Impact of Brachytherapy on Local Recurrence Rates After Sublobar Resection: Results From ACOSOG Z4032 (Alliance), a Phase III Randomized Trial for High-Risk Operable Non–Small-Cell Lung Cancer

Fernando, Hiran C.; Landreneau, Rodney J.; Mandrekar, Sumithra J.; Nichols, Francis C.; Hillman, Shauna L.; Heron, Dwight E.; Meyers, Bryan F.; DiPetrillo, Thomas A.; Jones, David R.; Starnes, Sandra L.; Tan, Angelina D.; Daly, Benedict D.T.; Putnam, Joe B.

doi:10.1200/jco.2013.53.4115

Cited by 94 publications

(57 citation statements)

References 17 publications

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“…An initial presentation of the data at ASCO 2013 suggested that local recurrence and overall survival (OS) rates at 3-years were similar between arms. Fernando and colleagues 50 published the updated results with a median follow-up time of 4.38 years. Only 17 of 222 patients experienced local progression and there was no significant difference in the time to local recurrence or in the type of local recurrence with the addition of brachytherapy.…”

Section: Introductionmentioning

confidence: 99%

Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients

Jones

Kehrer

Kahn

et al. 2015

Clinical Lung Cancer

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Lung cancer is among the most common cancers worldwide, and the leading cause of cancer death in both men and women. For patients with early stage (AJCC T1-2, N0) non-small cell lung cancer the current standard of care is lobectomy with systematic lymph node evaluation. Unfortunately, medical comorbities often present in patients with lung cancer, may preclude the option of surgical resection . In such cases, a number of minimal to non-invasive treatment options have gained popularity in the treatment of these high-risk patients. These modalities provide significant advantages including patient convenience, treatment in an outpatient setting, and acceptable toxicities including reduced impact on lung function and a modest risk of post-procedure chest wall pain. This manuscript seeks to provide a comprehensive review of the literature including reported outcomes, complications and limitations of sublobar resection with or without intraoperative brachytherapy, radiofrequency ablation, microwave ablation, percutaneous cryoablation, photodynamic therapy and stereotactic body radiation therapy.

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Section: Introductionmentioning

confidence: 99%

Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients

Jones

Kehrer

Kahn

et al. 2015

Clinical Lung Cancer

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“…The ACOSOG-Z4032 trial investigated the role of sublobar resection with brachytherapy versus sublobar resection alone [22]. Brachytherapy did not reduce the incidence of local recurrence after sublobar resection, underlying the importance of adequate surgical margins of sublobar resections.…”

