Stereotactic Body Radiotherapy for Early-Stage Multiple Primary Lung Cancers

Nikitas, John; DeWees, T.A.; Rehman, Shabnam; Abraham, C.D.; Bradley, J.D.; Robinson, Clifford G.; Roach, Michael C.

doi:10.1016/j.cllc.2018.10.010

Cited by 24 publications

(18 citation statements)

References 20 publications

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“…We have described our institutional SBRT technique in a previous manuscript (20). Abdominal compression was utilized to minimize the range of tumor motion.…”

Section: Methodsmentioning

confidence: 99%

Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT

Kennedy

Gabani

Nikitas

et al. 2020

Radiotherapy and Oncology

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Purpose: Optimal management of isolated local recurrences after stereotactic body radiation therapy (SBRT) for early non-small cell lung cancer (NSCLC) is unknown and literature describing repeat SBRT for in-field recurrences after initial SBRT are sparse. We investigate the safety and efficacy of salvage SBRT for isolated local failures after initial SBRT for NSCLC.Methods/Materials: Patients receiving SBRT for isolated local recurrence after initial SBRT for early NSCLC were identified using a prospective registry. Both courses were 3-5 fractions with a biologically effective dose (BED10) of ≥100Gy. Local failure was defined as within 1 cm of the initial planning target volume (PTV) or an overlap of the ≥25% isodose lines of the first and second treatments. Failures >1 cm beyond the PTV and without ≥25% overlap, or with additional recurrence sites were excluded. Kaplan-Meier analysis was used to estimate survival. Results:A total 21 patients receiving salvage SBRT from 2008 to 2017 were identified. Median interval from initial SBRT to salvage SBRT was 23 months (7-52). Six patients (29%) had central tumors. Median follow-up time from salvage SBRT was 24 months (3-60). Median overall survival after salvage was 39 months. After reirradiation, two-year primary tumor control was 81%, regional nodal control was 89%, distant control was 75% and overall survival was 68%. Grade 2 pneumonitis occurred in 2 patients (10%) and grade 2 chest wall toxicity in 4 patients (19%). No grade 3+ toxicity was observed.Conclusions: Salvage SBRT for isolated local failures after initial SBRT appears safe, with low treatment-related toxicity and encouraging rates of tumor control.

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“…We have described our institutional SBRT technique in a previous manuscript (20). Abdominal compression was utilized to minimize the range of tumor motion.…”

Section: Methodsmentioning

confidence: 99%

Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT

Kennedy

Gabani

Nikitas

et al. 2020

Radiotherapy and Oncology

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“… 97 – 99 Some studies have also been conducted to explore the value of SBRT in early-stage MPLC patients. 16 , 100 – 108 …”

Section: Alternative Treatment Optionsmentioning

confidence: 99%

“…For MPLC patients whose initial cancer was resected, metachronous SBRT for other tumors could achieve a good survival (3-year OS rate: 95.4%; 3-year PFS rate: 95.4%). 16 Moreover, two studies proposed that mMPLCs patients receiving SBRT had a better 2-year PFS and OS rate in comparison with sMPLCs patients. 101 , 103 In general, SBRT can achieve a long-term survival and good tumor-control, and is a safe and feasible treatment option for patients with MPLCs, particularly those with limited respiratory function.…”

Section: Alternative Treatment Optionsmentioning

confidence: 99%

“…Most MPLC patients are diagnosed at the early stages of the disease; thus surgical intervention represents one of the most common therapeutic approaches, 13 although it is not applicable to patients with limited pulmonary function or to those with super multiple pulmonary nodules. 14 – 16 For these patients, novel systematic therapies including targeted therapy and immunotherapy are warranted and should be explored. With the advancement of multiple technologies, particularly next-generation sequencing (NGS), great progress has been made in diagnosing and treating MPLCs.…”

Section: Introductionmentioning

confidence: 99%

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<p>Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine</p>

Zhao¹,

Liu²,

Xie³

et al. 2020

CMAR

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With the widespread implementation of lung cancer screening, more and more patients are being diagnosed with multiple primary lung cancers (MPLCs). In the era of precision medicine, many controversies remain in differentiating MPLCs from intrapulmonary metastasis and the optimum treatment choice, especially in patients exhibiting similar histology. In this review, we summarize common diagnostic criteria and novel discrimination methods with a special emphasis on the emerging value of broad panel next-generation sequencing (NGS) for the diagnosis of MPLCs. We then discuss current advances regarding therapeutic approaches for MPLCs. Radical surgery is the main treatment modality, while stereotactic body radiotherapy (SBRT) is safe and feasible for early-stage MPLC patients with inoperable tumors. In addition, immunotherapy and targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitors, are emerging therapeutic strategies that are still in their infancy. Characteristics of both genomic profiles and tumor microenvironment are currently being evaluated but warrant further exploration to facilitate the application of targeted systematic therapies in MPLC patients.

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“…SBRT planning and delivery were performed as previously described [5]. For peripheral lesions, patients received 5400 cGy in 3 every-other-day fractions.…”

Section: Lung Sbrtmentioning

confidence: 99%

Treatment of oligometastatic lung cancer with brain metastases using stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT)

Nikitas

Roach

Robinson

et al. 2020

Clinical and Translational Radiation Oncology

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Background: There is increasing interest in treating oligometastatic non-small cell lung cancer (NSCLC) patients with stereotactic radiation. We aimed to address whether patients definitively treated with synchronous thoracic stereotactic body radiation therapy (SBRT) and brain stereotactic radiosurgery (SRS) had favorable outcomes with local therapy. Materials and methods: We reviewed a database of patients receiving lung SBRT as well as a database for brain metastasis patients treated with SRS between June 2004 and January 2016. We selected for cT1-2aN0M1 NSCLC patients with brain metastases and calculated their overall survival (OS), freedom from progression (FFP), and local control (LC) rates. Results: Six patients had oligometastatic NSCLC with 1-3 synchronous brain metastases treated with lung SBRT and brain SRS. No patients received immunotherapy and two-thirds did not receive systemic therapy. Median follow-up was 9 months for the entire cohort (range, 2-95 months) and 95 months for the surviving patient. Median OS was 12.4 months (95% confidence interval [CI], 7-18 months). At 1 year, patients had 67% OS (95% CI, 29-100%), 17% FFP (95% CI, 0-46%), and 100% LC. Their brain disease had 80% 1-year LC (95% CI, 45-100%) and 53% 1-year FFP (95% CI, 5-100%). Two patients had no distant progression, two had brain progression, one had adrenal gland progression, and one had bone and liver progression. Conclusion: In patients presenting with oligometastatic lung cancer limited to the brain, treatment with both lung SBRT and brain SRS achieves good LC of all sites with encouraging OS.

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Stereotactic Body Radiotherapy for Early-Stage Multiple Primary Lung Cancers

Cited by 24 publications

References 20 publications

Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT

Repeat stereotactic body radiation therapy (SBRT) for salvage of isolated local recurrence after definitive lung SBRT

<p>Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine</p>

Treatment of oligometastatic lung cancer with brain metastases using stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT)

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