Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: A noninvasive treatment approach in medically inoperable patients

Wulf, Joern; Haedinger, Ulrich; Oppitz, Ulrich; Thiele, Wibke; Mueller, Gerd; Flentje, Michael

doi:10.1016/j.ijrobp.2004.02.060

Cited by 321 publications

(169 citation statements)

References 46 publications

Supporting

Mentioning

166

Contrasting

Unclassified

Order By: Relevance

“…At our institution, a similar dosing schedule is used for patients who present with oligometastatic lung and liver metastases. Various fractionation schedules have been reported for patients treated for lung [23][24][25] and liver metastases [13,26,27]. Dose escalation was reported to improve local control rates in a phase I dose-escalation trial of hepatic metastases from Rule et al The study randomized 27 patients to 30 Gy in 3 fractions, 50 Gy in 5 fractions, and 60 Gy in 5 fractions [12].…”

Section: Discussionmentioning

confidence: 99%

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Ahmed

Berglund

Shridhar

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

Purpose/Objectives-We have previously developed a multigene expression model of tumor radiosensitivity (RSI) with clinical validation in multiple independent cohorts (breast, rectal, esophageal, and head and neck). The purpose of this study was to assess differences in RSI scores between primary colon cancer and metastases.Methods and Materials-Patients were identified from our institutional IRB approved prospective observational protocol. A total of 704 metastatic and 1,362 primary lesions were obtained from a de-identified meta-data pool. RSI was calculated using the previously published ranked based algorithm. An independent cohort of 29 lung or liver colon metastases treated with 60 Gy in 5 fractions stereotactic body radiotherapy (SBRT) was used for validation.Results-The most common sites of metastases included liver (n=374; 53%), lung (n=116; 17%), and lymph nodes (n=40; 6%). Sixty percent of metastatic tumors compared with 54% of primaries were in the RSI-radioresistant (RSI-RR) peak, suggesting that, metastatic tumors may be slightly more radioresistant than primaries (p=0.01). In contrast, when we analyzed metastases based on anatomical site, we uncovered large differences in RSI. The median RSIs for metastases Corresponding Author: Javier F. Torres-Roca MD, H. Lee Moffitt Cancer Center and Research Institute, Department of Radiation Oncology, 12902 Magnolia Dr., Tampa, FL 33612 USA, Telephone: 00-1-813-745-3568, Fax: 00-1-813-745-7231, javier.torresroca@moffitt.org. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflicts of HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript in descending order of radioresistance were ovary (0.48), abdomen (0.47), liver (0.43), brain (0.42), lung (0.32), and lymph nodes (0.31), p<0.0001. These findings were confirmed when the analysis was restricted to lesions from the same patient (n=139). In our independent cohort of treated lung and liver metastases, lung metastases had an improved local control (LC) rate over patients with liver metastases (2 yr LC 100% vs. 73.0%, p=0.026).Conclusions-Assessment of radiosensitivity between primary and metastatic tissues of colon cancer histology, reveals significant differences based on anatomical location of metastases. These initial results warrant validation in a larger clinical cohort.

show abstract

Section: Discussionmentioning

confidence: 99%

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Ahmed

Berglund

Shridhar

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

View full text Add to dashboard Cite

show abstract

“…There is some evidence that cancer metastases themselves may become the source of additional metastases (4). Patients with MLLs may gain benefit from a high local control (LC) of their oligometastases, if they are at a very low risk to develop further distant metastases (5). There have been a few studies that addressed the issue of comparison between MLLs and PLLs patients (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

“…Patients with MLLs may gain benefit from a high local control (LC) of their oligometastases, if they are at a very low risk to develop further distant metastases (5). There have been a few studies that addressed the issue of comparison between MLLs and PLLs patients (5)(6)(7)(8). In contrast to them, lung lesions of pulmonary origin, i.e., metastases from lung cancer were strictly excluded from the MLLs group.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

