Long-term Overall Survival Outcomes in Patients with Early Stage, Peripherally Located, Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiotherapy in a Non-academic Cancer Centre

Wood, Angela; Aynsley, E.; Kumar, Gourav; Masinghe, S.; Anderson, Mark D.; Veeratterapillay, J.; Huntley, Christopher D.; Blower, A.; Green, J; Johnson, Douglas; Daniel, J.; Curtis, Helen J; Reynolds, John; Turnbull, Marion T.; Harland, Karisa; Swingler, A.; Banham, E; Burke, Kristin E.; Bradley, Jeffrey D.; Greenhalgh, Andrew D.; Peedell, C.

doi:10.1016/j.clon.2020.12.001

Cited by 4 publications

(2 citation statements)

References 30 publications

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“…The treatment was usually well tolerated with 1% rate of 3-4 toxicity. 17 A randomized pilot study compared acute toxicity of peripheral tumors treated with SBRT delivered in 4 or 11 days. The prescribed treatment was 12-13 Gy in four fractions.…”

Section: Methodsmentioning

confidence: 99%

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An optimal dose‐fractionation for stereotactic body radiotherapy in peripherally, centrally and ultracentrally located early‐stage non‐small lung cancer

Zarębska,

Harat

2023

Thoracic Cancer

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Stereotactic body radiotherapy (SBRT), also known as stereotactic ablative radiotherapy (SABR), is commonly used in inoperable patients with early‐stage non‐small lung cancer (NSCLC). This treatment has good outcomes and low toxicity in peripherally located tumors. However, in lesions which are located close to structures such as the bronchial tree or mediastinum the risk of severe toxicity increases. This review summarizes the evidence of dose‐fractionation in SBRT of NSCLC patients in various locations.

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Section: Methodsmentioning

confidence: 99%

“…However, the schedule of 10 × 5 Gy as well as poor performance status were connected with significantly poorer survival. The treatment was usually well tolerated with 1% rate of 3–4 toxicity 17 …”

Section: Methodsmentioning

confidence: 99%

An optimal dose‐fractionation for stereotactic body radiotherapy in peripherally, centrally and ultracentrally located early‐stage non‐small lung cancer

Zarębska,

Harat

2023

Thoracic Cancer

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Fractionation dose optimization facilities the implementation of transmission proton FLASH-RT

Zeng,

Zhang,

Pang

et al. 2024

Phys. Med. Biol.

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Objective. The beam switching time and fractional dose influence the FLASH effect. A single-beam-per-fraction (SBPF) scheme using uniform fractional dose (UFD) has been proposed for FLASH- radiotherapy (FLASH-RT) to eliminate the beam switching time. Based on SBPF schemes, a fractionation dose optimization algorithm is proposed to optimize non-UFD plans to maximize the fractionation effect and dose-dependent FLASH effect. Approach. The UFD plan, containing five 236 MeV transmission proton beams, was optimized for 11 patients with peripheral lung cancer, with each beam delivering a uniform dose of 11 Gy to the target. Meanwhile, the non-UFD plan was optimized using fractionation dose optimization. To compare the two plans, the equivalent dose to 2 Gy (EQD2) for the target and normal tissues was calculated with an α/β ratio of 10 and 3, respectively. Both UFD and non-UFD plans ensured that the target received an EQD2 of 96.3 Gy. To investigate the overall improvement in normal tissue sparing with the non-UFD plan, the FLASH-enhanced EQD2 was calculated. Main results. The fractional doses in non-UFD plans ranged between 5.0 Gy and 24.2 Gy. No significant differences were found in EQD22% and EQD298% of targets between UFD and non-UFD plans. However, the D 95% of the target in non-UFD plans was significantly reduced by 15.1%. The sparing effect in non-UFD plans was significantly improved. The FLASH-enhanced EQD2mean in normal tissue and ipsilateral lung was significantly reduced by 3.5% and 10.4%, respectively, in non-UFD plans. The overall improvement is attributed to both the FLASH and fractionation effects. Significance. The fractionation dose optimization can address the limitation of multiple-beam FLASH-RT and utilize the relationship between fractional dose and FLASH effect. Consequently, the non-UFD scheme results in further improvements in normal tissue sparing compared to the UFD scheme, attributed to enhanced fractionation and FLASH effects.

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Patient, tumour, and dosimetric factors influencing survival in non-small cell lung cancer patients treated with stereotactic ablative body radiotherapy

Padden-Modi,

Spivak,

Gleeson

et al. 2023

BJR|Open

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Objectives We aimed to analyse clinical outcomes of peripheral, early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic ablative body radiotherapy (SABR), and evaluate potential patient, tumour and dosimetric variables influencing survival. Methods Data was collected retrospectively from patients treated between September 2012 and December 2016 and followed up until January 2021. Patient demographics, tumour characteristics, SABR dosimetric parameters and survival data were collected from electronic patient medical records. Descriptive statistics were performed, and SPSS software was used for survival analysis. Results 89 patients were included of whom 49.5% were male and 50.5% female. Median age was 74 years. 98.8% of patients had T1-2 tumours and 89.9% underwent 55 Gy in 5 fractions. Median overall survival time was 58.7 months. On uni- and multi-variate analysis, neither patient nor tumour variables showed association with overall survival. However, PTV volume and minimum dose to PTV correlated with overall survival. There was a signal for association between mean lung dose and overall survival on multivariate analysis. Conclusions Our long-term results show SABR is an effective treatment for peripheral, early-stage NSCLC with excellent overall survival, comparable to other series. Our study found only the PTV volume and minimum dose to PTV had an impact on overall survival, which demonstrates the importance of generating optimal SABR plans. Advances in knowledge Our work identified lung SABR dosimetric parameters that correlate with survival, which illustrates the importance of producing optimal lung SABR plans.

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Long-term Overall Survival Outcomes in Patients with Early Stage, Peripherally Located, Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiotherapy in a Non-academic Cancer Centre

Cited by 4 publications

References 30 publications

An optimal dose‐fractionation for stereotactic body radiotherapy in peripherally, centrally and ultracentrally located early‐stage non‐small lung cancer

An optimal dose‐fractionation for stereotactic body radiotherapy in peripherally, centrally and ultracentrally located early‐stage non‐small lung cancer

Fractionation dose optimization facilities the implementation of transmission proton FLASH-RT

Patient, tumour, and dosimetric factors influencing survival in non-small cell lung cancer patients treated with stereotactic ablative body radiotherapy

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