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confidence: 99%

Optimising treatment for post-operative lung cancer recurrence

2016

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@ERSpublicationsThe second lung resection is a valuable option for post-operative lung cancer recurrence http://ow.ly/U8z3cSurgical treatment offers the best chances for long-term survival in patients with primary nonsmall cell lung cancer (NSCLC). However, long-term survival after surgery remains less than 50%, mostly due to a 30-77% rate of tumour recurrence. Unlike the distant type of recurrence that is treated nonsurgically in the vast majority of patients, local or loco-regional recurrence, which occurs in 4.6-24% of patients after complete resection (∼80% of cases in the first 2 years) [1], raises several concerns related to the optimal therapeutic approach.Unfortunately, literature data are not always helpful in practice. For example, 5-year loco-regional recurrence rates are between 15 and 38.5% [2], and the incidence of local recurrence in early-stage lung cancer of 10-15% [3], or a mean disease-free interval of 14.1-19.8 months, that is similar to distant recurrent disease [4]. Failure to demonstrate the advantage of complete lymphadenectomy over nodal sampling in terms of local recurrence or survival in patients operated for T1-2, N0 or T1-2, N1 disease, makes the clinical approach more complex [5]. Moreover, the impact of intensified follow-up on overall survival or local recurrence detection could not be clearly demonstrated. In ∼50-67% of patients, recurrence will appear before a scheduled control because of the onset of symptoms [6].Finally, switching to seventh edition of the TNM (tumour, node, metastasis) staging system automatically led to the stage migration, reaching 21% in some studies. The only study of the role of computed tomography (CT) in post-operative recurrence detection demonstrated a high negative predictive value of 95%, but a positive predictive value of only 53% (94% sensitivity and 87% specificity) [7]. For positron emission tomography, although it is more sensitive than CT in detecting recurrent tumours (97-100%), variations of the cut-off values for the standardised uptake value (⩾4.5-⩾10) make its clinical application difficult, together with its specificity (62-100%) that is lower than for CT.The role of prognostic factors after surgery is more evidence-based, owing to awareness of the poor 5-year survival of patients in stages IA and IB (73% and 58%, respectively). This also applies to the high recurrence rate in patients with stage I after complete resection (25-50%) [8]. The results of these studies really helped to identify patients who would probably benefit from adjuvant therapy.Among tumour markers, although increased serum concentrations of carcinoembryonic antigen (CEA) are rare (17%), persistently high post-operative CEA levels were found to be a strong indicator of poor prognosis. In 55-70% of patients with CEA values of 5-10 ng·mL , an early recurrence will develop [9].Of the many analysed clinical and pathological prognostic factors, vascular invasion, lymphatic vessel and visceral pleural invasion have been identified as clearly unfavourable in terms of surviv...

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“…The primary endpoint of the study was local recurrence, and results were published in 2014 9 . There was no statistically significant difference in the time to local recurrence, the overall local recurrence rates, patterns of recurrence (local, regional or distant), or overall survival between sublobar resection with or without brachytherapy.…”

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confidence: 99%

A Nomogram to Predict Recurrence and Survival of High-Risk Patients Undergoing Sublobar Resection for Lung Cancer: An Analysis of a Multicenter Prospective Study (ACOSOG Z4032)

Kent

Mandrekar

Landreneau

et al. 2016

The Annals of Thoracic Surgery

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Background Individualized prediction of outcomes may help with therapy decisions for patients with non-small cell lung cancer (NSCLC). We developed a nomogram by analyzing 17 clinical factors and outcomes from a randomized study of sublobar resection for NSCLC in high-risk operable patients. The study compared sublobar resection alone, to sublobar resection with brachytherapy. There were no differences in primary and secondary outcomes between the study arms, and were thus combined for this analysis. Methods The clinical factors of interest (considered as continuous variables) were assessed in a univariate Cox Proportional Hazards model for significance at the 0.10 level for their impact on overall survival (OS), local recurrence free survival (LRFS) and any recurrence free survival (RFS). The final multivariable model was developed using a stepwise model selection. Results 173 of 212 patients had complete data on all 17 risk factors. Median (range) follow-up was 4.94 (0.04–6.22) years. The 5-year OS, LRFS and RFS were 58.4%, 53.2% and 47.4% respectively. Age, baseline DLCO % and maximum tumor diameter were significant predictors for OS, LRFS and RFS in the multivariable model. Nomograms were subsequently developed for predicting 5-year OS, LFRS and RFS. Conclusions Age, baseline DLCO% and maximum tumor diameter significantly predicted outcomes after sublobar resection. Such nomograms may be helpful for treatment planning in early stage NSCLC and to guide future studies.

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Impact of Brachytherapy on Local Recurrence Rates After Sublobar Resection: Results From ACOSOG Z4032 (Alliance), a Phase III Randomized Trial for High-Risk Operable Non–Small-Cell Lung Cancer

Cited by 94 publications

References 17 publications

Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients

Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients

Optimising treatment for post-operative lung cancer recurrence

A Nomogram to Predict Recurrence and Survival of High-Risk Patients Undergoing Sublobar Resection for Lung Cancer: An Analysis of a Multicenter Prospective Study (ACOSOG Z4032)

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