Patterns of Disease Recurrence after SABR for Early Stage Non–Small-Cell Lung Cancer: Optimizing Follow-Up Schedules for Salvage Therapy

Verstegen, Naomi E.; Lagerwaard, Frank J.; Hashemi, S.; Dahele, Max; Slotman, Ben J.; Senan, Suresh

doi:10.1097/jto.0000000000000576

Cited by 54 publications

(68 citation statements)

References 25 publications

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“…Local recurrence after SBRT are not common, and most of them appear in the first 2 years after treatment (3,6). Benign lung changes after SBRT are common.…”

Section: S3mentioning

confidence: 99%

“…The possibility to extend the prescription of SBRT also in the operable setting makes an early detection of recurrences crucial for salvage treatment (6). Local recurrence after SBRT are not common, and most of them appear in the first 2 years after treatment (3,6).…”

Section: S3mentioning

confidence: 99%

“…Benign lung changes after SBRT are common. Late changes can mimic recurrence making early diagnosis difficult (5,6). Hence, the identification of HRFs to predict recurrences is very important.…”

Section: S3mentioning

confidence: 99%

“…Although local recurrences after SBRT for early stage NSCLC are uncommon (3,6), an early detection may allow curative surgical treatment in selected patients (6).…”

Section: Original Articlementioning

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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“…Local recurrence after SBRT are not common, and most of them appear in the first 2 years after treatment (3,6). Benign lung changes after SBRT are common.…”

Section: S3mentioning

confidence: 99%

Section: S3mentioning

confidence: 99%

Section: S3mentioning

confidence: 99%

“…Although local recurrences after SBRT for early stage NSCLC are uncommon (3,6), an early detection may allow curative surgical treatment in selected patients (6).…”

Section: Original Articlementioning

confidence: 99%

See 2 more Smart Citations

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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“…Treatment options for local recurrence after SRT include salvage surgery, systemic chemotherapy, targeted agents, chemoradiation, repeat high-dose radiotherapy or best supportive therapy in patients with poor performance status (30)(31)(32). Indications for salvage surgery are listed in Table 1 ( Figures 1,2).…”

Section: Salvage Surgery In Early-stage Lung Cancermentioning

confidence: 99%

Salvage surgery after high-dose radiotherapy

Breussegem¹,

Hendriks²,

Lauwers³

et al. 2017

J. Thorac. Dis.

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Association of Long-term Outcomes and Survival With Multidisciplinary Salvage Treatment for Local and Regional Recurrence After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

et al. 2018

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Importance Stereotactic ablative radiotherapy (SABR) is first-line treatment for patients with early-stage non–small cell lung cancer (NSCLC) who cannot undergo surgery. However, up to 1 in 6 such patients will develop isolated local recurrence (iLR) or isolated regional recurrence (iRR). Little is known about outcomes when disease recurs after SABR, or about optimal management strategies for such recurrences. Objective To characterize long-term outcomes for patients with iLR or iRR after SABR for early-stage NSCLC with the aim of informing treatment decision making for these patients with potentially curable disease. Design, Setting, and Participants In this cohort study, a retrospective review was conducted of 912 patients prospectively enrolled in an institutional database at a tertiary cancer center from January 1, 2004, through December 31, 2014. Main Outcomes and Measures Overall survival, progression-free survival, recurrence patterns, demographics, salvage techniques, patterns of salvage failure, and toxic effects. Results Of the 912 patients in the study (456 women and 456 men; median age, 72 years [range, 46-91 years]), 756 (82.9%) had T1 tumors at initial diagnosis; 502 tumors (55.0%) were adenocarcinomas and 309 tumors (33.9%) were squamous cell carcinomas. Of 912 patients with early-stage I to II NSCLC who received definitive SABR (50 Gy in 4 fractions or 70 Gy in 10 fractions), 102 developed isolated recurrence (49 with iLR and 53 with iRR), and 658 had no recurrence. Median times to recurrence after SABR were 14.5 months (range, 1.5-60.8 months) for iLR and 9.0 months (range, 1.9-70.7 months) for iRR; 39 of 49 patients (79.6%) with iLR and 48 of 53 patients (90.6%) with iRR underwent salvage with reirradiation, surgery, thermal ablation, or chemotherapy. Median follow-up times for patients with iLR or iRR were 57.2 months (interquartile range, 37.7-87.6 months) from initial SABR and 38.5 months (interquartile range, 19.9-69.3 months) from recurrence. Rates of overall survival at 5 years from initial SABR were no different between patients with iLR and salvage treatment (57.9%) and patients with no recurrence (54.9%; hazard ratio, 0.89; 95% CI, 0.56-1.43; P = .65) but were lower for patients with iRR and salvage treatment (31.1%; hazard ratio, 1.43; 95% CI, 1.00-2.34; P = .049). Patients receiving salvage treatment had longer overall survival than patients who did not (median, 37 vs 7 months after recurrence; hazard ratio, 0.40; 95% CI, 0.09-0.66; P = .006). Twenty-four of 87 patients (27.6%) who received salvage treatment for iLR or iRR subsequently developed distant metastases. No patient experienced grade 5 toxic effects after salvage treatment. Conclusions and Relevance Life expectancy after salvage treatment for iLR was similar to that for patients without ...

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Patterns of Disease Recurrence after SABR for Early Stage Non–Small-Cell Lung Cancer: Optimizing Follow-Up Schedules for Salvage Therapy

Abstract: Both the timing of LR and persistent risk of SPLC serve as rationale for long-term follow-up using computed tomography scans in patients fit enough to undergo any radical treatment.

Cited by 54 publications

References 25 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)

Salvage surgery after high-dose radiotherapy

Association of Long-term Outcomes and Survival With Multidisciplinary Salvage Treatment for Local and Regional Recurrence After Stereotactic Ablative Radiotherapy for Early-Stage Lung Cancer

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