Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience

Figlia, Vanessa; Mazzola, Rosario; Cuccia, Francesco; Alongi, Filippo; Mortellaro, Gianluca; Cespuglio, D.; Cucchiara, Teresa; Iacoviello, Giuseppina; Valenti, Vito; Molino, Massimo; Verderame, Francesco; Matranga, Domenica; Casto, Antonio Lo; Ferrera, Giuseppe

doi:10.1007/s11547-018-0858-7

Cited by 17 publications

(10 citation statements)

References 44 publications

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“…In this study, pimonidazole hydrochloride staining (Figure 2) revealed that HFRT attenuated the tumor hypoxia much more than CRT, yielding a stronger killing effect on tumor cells. This result was consistent with the results of most related studies, 14,23,28,29 while Kelada et al showed a conflicting result: SBRT might induce an elevated and persistent state of tumor hypoxia in some NSCLC cases, which might be contributing to treatment failure in SBRT. 36 Therefore, further researches on the molecular mechanism are needed to enhance the credibility of the results in the present study.…”

Section: Discussionsupporting

confidence: 91%

“…Some studies suggested that this inconsistency might be due to a secondary tumor-killing effect as a result of vascular injury caused by HFRT-induced endothelial cell apoptosis and the specific normalizing effect of HFRT on structural and functional disturbances of the tumor vasculature. 6 The potential favorable impact of HFRT on tumor control, partly contributed to by the advantage in re-oxygenation effect of HFRT, has been demonstrated by Figlia et al and Onishi et al 28 , 29 …”

Section: Discussionmentioning

confidence: 94%

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RETRACTED: Hypo-fractionation radiotherapy normalizes tumor vasculature in non-small cell lung cancer xenografts through the p-STAT3/HIF-1 alpha signaling pathway

et al. 2020

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Background: Hypo-fractionation radiotherapy (HFRT) was considered to be an important treatment for non-small cell lung cancer (NSCLC), but the radiobiological effects of HFRT on NSCLC remain unclear. The aim of this study was to investigate specific biological effect of HFRT on tumor angiogenesis, compared with conventional radiotherapy (CRT). Methods: The subcutaneous xenograft models and the dorsal skinfold window chamber (DSWC) models of nude mice bearing H460 and HCC827 NSCLC cells were irradiated with doses of 0 Gy (sham group), 22 Gy delivered into 11 fractions (CRT group) or 12 Gy delivered into 1 fraction (HFRT group). At certain time-points after irradiation, the volumes, hypoxic area, coverage rate of pericyte and micro-vessel density (MVD) of the subcutaneous xenograft models were detected, and the tumor vasculature was visualized in the DSMC model. The expressions of phosphorylated signal transducer and activator of transcription (p-STAT3), hypoxia-inducible factor 1-α (HIF-1α), CXCL12 and VEGFA were detected. Results: Compared with the CRT groups, HFRT showed more-efficient tumor growth-suppression, accompanied by a HFRT-induced window-period, during which vasculature was normalized, tumor hypoxia was improved and MVD was decreased. Moreover, during the window-period, the signal levels of p-STAT3/HIF-1α pathway and the expressions of its downstream angiogenic factors (VEGFA and CXCL12) were inhibited by HFRT. Conclusion: Compared with CRT, HFRT induced tumor vasculature normalization by rendering the remaining vessels less tortuous and increasing pericyte coverage of tumor blood vessels, thereby ameliorating tumor hypoxia and enhancing the tumor-killing effect. Moreover, HFRT might exert the aforementioned effects through p-STAT3/HIF-1α signaling pathway.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 94%

RETRACTED: Hypo-fractionation radiotherapy normalizes tumor vasculature in non-small cell lung cancer xenografts through the p-STAT3/HIF-1 alpha signaling pathway

et al. 2020

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“…Two reports with three and four ultra-central patients, respectively, were also excluded due to small sample sizes, with one reporting no toxicity (0 of 3 patients) and the other not directly reporting the toxicity rate for patients considered ultra-central. 32,33 We believe that our results will shed light on the feasibility of SABR for ultra-central lung lesions, as well as provide guidance on patient selection so that those patients at higher risk are adequately counselled on the competing risks and benefits of SABR. 34 Ultimately, further prospective research in this setting is needed to define the optimal dose and fractionation of radiation for ultra-central tumors, and the results of one such study (SUNSET: SABR for Ultra-central NSCLC: A Safety and Efficacy Trial, NCT03306680) are awaited.…”

