Possible Misinterpretation of Demarcated Solid Patterns of Radiation Fibrosis on CT Scans as Tumor Recurrence in Patients Receiving Hypofractionated Stereotactic Radiotherapy for Lung Cancer

Takeda, Atsuya; Kunieda, Etsuo; Takeda, Toshiaki; Tanaka, Michio; Sanuki, Naoko; Fujii, Hirofumi; Shigematsu, Naoyuki; Kubo, Atsushi

doi:10.1016/j.ijrobp.2007.07.2383

Cited by 128 publications

(83 citation statements)

References 17 publications

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“…One relevant bias is the questionable definition of LR based solely on CT-criteria in the majority of patients, which may have overestimated the rate of tumor LR (32,33).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

et al. 2017

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Background: The net benefit from local ablative therapy for pulmonary oligometastases remains unknown.The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs). Methods: Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni-and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints. Results: Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dosefractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or <12 Gy) was an independent predictor for LC (P=0.02) and PFS (P=0.01) for the whole population, and for PFS (P=0.02) in the PLLs group. Late toxicities ≥ G2 occurred in six patients with PLLs, compared with none in the metastatic group. Conclusions: SABR for MLLs was as successful as for PLLs with respect to LC and OS with lower longterm toxicity in patients with MLLs. Dose per fraction ≥12 Gy turned out to be an independent, favorable prognostic factor. IntroductionBased on conceptual theories of breast cancer growth and dissemination, Hellman and Weichselbaum inferred the existence of a clinically and biologically relevant group of oligometastatic patients, in whom aggressive local therapy may prolong survival and even be a curative treatment option (1). The incentive for using stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) came from favorable results of surgical removal of oligometastases in different types of solid tumors (2). High rates of survival in treated compared with untreated patients have also been demonstrated for lung metastasectomy (3). However, the temporal and locational burden of oligometastatic state remains blurred and diffuse and-until now-no clear guidelines have been defined for the selection of patients who would really benefit from local ablative treatment.During the past decade, SABR emerged as a new standard of care for medically inoperable patients with early stage non-small-cell lung cancer. For oligometastatic diseases the benefit from SABR has been extrapolated from the experience with pr...

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“…One relevant bias is the questionable definition of LR based solely on CT-criteria in the majority of patients, which may have overestimated the rate of tumor LR (32,33).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

et al. 2017

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“…47 Such changes can evolve over time, and in some situations can be difficult to distinguish from recurrence as some patients have undergone resection for lesions which proved to be benign fibrosis. 48 PET-CT may be helpful to distinguish recurrence from fibrosis, but low-or moderategrade FDG uptake can be found after SBRT in the absence of malignancy. 49 Recently, high-risk features (HRFs) on CT have shown promise as predictors of recurrence.…”

Section: Assessment Of Response After Sbrtmentioning

confidence: 99%

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

Chehade

Palma

2015

Reports of Practical Oncology & Radiotherapy

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“…Late changes typically manifest as a modified conventional pattern, masslike fibrosis or scar-like fibrosis (7). The possible masslike appearance of RILI is likely a product of the highly conformal treatment (8), and this appearance may mimic the growth pattern of locally recurrent disease. Benign CT changes may continue to evolve in morphology and severity up to 2 years following SABR (7), which can further impair the detection of LR during the critical period of time when LRs are most likely to occur (9).…”

Section: Introductionmentioning

confidence: 99%

Pros: After stereotactic ablative radiotherapy for a peripheral early-stage non-small cell lung cancer, radiological suspicion of a local recurrence can be sufficient indication to proceed to salvage therapy

Nguyen

Palma

2016

Transl. Lung Cancer Res.

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Possible Misinterpretation of Demarcated Solid Patterns of Radiation Fibrosis on CT Scans as Tumor Recurrence in Patients Receiving Hypofractionated Stereotactic Radiotherapy for Lung Cancer

Cited by 128 publications

References 17 publications

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

Pros: After stereotactic ablative radiotherapy for a peripheral early-stage non-small cell lung cancer, radiological suspicion of a local recurrence can be sufficient indication to proceed to salvage therapy

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