Prognostic factors and clinical outcomes after stereotactic radiotherapy for primary lung tumors

Rodrigues, Isabel; Figueiredo, Tiago; Gagean, J.; Ferreira, C.; Laranja, André; Ramos, T.; Conde, S.; Moreira, Diana; Cardia, J.

doi:10.1016/j.rpor.2020.09.015

Cited by 5 publications

(3 citation statements)

References 28 publications

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“…Rodrigues et al. reported in contrast that LPFS was negatively influenced by female gender after SBRT for early-stage inoperable primary lung tumors [ 24 ]. No other factors were found to have an impact on local LPFS, probably due to, fortunately, very high response rates.…”

Section: Discussionmentioning

confidence: 99%

“…Rodrigues at al. showed that T2 tumors were associated with lower local control rates than T1, with no significant impact on overall survival [ 24 ]. Other factors that were evaluated during statistical analysis, included age, number of irradiated lesions in the lung, presence of other distant metastases at the irradiation timepoint, application of a concurrent systemic therapy regimen, PET-CT diagnostics prior to irradiation, and the presence of local progression, were all found to be non-statistically significant for LPFS, PFS, and OS.…”

Section: Discussionmentioning

confidence: 99%

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12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

et al. 2021

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Purpose The aim of this study was to evaluate the safety and long-term tumor control after stereotactic radiotherapy (SRT) with 12 × 6 Gy of patients with primary bronchial carcinoma (BC) or with pulmonary metastases (MET) of various solid tumors. Local progression-free survival (LPFS), progression-free survival (PFS), overall survival (OS), and prognostic factors were compared. Methods Between May 2012 and January 2020, 168 patients with 206 pulmonary lesions (170 MET and 36 primary BC) were treated with 12 × 6 Gy (BED10 116 Gy). The irradiated pulmonary MET were from the following cancers: 47 (27.6%) head and neck, 37 (21.8%) rectum or colon, 30 (17.6%) bronchial, 13 (7.6%) malignant melanoma, 9 (5.3%) esophageal, 9 (5.3%) sarcoma, and 25 (14.8%) other. Results The median follow-up was 16.26 months (range: 0.46–89.34) for BC and 19.18 months (0.89–91.11) for MET. Survival rates at 3 years were: OS 43% for BC and 35% for MET; LPFS BC 96% and MET 85%; PFS BC 35% and MET 29%. The most frequently observed grade 3 adverse events (AEs) were pneumonitis (5.9% BC, 4.8% MET), pulmonary fibrosis (2.9% BC, 4% MET), and pulmonary embolism (2.9% BC, 0.8% MET). The favorable prognostic effects on overall survival of patients with MET were female gender (log-rank: p < 0.001), no systemic progression (log-rank; p = 0.048, multivariate COX regression p = 0.039), and malignant melanoma histology (log-rank; p = 0.015, multivariate COX regression p = 0.020). For patients with BC, it was tumor location within the lower lobe (vs. upper lobe, log-rank p = 0.027). LPFS of patients with metastatic disease was beneficially influenced by female gender (log-rank: p = 0.049). Conclusion The treatment concept of 12 × 6 Gy is associated with 96% local progression-free survival for BC and 85% for pulmonary metastases after 3 years. There was no difference in response after SRT of primary lung carcinoma or pulmonary metastases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

et al. 2021

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“…Toxicity concerns remain for ultracentral tumors (≤1 cm from the trachea, mainstem and lobar bronchi), especially with higher doses and fewer fractions Factors independently associated with long-term outcomes are not well-defined. Worse outcomes are reported with squamous vs. adenocarcinoma in some studies (multivariable HR ~1.7-2.4) (66,107), but not others (108,109), with rapidly growing tumors (multivariable HR ~1.4-1.5) (109), with high PET-avidity in some studies (multivariable HR ~4-6) (110) but not others (107,111), and larger tumors in some studies (multivariable HR ~1.2-9) (66,108,110,111) but not others (107,109,112). Reasonable outcomes are reported even for tumors >5 cm (113,114).…”

Section: Nuances and Sources Of Ambiguitymentioning

confidence: 99%

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation

Park¹,

Detterbeck²,

Madoff³

et al. 2022

J Thorac Dis

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Background: Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation],weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making.Methods: A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation vs. resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved.Results: Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT vs. surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation vs. surgery; there is less difference between ablation and SBRT.Conclusions: A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation vs. resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.

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Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy

Appel

Lawrence²,

Bar³

et al. 2023

Cancer/Radiothérapie

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Prognostic factors and clinical outcomes after stereotactic radiotherapy for primary lung tumors

Cited by 5 publications

References 28 publications

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation

Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy

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Prognostic factors and clinical outcomes after stereotactic radiotherapy for primary lung tumors

Cited by 5 publications

References 28 publications

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation—part 4: systematic review of evidence involving SBRT and ablation

Deep inspiratory breath hold assisted by continuous positive airway pressure ventilation for lung stereotactic body radiotherapy

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Product

Resources

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12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?

12 × 6 Gy stereotactic radiotherapy for lung tumors. Is there a difference in response between lung metastases and primary bronchial carcinoma?