Prognostic factors for survival in stage III non–small-cell lung cancer treated with definitive radiation therapy: Impact of tumor volume

Basaki, Kiyoshi; Abe, Yoshinao; Aoki, Masahiko; Kondo, Hidehiro; Hatayama, Yoshiomi; Nakaji, Shigeyuki

doi:10.1016/j.ijrobp.2005.07.967

Cited by 90 publications

(85 citation statements)

References 25 publications

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“…GTV1 before RT trended to be associated with OS in univariate analysis which amends current literature showing strong evidence for a prognostic significance of tumor volume detected before RT (13)(14)(15)(16)22) or chemotherapy of NSCLC (23). Koo et al (14) for instance reported a trend for inferior survival outcome in patients with poor tumor volume reduction during CCRT of Decrease Increase Total GTV1 to GTV2 Decrease 15 10 25 Increase 0 2 2 Total 15 12 27 OPN, osteopontin.…”

Section: Discussionsupporting

confidence: 52%

“…Furthermore, there is strong evidence in the literature that GTV is a potential prognostic factor in conformal RT of NSCLC (13)(14)(15)(16)21).…”

Section: Discussionmentioning

confidence: 99%

“…higher basal OPN plasma levels in patients with larger GTV) in a series of 69 NSCLC M0-stage patients treated with definite CCRT. In the literature, there is evidence that GTV has a clinically relevant impact on overall survival (OS) after CCRT of NSCLC (13)(14)(15)(16).…”

Section: Introductionmentioning

confidence: 99%

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The relationship between tumor volume changes and serial plasma osteopontin detection during radical radiotherapy of non-small-cell lung cancer

et al. 2016

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Abstract. The prognostic quality of increased osteopontin (OPN) plasma levels has been demonstrated for the chemotherapy and surgery of lung cancer. There is also evidence in the literature that tumor volume impacts prognosis in definitive radiotherapy (RT) of (lung) cancer. We previously demonstrated that elevated plasma levels of OPN before, and increasing OPN plasma levels after RT significantly correlate with survival and outcome after curative-intent RT of non-small-cell lung cancer (NSCLC). Tumor volume was also associated with prognosis. The present prospective clinical study investigated the prognostic interrelation of OPN plasma levels and tumor volume and their changes in the radical RT of NSCLC. We evaluated a subset of patients (n=27) with inoperable, non-metastasized NSCLC of the previously published patient collective. Patients were treated with radical radiochemotherapy (2 Gy ad 66 Gy). OPN plasma concentrations were determined by ELISA before (t0), at the end (t1), and 4 weeks after RT (t2). GTV was delineated PET-and CT-correlated before RT (GTV1) and after 40 Gy (GTV2). The course of OPN during and after RT and the change of GTV during RT was monitored over time and correlated with prognosis. Median GTV2 after 40 Gy (63 ml) was significantly lower than pre-RT GTV1 (90 ml, P<0.0001). Median OPN before (t0), at the end of (t1) and four weeks after RT (t2) was 846, 777 and 624 ng/ml and not significantly different. GTV significantly declined by 39 ml during RT (P<0.0001) and OPN non-significantly decreased by 56 ng/ml during (t0 to t1) and by 54 ng/ml after RT (t1 to t2). No correlations were determined between absolute OPN and GTV values or their relative changes during RT. In univariate analysis, only GTV2 significantly predicted overall survival (OS, P=0.03). In multivariate analysis, both OPN t1 (P<0.001) and GTV2 (P= 0.001) remained significant predictors of OS. Relative OPN plasma level changes after (t1 to t2) and GTV changes during RT (GTV 1 to GTV 2) significantly predicted OS (P=0.02). The combination of absolute GTV values before RT (GTV1) and GTV changes during RT (GTV1 to 2) were significantly associated with OS in both uni-and multivariate analysis (P=0.03). The combination of absolute OPN plasma levels and their changes with GTV and its changes did not reach statistical significance. The lack of a significant correlation between OPN and GTV together with the finding that OPN and GTV remained independent predictors of survival outcome but were not associated with OS in combination supports the hypothesis that tumor volume (GTV) and OPN plasma levels (both their changes and absolute values) are not interrelated in terms of prognosis but do possess each parameter separately, a prognostic quality in the radical RT of NSCLC which justifies further prospective studies to validate these results.

