Optimization of mediastinal staging in potential candidates for stereotactic radiosurgery of the chest

Sarwate, Devadatta; Sarkar, Saiyad; Krimsky, William; Burgan, Constantine M.; Patel, Kalpesh; Evans, Ruth; Harley, Daniel P.

doi:10.1016/j.jtcvs.2012.03.004

Cited by 23 publications

(11 citation statements)

References 16 publications

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“…This study included patients undergoing EBUS-directed fiducial marker placement and mediastinal lymph node sampling prior to Cyberknife. 30 In this study, 4 (8%) of 50 patients had negative CT and PET imaging but were found to have positive mediastinal and/or hilar lymph nodes with EBUS-directed biopsies. All patients tolerated the procedure well with no reported cases of anesthesia-related complications, hospital readmissions, or pneumothoraces.…”

Section: Discussionmentioning

confidence: 54%

Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy

Akthar

Ferguson

Koshy

et al. 2016

Technol Cancer Res Treat

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Section: Discussionmentioning

confidence: 54%

Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy

Akthar

Ferguson

Koshy

et al. 2016

Technol Cancer Res Treat

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“…Lung ADC patients with mediastinal lymph node biopsy establishing early stage disease have been shown to be associated with lower local recurrence rates and improved overall survival (13). High dose radiation therapy using stereotactic ablative body radiation (SBAR) or stereotactic body radiation therapy (SBRT) in patients that are unfit for surgical treatment has been shown to be a successful approach (14).…”

Section: Introductionmentioning

confidence: 99%

MicroRNA-31 Predicts the Presence of Lymph Node Metastases and Survival in Patients with Lung Adenocarcinoma

Wang

Cui

et al. 2013

Clinical Cancer Research

102

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Purpose We performed genome-wide microRNA-sequencing (miRNA-seq) in primary cancer tissue from lung adenocarcinoma patients to identify markers for the presence of lymph node metastasis. Experimental Design Markers for lymph node metastasis identified by sequencing were validated in a separate cohort using QPCR. After additional validation in the TCGA dataset, functional characterization studies were performed in vitro. Results MiR-31 was upregulated in lung adenocarcinoma tissues from patients with lymph node metastases compared to those without lymph node metastases. We confirmed miR-31 to be up-regulated in lymph node positive patients in a separate patient cohort (p=0.009, t-test), and to be expressed higher in adenocarcinoma tissue than in matched normal adjacent lung tissues (p<0.0001, paired t-test). MiR-31 was then validated as a marker for lymph node metastasis in an external validation cohort of 233 lung adenocarcinoma cases of the TCGA (p=0.031, t-test). In vitro functional assays showed that miR-31 increases cell migration, invasion, and proliferation in an ERK1/2 signaling dependent manner. Of note, miR-31 was a significant predictor of survival in a multivariate cox regression model even when controlling for cancer staging. Exploratory in silico analysis showed that low expression of miR-31 is associated with excellent survival for T2N0 patients. Conclusions We applied microRNA-seq to study microRNomes in lung adenocarcinoma tissue samples for the first time and identified potentially a microRNA predicting the presence of lymph node metastasis and survival outcomes in lung adenocarcinoma patients.

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“…It is unknown whether histologic evaluation of lymph nodes before SBRT may decrease the risk of subsequent regional failure. In one study of patients referred for SBRT after lymph node–negative PET-CT results, 16% of patients undergoing EBUS had lymph node involvement 19 . If not evaluated with EBUS, these involved nodes would have posed a risk of subsequent regional failure after treatment with SBRT alone.…”

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confidence: 99%

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

Hobbs

Paryani

et al. 2018

Mayo Clinic Proceedings: Innovations, Quality & Outcomes

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ObjectiveTo examine disease control and survival after stereotactic body radiotherapy (SBRT) for medically inoperable, early-stage non–small cell lung cancer (NSCLC) and determine associations of pretreatment 18F-fluorodeoxyglucose–positron emission tomography (FDG-PET) maximum standardized uptake values (SUVmax), biologically effective dose, and mediastinal staging with disease control and survival outcomes.Patients and MethodsWe retrospectively reviewed the cases of consecutive patients with FDG-PET–staged, medically inoperable NSCLC treated with SBRT at our institution between January 1, 2008, and August 4, 2014. Cumulative incidences of recurrence were estimated, accounting for the competing risk of death. Associations of SUVmax, biologically effective dose, and mediastinal staging with outcomes were evaluated using Cox proportional hazards regression models.ResultsAmong 282 patients, 2-year cumulative incidences of recurrence were 4.9% (95% CI, 2.6%-8.3%) for local, 9.8% (95% CI, 6.3%-14.2%) for nodal, 10.8% (95% CI, 7.0%-15.5%) for ipsilateral lung, 6.0% (3.3%-9.8%) for contralateral lung, 9.7% (95% CI, 6.3%-14.0%) for distant recurrence, and 26.1% (95% CI, 20.4%-32.0%) for any recurrence. The 2-year overall survival was 70.4% (95% CI, 64.5%-76.8%), and the 2-year disease-free survival was 51.2% (95% CI, 44.9%-58.5%). Risk of any recurrence was significantly higher for patients with higher SUVmax (hazard ratio [per each doubling], 1.29 [95% CI, 1.05-1.59]; P=.02). A similar association with SUVmax was observed when considering the composite outcome of any recurrence or death (hazard ratio, 1.23 [95% CI, 1.05-1.44]; P=.01). The SUVmax was not significantly associated with other outcomes (P≥0.69). Two-year cumulative incidences of local recurrence for patients receiving 48 Gy in 4 fractions, 54 Gy in 3 fractions, or 50 Gy in 5 fractions were 1.7% (95% CI, 0.3%-5.6%), 3.7% (95% CI, 0.7%-11.4%), and 15.3% (95% CI, 5.9%-28.9%), respectively (P=.02); this difference was independent of lesion size (P=.02).ConclusionDisease control was excellent for patients who received SBRT for early-stage NSCLC, and this series represents the largest single-institution experience from the United States on SBRT for early-stage inoperable NSCLC. Higher pretreatment FDG-PET SUVmax was associated with increased risk of any recurrence, and the 50 Gy in 5 fractions dose prescription was associated with increased risk of local recurrence.

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Optimization of mediastinal staging in potential candidates for stereotactic radiosurgery of the chest

Cited by 23 publications

References 16 publications

Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy

Limitations of PET/CT in the Detection of Occult N1 Metastasis in Clinical Stage I(T1-2aN0) Non-Small Cell Lung Cancer for Staging Prior to Stereotactic Body Radiotherapy

MicroRNA-31 Predicts the Presence of Lymph Node Metastases and Survival in Patients with Lung Adenocarcinoma

Stereotactic Body Radiotherapy for Medically Inoperable Stage I-II Non–Small Cell Lung Cancer: The Mayo Clinic Experience

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