et al. 2017

View full text Add to dashboard Cite

Background: The net benefit from local ablative therapy for pulmonary oligometastases remains unknown.The outcomes of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) were analyzed retrospectively and compared with those of SABR for primary lung lesions (PLLs). Methods: Medical records of patients treated with lung SABR between 2011 and 2014 were retrospectively reviewed. Basic patient, lesion and treatment characteristics were compared using the Pearson chi-square test for categorical and Mann-Whitney U test for continuous variables. To estimate the rates of local control (LC), progression-free survival (PFS), survival after the first progression post-SABR (SAPF) and overall survival (OS), the Kaplan-Meier method was used, and the differences between groups were assessed by means of the log rank test. The uni-and multivariate Cox proportional hazards regression model was used to identify predictive factors for these endpoints. Results: Twenty-nine MLLs in 18 consecutive patients and 51 PLLs in 42 patients were treated stereotactically and included in the study. Median follow-up was 14 months (range, 4-40 months). Although patients with MLLs had a significantly better cardiopulmonary function (P=0.0001), more conservative dosefractionation schedules were prescribed (P=0.0001), but this did not result in a significant difference in LC (P=0.98), PFS (P=0.06) and OS (P=0.14). Multivariate analysis revealed that the dose per fraction (≥ or <12 Gy) was an independent predictor for LC (P=0.02) and PFS (P=0.01) for the whole population, and for PFS (P=0.02) in the PLLs group. Late toxicities ≥ G2 occurred in six patients with PLLs, compared with none in the metastatic group. Conclusions: SABR for MLLs was as successful as for PLLs with respect to LC and OS with lower longterm toxicity in patients with MLLs. Dose per fraction ≥12 Gy turned out to be an independent, favorable prognostic factor. IntroductionBased on conceptual theories of breast cancer growth and dissemination, Hellman and Weichselbaum inferred the existence of a clinically and biologically relevant group of oligometastatic patients, in whom aggressive local therapy may prolong survival and even be a curative treatment option (1). The incentive for using stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) came from favorable results of surgical removal of oligometastases in different types of solid tumors (2). High rates of survival in treated compared with untreated patients have also been demonstrated for lung metastasectomy (3). However, the temporal and locational burden of oligometastatic state remains blurred and diffuse and-until now-no clear guidelines have been defined for the selection of patients who would really benefit from local ablative treatment.During the past decade, SABR emerged as a new standard of care for medically inoperable patients with early stage non-small-cell lung cancer. For oligometastatic diseases the benefit from SABR has been extrapolated from the experience with pr...

show abstract

“…Specifically for lung SBRT, the Radiation Therapy Oncology Group (RTOG) protocols accept a range between 60% and 90% 13 , 14 , 15 . Various studies have reported prescription isodose lines at the 40%–48%, (16) 50%, (17) 60%, (18) 65%, 19 , 20 , 21 , 22 80%, 2 , 3 , 22 , 23 , 24 , 25 85%, (26) and 90% (27) levels.…”

Section: Introductionmentioning

confidence: 99%

Effect of the normalized prescription isodose line on the magnitude of Monte Carlo vs. pencil beam target dose differences for lung stereotactic body radiotherapy

Zheng

Liang

Zhu

et al. 2016

J Applied Clin Med Phys

View full text Add to dashboard Cite

In lung stereotactic body radiotherapy (SBRT) cases, the pencil beam (PB) dose calculation algorithm is known to overestimate target dose as compared to the more accurate Monte Carlo (MC) algorithm. We investigated whether changing the normalized prescription isodose line affected the magnitude of MC vs. PB target dose differences. Forty‐eight patient plans and twenty virtual‐tumor phantom plans were studied. For patient plans, four alternative plans prescribed to 60%, 70%, 80%, and 90% isodose lines were each created for 12 patients who previously received lung SBRT treatments. Using 6 MV dynamic conformal arcs, the plans were individually optimized to achieve similar dose coverage and conformity for all plans of the same patient, albeit at the different prescription levels. These plans, having used a PB algorithm, were all recalculated with MC to compare the target dose differences. The relative MC vs. PB target dose variations were investigated by comparing PTV D95, Dmean, and D5 loss at the four prescription levels. The MC‐to‐PB ratio of the plan heterogeneity index (HI) was also evaluated and compared among different isodose levels. To definitively demonstrate the cause of the isodose line dependence, a simulated phantom study was conducted using simple, spherical virtual tumors planned with uniform block margins. The tumor size and beam energy were also altered in the phantom study to investigate the interplay between these confounding factors and the isodose line effect. The magnitude of the target dose overestimation by PB was greater for higher prescription isodose levels. The MC vs. PB reduction in the target dose coverage indices, D95 and V100 of PTV, were found to monotonically increase with increasing isodose lines from 60% to 90%, resulting in more pronounced target dose coverage deficiency at higher isodose prescription levels. No isodose level‐dependent trend was observed for the dose errors in the target mean or high dose indices, Dmean or D5. The phantom study demonstrated that the observed isodose level dependence was caused by different beam margins used for the different isodose levels: a higher prescription line required a larger beam margin, leading to more low‐density lung tissues in the field and, therefore, larger dose errors at the target periphery (when calculated with PB). The phantom study also found that the observed isodose level dependence was greater for smaller targets and for higher beam energies. We hereby characterized the effect of normalized prescription isodose line on magnitude of PTV dose coverage as calculated by MC vs. PB. When comparing reported MC dose deficiency values for different patients, the selection of prescription isodose line should be considered in addition to other factors known to affect differences in calculated doses between various algorithms.PACS number(s): 87.55.kh, 87.55.dk, 87.55.de

show abstract

Stereotactic radiotherapy for primary lung cancer and pulmonary metastases: A noninvasive treatment approach in medically inoperable patients

Cited by 321 publications

References 46 publications

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Differences Between Colon Cancer Primaries and Metastases Utilizing a Molecular Assay for Tumor Radiosensitivity Suggest Implications for Potential Oligometastatic SBRT Patient Selection

Retrospective analysis of stereotactic ablative radiotherapy (SABR) for metastatic lung lesions (MLLs) in comparison with a contemporaneous cohort of primary lung lesions (PLLs)

Effect of the normalized prescription isodose line on the magnitude of Monte Carlo vs. pencil beam target dose differences for lung stereotactic body radiotherapy

Contact Info

Product

Resources

About