FDG-PET/CT scanning was not routinely used in staging and follow-up. Only when disease recurrence was suspected, a 18 F-FDG-PET/CT was performed.…”

Section: Methodsmentioning

confidence: 99%

“…Also, 18 F-FDG-PET/CT has limitations, FDG avidity can appear transiently following SBRT and can persist at a low value for over 12 months due to inflammatory reaction lung parenchyma and in tumor (17). The optimal time recommendation of PET/CT examination after SBRT has not yet been established, also if it is advisable to perform a PET scan not before than 6 months due to the possible interference of the inflammatory changes in the lungs which follow high-dose irradiation.…”

Section: S3mentioning

confidence: 99%

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Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Frakulli¹,

Salvi²,

Balestrini³

et al. 2017

Transl. Lung Cancer Res.

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Background: Parenchymal changes after stereotactic body radiation therapy (SBRT) make differential diagnosis between treatment outcomes and disease recurrence often difficult. The purpose of our study was to identify the radiographic features detectable at computed tomography (CT) scan [high-risk features (HRFs)] that allow enough specificity and sensitivity for early detection of recurrence. Methods:We retrospectively evaluated patients who underwent SBRT for inoperable early stage nonsmall cell lung cancer (NSCLC). The median delivered dose performed was 50 Gy in 5 fractions prescribed to 80% isodose. All patients underwent chest CT scan before SBRT and at 3, 6, 12, 18, 24 months after, and then annually. Each CT scan was evaluated and benign and HRFs were recorded.18 F-fluorodeoxyglucose-CT was not used routinely.Results: Forty-five patients were included (34 males, 11 females; median age: 77 years; stage IA: 77.8%, stage IB: 22.2%; median follow-up: 21.7 months). Two year and actuarial local control was 77%. HRFs were identified in 20 patients. The most significant predictor of relapse was an enlarging opacity at 12 months (P<0.001) with 84.6% sensitivity and 71.8% specificity. The presence of ≥2 HRFs demonstrated a high sensibility (92.3%) and specificity (71.9%) (P<0.0001).Conclusions: Detection of HRFs is predictive of relapse with a sensibility that increases with the number of HRFs observed. This observation may allow to better define the diagnostic follow algorithm up suggesting to performing further exams only in patients with >2 HRFs.

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Section: S3mentioning

confidence: 90%

Section: Methodsmentioning

confidence: 99%

Section: S3mentioning

confidence: 99%

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Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Frakulli¹,

Salvi²,

Balestrini³

et al. 2017

Transl. Lung Cancer Res.

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“…7) The radiological image reveals bronchiectasis similar to but less extensive than conventional radiation fibrosis, scar-like fibrosis (linear opacity in the region of the original tumor) and mass-like fibrosis. 5,6) Therefore, in this case, advanced adhesions formed without tumor invasion. This should be taken into consideration when performing salvage surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The radiological image reveals grand grass attenuation (GGA). 5,6) In the later phase (after two years), these changes become localized to the area of the radiation port, with fibrosis affecting all compartments of the lung, most notably the lung parenchyma and vasculature. 7) The radiological image reveals bronchiectasis similar to but less extensive than conventional radiation fibrosis, scar-like fibrosis (linear opacity in the region of the original tumor) and mass-like fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Combined Aortic Resection and Stent Graft Insertion for Local Recurrence of Metastatic Lung Carcinoma Following Stereotactic Radiotherapy: A Case Report

Dejima

Matsutani

Imazuru

et al. 2016

ATCS

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First UK patient cohort treated with stereotactic ablative radiotherapy for primary kidney cancer

et al. 2023

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Aims: Stereotactic ablative radiotherapy (SABR) for primary renal cell carcinoma (RCC) is a promising non-invasive ablative treatment option. A prospective interventional clinical trial published showed that treatment was feasible and well tolerated. We present the first single-institution UK cohort of patients with primary RCC receiving protocol-based SABR with prospective follow-up. We also present a protocol that could be used to facilitate more widespread use of the treatment.Materials and methods: Nineteen biopsy-proven primary RCC patients were treated with either 42 Gy in three fractions on alternate days or 26 Gy in a single fraction based on predefined eligibility criteria using either Linear Accelerator or CyberKnife platform. Prospective toxicity data using CTCAE V4.0 and outcome data such as estimated glomerular filtration rate (eGFR) and tumour response using CT thorax, abdomen and pelvis (CT-TAP) were collected at 6 weeks, 3, 6, 12, 18 and 24 months post treatment. Results:The 19 patients had a median age of 76 years (interquartile range [IQR] 64-82 years) and 47.4% were males, and they had a median tumour size of 4.5 cm (IQR 3.8-5.2 cm). Single and fractionated treatment was well tolerated and there were no significant acute side effects. The mean drop from baseline in eGFR at 6 months was 5.4 ml/min and that at 12 months was 8.7 ml/min. The overall local control rate at both 6 and 12 months was 94.4%. Overall survival at 6 and 12 months was 94.7% and 78.3%, respectively. After a median follow-up of 17 months, three patients experienced a Grade 3 toxicity, which was resolved with conservative management. Conclusion:SABR for primary RCC is a safe and feasible treatment for medically unfit patients, which can be delivered in most UK cancer centres using standard Linear Accelerator as well as CyberKnife platforms.

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Follow-Up of Patients after Stereotactic Radiation for Lung Cancer: A Primer for the Nonradiation Oncologist

Abstract: The appropriate follow-up of patients after SABR requires collaborative input from nearly all members of the thoracic multidisciplinary team, and evidence is available to guide treatment decisions. Further research is required to develop better predictors of toxicity and recurrence.

Cited by 53 publications

References 70 publications

Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Radiological differential diagnosis between fibrosis and recurrence after stereotactic body radiation therapy (SBRT) in early stage non-small cell lung cancer (NSCLC)

Combined Aortic Resection and Stent Graft Insertion for Local Recurrence of Metastatic Lung Carcinoma Following Stereotactic Radiotherapy: A Case Report

First UK patient cohort treated with stereotactic ablative radiotherapy for primary kidney cancer

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