Section: Discussionmentioning

confidence: 83%

Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review

Chen

Laba

Zayed

et al. 2019

Journal of Thoracic Oncology

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Introduction: The safety and effectiveness of stereotactic ablative radiotherapy (SABR) in patients with ultra-central lung tumors is currently unclear. We performed a systematic review to summarize existing data and identify trends in treatment-related toxicity and local control following SABR in patients with ultra-central lung lesions. Methods: We performed a systematic review based on the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines using the PubMed and Embase databases. The databases were queried from dates of inception until September 27, 2018. Studies in the English language that reported treatment-related toxicity and local control outcomes post-SABR for patients with ultra-central lung lesions were included. Guidelines, reviews, non-peer reviewed correspondences, studies focused on re-irradiation, and studies with fewer than five patients were excluded. Results: A total of 446 studies were identified, with 10 meeting all criteria for inclusion. The total sample size from the identified studies was 250 ultra-central lung patients and all studies were retrospective in design. Radiotherapy dose and fractionation ranged from 30 to 60 Gy in 3 to 12 fractions, with biologically effective doses (BED 10) ranging from 48 to 138 Gy 10 (median, 78-103 Gy 10). Median treatment-related grade 3 or greater toxicity was 10% (range, 0-50%). Median treatmentrelated mortality was 5% (range, 0-22%), most commonly from pulmonary hemorrhage (55%). High-risk indicators for SABR-related mortality included gross endobronchial disease, maximum dose to the proximal bronchial tree greater than or equal to 180 Gy 3 (BED 3 , corresponding to 45 Gy in 5 fractions or 55 Gy in 8 fractions), peri-SABR bevacizumab use, and antiplatelet/ anticoagulant use. Median 1-year local control rate was 96% (range, 63%-100%) and 2-year local control rate was 92% (range, 57%-100%). Conclusions: SABR for ultra-central lung lesions appears feasible but there is a potential for severe toxicity in patients receiving high doses to the proximal bronchial tree, those with endobronchial disease, and those receiving bevacizumab or anticoagulants around the time of SABR. Prospective studies are required to establish the optimal doses, volumes, and normal tissue tolerances for SABR in this patient population.

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“…For inoperable early-stage patients, the finding of cOLNM is especially important, as the standard treatment pattern of inoperable early-stage patients is SBRT, 23 but lymph nodes are not be delineated in the target volume of SBRT. 24 , 25 Thus, this Radiomics model could increase the accuracy of the current lymph node staging system, and identify patients a high risk of cOLNM who should therefore be offered additional treatment, such as radiation of the cOLNM region, chemotherapy and even immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

A Radiomics Nomogram for Preoperative Prediction of Clinical Occult Lymph Node Metastasis in cT1-2N0M0 Solid Lung Adenocarcinoma

Zhang

Ran-ran

Luan

et al. 2021

CMAR

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Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience

Abstract: The use of 8-10 fractions schedule HT-SBRT for lung malignancies results in high LC and OS rates with minimal toxicities reported.

Cited by 17 publications

References 44 publications

RETRACTED: Hypo-fractionation radiotherapy normalizes tumor vasculature in non-small cell lung cancer xenografts through the p-STAT3/HIF-1 alpha signaling pathway

RETRACTED: Hypo-fractionation radiotherapy normalizes tumor vasculature in non-small cell lung cancer xenografts through the p-STAT3/HIF-1 alpha signaling pathway

Safety and Effectiveness of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Lesions: A Systematic Review

A Radiomics Nomogram for Preoperative Prediction of Clinical Occult Lymph Node Metastasis in cT1-2N0M0 Solid Lung Adenocarcinoma

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