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Section: Discussionsupporting

confidence: 52%

“…Furthermore, there is strong evidence in the literature that GTV is a potential prognostic factor in conformal RT of NSCLC (13)(14)(15)(16)21).…”

Section: Discussionmentioning

confidence: 99%

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The relationship between tumor volume changes and serial plasma osteopontin detection during radical radiotherapy of non-small-cell lung cancer

et al. 2016

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“…Liao et al [16] reported that whole-body measurement of MTV successfully predicted survival in stage IV NSCLC. Clinical variables including TNM staging system, histological type, performance status, and smoking status are known to predict the prognosis of NSCLC patients [19][20][21]. This study aimed to further stratify patients with stage IV NSCLC by measuring MTV using F-18 FDG PET/CT and compared it with various clinical factors for prediction of prognosis.…”

Section: Introductionmentioning

confidence: 99%

Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer

Yoo

Kim

Chong

et al. 2012

Nucl Med Mol Imaging

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Purpose This study aimed to further stratify prognostic factors in patients with stage IV non-small cell lung cancer (NSCLC) by measuring their metabolic tumor volume (MTV) using F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Materials and MethodsThe subjects of this retrospective study were 57 patients with stage IV NSCLC. MTV, total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) were measured on F-18 FDG PET/CT in both the primary lung lesion as well as metastatic lesions in torso. Optimal cutoff values of PET parameters were measured by receiver operating characteristic (ROC) curve analysis. Kaplan-Meier survival curves were used for evaluation of progression-free survival (PFS). The univariate and multivariate Cox proportional hazards models were used to select the significant prognostic factors. Results Univariate analysis showed that both MTV and TLG of primary lung lesion (MTV-lung and TLG-lung) were significant factors for prediction of PFS (P<0.001, P00.038, respectively). Patients showing lower values of MTV-lung and TLG-lung than the cutoff values had significantly longer mean PFS than those with higher values. Hazard ratios (95 % confidence interval) of MTV-lung and

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“…Evidence has been accumulating (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11) that an increasing tumor volume has a significant effect on patient outcome, possibly even overriding the T stage assignment. Other factors influencing the American Joint…”

Section: Introductionmentioning

confidence: 99%

Increasing Tumor Volume is Predictive of Poor Overall and Progression-Free Survival: Secondary Analysis of the Radiation Therapy Oncology Group 93-11 Phase I-II Radiation Dose-Escalation Study in Patients with Inoperable Non–Small-Cell Lung Cancer

Werner‐Wasik

Swann

Bradley

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Recommended CitationWerner-Wasik, Maria; Swann, R. Suzanne; Bradley, Jeffrey; Graham, Mary; Emami, Bahman; Purdy, James; and Sause, William, "Increasing tumor volume is predictive of poor overall and progressionfree survival: Secondary analysis of the Radiation Therapy Oncology Group 93-11 phase I-II radiation dose-escalation study in patients with inoperable non-small-cell lung cancer" (2008 Patients with non-small-cell lung cancer (NSCLC) in the Radiation Therapy Oncology Group (RTOG) 93-11 trial received radiation doses of 70.9, 77.4, 83.8, or 90.3 Gy. The locoregional control and survival rates were similar among the various dose levels. We investigated the effect of the gross tumor volume (GTV) on the outcome. Methods and Materials:The GTV was defined as the sum of the volumes of the primary tumor and involved lymph nodes. The tumor response, median survival time (MST), and progression-free survival (PFS) were analyzed separately for smaller (≤45 cm 3 ) vs. larger (>45 cm 3 )tumors.Results:The distribution of the GTV was as follows: ≤45 13.3 months, p < 0.0001; and 15.8 vs. 8.3 months, p < 0.0001, respectively). Increasing the radiation dose had no effect on the MST or PFS. On multivariate analysis, only a smaller GTV was a significant prognostic factor for improved MST and PFS (hazard ratio [HR], 2.12, p = 0.0002; and HR, 2.0, p = 0.0002, respectively). The GTV as a continuous variable was also significantly associated with the MST and PFS (HR, 1.59, p < 0.0001; and HR, 1.39, p < 0.0001, respectively). Conclusions:Radiation dose escalation up to 90.3Gy did not result in improved MST or PFS. The tumor responses were greater in node-negative patients and women. An increasing GTV was strongly associated with decreased MST and PFS. Future radiotherapy trials patients might need to use stratification by tumor volume.

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Prognostic factors for survival in stage III non–small-cell lung cancer treated with definitive radiation therapy: Impact of tumor volume

Cited by 90 publications

References 25 publications

The relationship between tumor volume changes and serial plasma osteopontin detection during radical radiotherapy of non-small-cell lung cancer

The relationship between tumor volume changes and serial plasma osteopontin detection during radical radiotherapy of non-small-cell lung cancer

Metabolic Tumor Volume Measured by F-18 FDG PET/CT can Further Stratify the Prognosis of Patients with Stage IV Non-Small Cell Lung Cancer

Increasing Tumor Volume is Predictive of Poor Overall and Progression-Free Survival: Secondary Analysis of the Radiation Therapy Oncology Group 93-11 Phase I-II Radiation Dose-Escalation Study in Patients with Inoperable Non–Small-Cell Lung Cancer

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