Stereotactic body radiotherapy: current strategies and future development

Tsang, Maverick W.K.

doi:10.21037/jtd.2016.03.14

Cited by 34 publications

(25 citation statements)

References 42 publications

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“…In animal experiments, the radiation doses are higher (10 Gy/5 fr to 30 Gy/15 fr) and tumor reduction is observed within 1–2 weeks after irradiation [ 23 – 25 ]. In the clinic, radiation doses vary between 60 Gy/30 fr and 50 Gy/4 fr, and maximal tumor reduction is observed within 4–8 weeks after irradiation [ 26 , 27 ]. In the present study, we determined the effects of radiotherapy on the levels of tumoral cfDNA in 17 NSCLC patients (stages I and IV).…”

Section: Introductionmentioning

confidence: 99%

Radiotherapy increases plasma levels of tumoral cell-free DNA in non-small cell lung cancer patients

et al. 2018

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We investigated the plasma levels of tumor-specific cell-free DNA (cfDNA) in 17 stage I–II (early) and IV (advanced) non-small cell lung cancer (NSCLC) patients who underwent radiotherapy. Digital polymerase chain reaction (PCR) and targeted sequencing showed that total and tumor-specific cfDNA levels increased in response to radiotherapy in both early- and advanced-stage NSCLC patients. We detected high copy numbers of epidermal growth factor receptor mutations (L858R and T790M) in the cfDNA samples from stage IV NSCLC patients who underwent stereotactic body radiation therapy to treat brain metastasis related to tyrosine kinase inhibitor (TKI) treatment failure. In conclusion, our study demonstrates that radiotherapy increases tumoral cfDNA levels in the plasma and shows potential to serve as an indicator for diagnosing drug-resistant tumor-related gene mutations in early-stage NSCLC patients or those undergoing molecular targeted therapy.

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Section: Introductionmentioning

confidence: 99%

Radiotherapy increases plasma levels of tumoral cell-free DNA in non-small cell lung cancer patients

et al. 2018

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“…Also, other characteristics of the initially resected tumor, such as tumor CT morphology, and histologic classifications could be potentially confounding factors, thus further studies are warranted with homogenizing characteristics of the first resection as much as possible 20. Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged NSCLC 21,22. The local control rate after SBRT is >90%.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of patients with metachronous second primary lung adenocarcinomas

Zhao¹,

Yang²,

Han³

et al. 2017

OTT

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BackgroundThe incidence of adenocarcinomas as multiple primary lung cancers (MPLCs) is increasing. How to determine the treatment strategies of MPLCs, especially second primary lung adenocarcinomas (SPLACs), and the prognostic factors associated with it are unclear.MethodsThe clinical records of patients undergoing surgery for second adenocarcinomas based on Martini–Melamed criteria between 2001 and 2014 were retrospectively reviewed. Survival rates were calculated by the Kaplan–Meier method and compared using the log-rank test. Multivariate analysis was conducted using the Cox proportional hazards model.ResultsA total of 115 patients with SPLACs were identified based on Martini–Melamed criteria. With respect to the second resections, three subgroups with low- (adenocarcinoma in situ, n=6; minimally invasive adenocarcinoma, n=19), intermediate- (lepidic, n=9; acinar, n=40; papillary, n=23), and high-grades (solid, n=9; micropapillary, n=2; invasive mucinous, n=7) were assigned. The 5-year overall survival (OS) rates from the time of the first and the second resections were 86.5% and 69.5%, respectively. Cox multivariate analysis identified computed tomography (CT) morphology of SPLACs (ground glass opacity predominant versus solid predominant; hazard ratio [HR]=0.42; P=0.036), histologic classification (same/similar vs different; HR=0.06; P<0.001), pathologic stage of the primary (stage I vs II; HR=0.20; P=0.015) and second tumors (stage I vs IIIa; HR=0.21; P=0.002), and histologic grade of SPLACs (low- vs high-grade, HR=0.05, P=0.016; intermediate- vs high-grade, HR=0.37, P=0.027) as significantly favorable prognostic factors for OS.ConclusionIn addition to pathologic stage of the initial tumors and histologic classification, pathologic stage and CT morphology of SPLACs were identified as predictors of survival. The histologic grade of SPLACs based on the new adenocarcinoma classification could provide additional prognostic information.

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“…The treatment regimen for peripheral tumors varies from a single fraction to up to five fractions. The standard total radiation dose varies from 48 Gy to 60 Gy (19).…”

Section: Indications For Sbrt For Early-stage Nsclc Early-stage Nsclcmentioning

confidence: 99%

Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists

2018

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The past 2 decades have seen a rapid growth in use of stereotactic body radiation therapy (SBRT) for the management of non-small cell lung cancer (NSCLC). Not only is SBRT the reference standard for treatment of early-stage node-negative NSCLC in medically inoperable patients, it is also currently challenging the role of surgery for early-stage operable disease. SBRT is also used to treat recurrent disease and has a role in the management of multiple synchronous lung cancers. Imaging changes after SBRT differ from the changes after conventional radiation therapy in many ways, the knowledge of which is pertinent for accurate image interpretation. Posttreatment response assessment and detection of recurrent disease are heavily reliant on radiologic assessment, and often the decision to treat recurrent disease is based on the imaging findings themselves. This article provides a comprehensive review of the concepts of SBRT and the current indications for its use in the treatment of early-stage NSCLC, as well as a discussion of the CT findings seen after SBRT compared with the changes after conventional radiation therapy. Radiologic findings that are suggestive of recurrent disease and the imaging pitfalls are also highlighted. Finally, the rare complications after SBRT are described. SBRT is a major component of the changing treatment paradigms for early- and late-stage NSCLC. The imaging findings after SBRT often determine the next steps in a patient's clinical management. Therefore, radiologists must be familiar with the uses of this therapy and its radiologic appearance to be able to effectively contribute to the care of patients with NSCLC. RSNA, 2018.

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Stereotactic body radiotherapy: current strategies and future development

Cited by 34 publications

References 42 publications

Radiotherapy increases plasma levels of tumoral cell-free DNA in non-small cell lung cancer patients

Radiotherapy increases plasma levels of tumoral cell-free DNA in non-small cell lung cancer patients

Clinical outcomes of patients with metachronous second primary lung adenocarcinomas

Stereotactic Body Radiation Therapy for Early-Stage Non–Small Cell Lung Cancer: A Primer for Radiologists

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