Risk-adapted stereotactic ablative radiotherapy for central and ultra-central lung tumours

Lenglet, Alexis; Campeau, Marie-Pierre; Mathieu, Dominique; Bahig, Houda; Lambert, Louise; Vu, Toni; Roberge, David; Bilodeau, Laurent; Filion, Édith

doi:10.1016/j.radonc.2019.01.035

Cited by 12 publications

(15 citation statements)

References 21 publications

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“…It also compares well to reported outcomes of SBRT from both centrally located primary NSCLC in general 4,5 and from ultracentrally located tumors specifically which have reported 2-year local control rates of 57% to 100%, most of which being greater than 77%. [6][7][8][11][12][13][14][15][16][17] The trial included both primary tumors from NSCLC and metastases from other solid tumors, and despite including four cases of metastases from colorectal cancer, which is known to have a higher radioresistance to SBRT, 18 all failures but one originated from NSCLC.…”

Section: Discussionmentioning

confidence: 99%

The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy

Lindberg

Grozman

Karlsson

et al. 2021

Journal of Thoracic Oncology

141

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Section: Discussionmentioning

confidence: 99%

The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy

Lindberg

Grozman

Karlsson

et al. 2021

Journal of Thoracic Oncology

141

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“…Organs at risk contouring was adopted from RTOG 0813, EORTC LungTech, SUNSET, and RTOG 1106 contouring atlas, and normal tissue constraints were adopted from RTOG 0813 and previous HILUS studies . Meanwhile, maximum point dose and volumetric maximum dose analyses were evaluated for OAR including esophagus, heart, pulmonary artery, pulmonary vein, spinal cord, ipsilateral lung, contralateral lung, lung total, trachea, mainstem bronchi, lobe bronchi, and proximal bronchial tree.…”

Section: Methodsmentioning

confidence: 99%

“…Organs at risk contouring was adopted from RTOG 0813, 35 EORTC LungTech, 36 SUNSET, 18 and RTOG 1106 contouring atlas, 37 and normal tissue constraints were adopted from RTOG 0813 and previous HILUS studies. 6,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Meanwhile, maximum point dose and volumetric maximum dose analyses were evaluated for OAR including esophagus, heart, pulmonary artery, pulmonary vein, spinal cord, ipsilateral lung, contralateral lung, lung total, trachea, mainstem bronchi, lobe bronchi, and proximal bronchial tree. Treated doses were converted to biologically effective doses (BED) based on the formula: nd [1 + d/(α/β)], where n is number of fractions, and d is dose/fraction (Gy); assuming α/β value of 10 for NSCLC (ie BED 10 ) and α/β value of 3 for normal tissues (ie BED 3 ).…”

Section: Organs At Risk Normal Tissue Constraints and Biologicallmentioning

confidence: 99%

“…In the 2010s, a new subgroup within the cohort of patients with central tumors was designated as “high‐risk” or “ultra‐central” tumors, or those that abut the PBT . Ultra‐central tumors have increased grade 4+ toxicity, even with conservative radiotherapy fractionation .…”

Section: Introductionmentioning

confidence: 99%

“…11,12 In the 2010s, a new subgroup within the cohort of patients with central tumors was designated as "high-risk" or "ultra-central" tumors, or those that abut the PBT. 7,[13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] Ultra-central tumors have increased grade 4+ toxicity, even with conservative radiotherapy fractionation. 25 Of concern, Haseltine et al reported that in patients with PBT-abutting tumors who received conservative dose-fractionation SBRT plus bevacizumab, two patients experienced grade 5 pulmonary hemorrhages.…”

Section: Introductionmentioning

confidence: 99%

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Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

et al. 2019

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To determine the therapeutic efficacy and safety of risk‐adapted stereotactic body radiation therapy (SBRT) schedules for patients with early‐stage central and ultra‐central inoperable non‐small cell lung cancer. From 2006 to 2015, 80 inoperable T1‐2N0M0 NSCLC patients were treated with two median dose levels: 60 Gy in six fractions (range, 48‐60 Gy in 4‐8 fractions) prescribed to the 74% isodose line (range, 58%‐79%) for central lesions (ie within 2 cm of, but not abutting, the proximal bronchial tree; n = 43), and 56 Gy in seven fractions (range, 48‐60 Gy in 5‐10 fractions) prescribed to the 74% isodose line (range, 60%‐80%) for ultra‐central lesions (ie abutting the proximal bronchial tree; n = 37) on consecutive days. Primary endpoint was overall survival (OS); secondary endpoints included progression‐free survival (PFS), tumor local control rate (LC), and toxicity. Median OS and PFS were 64.47 and 32.10 months (respectively) for ultra‐central patients, and not reached for central patients. Median time to local failure, regional failure, and any distant failures for central versus ultra‐central lesions were: 27.37 versus 26.07 months, 20.90 versus 12.53 months, and 20.85 versus 15.53 months, respectively, all P < .05. Multivariate analyses showed that tumor categorization (ultra‐central) and planning target volume ≥52.76 mL were poor prognostic factors of OS, PFS, and LC, respectively (all P < .05). There was one grade 5 toxicity; all other toxicities were grade 1‐2. Our results showed that ultra‐central tumors have a poor OS, PFS, and LC compared with central patients because of the use of risk‐adapted SBRT schedules that allow for equal and favorable toxicity profiles.

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Incorporating the inflammation-related parameters enhances the performance of the nomogram for predicting local control in lung cancer patients treated with stereotactic body radiation therapy

Huang,

Lin,

Luo

et al. 2024

J Cancer Res Clin Oncol

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Purpose The study aims to investigate whether including the inflammation-related parameters would enhance the accuracy of a nomogram for local control (LC) prediction in lung cancer patients undergoing stereotactic body radiation therapy (SBRT). Methods 158 primary or metastatic lung cancer patients treated with SBRT were retrospectively analyzed. The clinical, dosimetric and inflammation-related parameters were collected for the Cox regression analysis. The ACPB model was constructed by employing the clinical and dosimetric factors. And the ACPBLN model was established by adding the inflammation-related factors to the ACPB model. The two models were compared in terms of ROC, Akaike Information Criterion (AIC), C-index, time-dependent AUC, continuous net reclassification index (NRI), integrated discrimination improvement (IDI), calibration plots and decision curve analysis (DCA). Results Multivariate Cox regression analysis revealed that six prognostic factors were independently associated with LC, including age, clinical stage, planning target volume (PTV) volume, BED of the prescribed dose (BEDPD), the lymphocyte count and neutrocyte count. The ACPBLN model performed better in AIC, bootstrap-corrected C-index, time-dependent AUC, NRI and IDI than the ACPB model. The calibration plots showed good consistency between the probabilities and observed values in the two models. The DCA curves showed that the ACPBLN nomogram had higher overall net benefit than the ACPB model across a majority of threshold probabilities. Conclusion The inflammation-related parameters were associated with LC for lung cancer patients treated with SBRT. The inclusion of the inflammation-related parameters improved the predictive performance of the nomogram for LC prediction.

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Risk-adapted stereotactic ablative radiotherapy for central and ultra-central lung tumours

Cited by 12 publications

References 21 publications

The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy

The HILUS-Trial—a Prospective Nordic Multicenter Phase 2 Study of Ultracentral Lung Tumors Treated With Stereotactic Body Radiotherapy

Risk‐adapted stereotactic body radiation therapy for central and ultra‐central early‐stage inoperable non‐small cell lung cancer

Incorporating the inflammation-related parameters enhances the performance of the nomogram for predicting local control in lung cancer patients treated with stereotactic body radiation therapy

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