The Effect of Biologically Effective Dose and Radiation Treatment Schedule on Overall Survival in Stage I Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy

Stahl, John M.; Ross, Rudi; Harder, E.; Mancini, B.R.; Soulos, Pamela R.; Finkelstein, Steven E.; Shafman, Timothy D.; Dosoretz, Arie P.; Evans, Suzanne B.; Husain, Zain; Yu, James B.; Gross, Cary P.; Decker, Roy H.

doi:10.1016/j.ijrobp.2016.08.033

Cited by 30 publications

(22 citation statements)

References 20 publications

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“…Multivariate analysis confirmed that patients receiving high‐dose treatment (BED ≥ 100 Gy 10 ) had better OS than those receiving low‐dose treatment (BED < 100 Gy 10 ). A similar effect has been reported in early‐stage NSCLC treated by SBRT, which support our findings. However, in this cohort, if we redefined the OS from the disease diagnosis to death, the 5‐years OS was 67.3%.…”

Section: Discussionsupporting

confidence: 92%

“…Multivariate analysis confirmed that patients receiving high-dose treatment (BED ≥ 100 Gy 10 ) had better OS than those receiving lowdose treatment (BED < 100 Gy 10 ). A similar effect has been reported in early-stage NSCLC treated by SBRT, [32][33][34] A recent study suggests that further elevation in the BED to 130 Gy 10 may provide even better LC of liver oligometastases in CRC patients. 35 Compared with the patients in that study, our patients had more extensive metastatic disease and a larger number of lesions.…”

Section: Discussionsupporting

confidence: 67%

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Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases

Tang

et al. 2019

Journal of Surgical Oncology

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Background and Objectives To assess the efficacy and the effect of biologic effective dose (BED) on outcomes treated by hypofractionated stereotactic radiotherapy for colorectal cancer (CRC) oligometastases. Methods Patients with CRC oligometastases treated at our hospital between 2009 and 2016 were included. The relationship between BED and risk of local recurrence was assessed. Recursive partitioning analysis (RPA) was used to evaluate the effect of BED on outcomes. Results A total of 48 patients were included in this study. Median follow‐up time of surviving patient was 15 months (range, 3‐82 months). The 1‐year local control rate was 85%. The risk of local recurrence decreased sharply when BED was >90 Gy10. RPA showed BED of 100 Gy 10 was the appropriate dose for recurrence risk stratification. BED ≥ 100 Gy 10 was significantly better than BED < 100 Gy 10 for achieving 1‐year local control (94.4% vs 63.2%; P = 0.022) and 1‐year OS (100% vs 73.4%; P = 0.028). One patient who received long‐term antiangiogenic treatment died of massive intestinal hemorrhage; no other grade 3 or above early or late events were observed. Conclusions Hypofractionated stereotactic radiotherapy provides favorable outcomes with acceptable toxicities in CRC oligometastases. BED ≥ 100 Gy is associated with better outcomes.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 67%

Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases

Tang

et al. 2019

Journal of Surgical Oncology

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“…We are taking steps to seek external databases for additional validation and look forward to reporting the results of external validation in a subsequent study, which would also provide a larger sample size and may thus potentially elucidate an association between RR-and TTP-related predictors. Second, because the median BED 10 of the prescription doses in our study is 112.5 Gy (which falls into the optimal dose range for tumor control according to previous reports 39,42,43 ), the applicability of our models in patients treated with lower BED 10 (<112.5 Gy) still requires validation. Additionally, caution should be exercised before applying these nomogram models in the setting of particularly large tumors (>5 cm) given the limited number of such patients (n Z 7) within our study population and patients with ultracentral lesions (because ultracentral lesions are not treated with SABR per our institutional standard of care).…”

Section: Discussionmentioning

confidence: 91%

Predicting 5-Year Progression and Survival Outcomes for Early Stage Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiation Therapy: Development and Validation of Robust Prognostic Nomograms

Kang

Ning

Feng

et al. 2020

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Our purpose was to develop predictive nomograms for overall survival (OS), progression-free survival (PFS), and time-to-progression (TTP) at 5 years in patients with early-stage non-small cell lung cancer (ES-NSCLC) treated with stereotactic ablative radiation therapy (SABR). Methods and Materials: The study cohort included 714 ES-NSCLC patients treated with SABR from 2004-2015 with median follow-up of 59 months, divided into training and testing sets (8:2), with the former used for nomogram development.

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“…(1)] does not consider tumor volume. A recent study also mentioned the escalation of BED to high levels (>150 Gy) would be required for patients with a tumor size >3 cm in lung SBRT. Modification of the linear quadratic model and dose escalation for patients with larger tumor volume were necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Biologically equivalent dose (BED) has been introduced into optimal doses and fractionation schedules of SBRT . BED 10 , BED calculated using α / β of 10 Gy in the linear quadratic model, is used to predict of local control in lung SBRT.…”

Section: Methodsmentioning

confidence: 99%

Using max standardized uptake value from positron emission tomography to assess tumor responses after lung stereotactic body radiotherapy for different prescriptions

Ding

Zollinger

Ebeling

et al. 2018

J Applied Clin Med Phys

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PurposeTo retrospectively investigate tumor responses of lung SBRT patients for different prescriptions. To analyze the relation between optimal biologically equivalent dose (BED) and tumor responses.Methods and MaterialsTumor responses after lung SBRT were compared by examining 48 treatments used four prescriptions. This study used simplified tumor response criteria: (a) Complete Response (CR) — post max SUV (SUV post) after SBRT in the treated tumor region was almost the same as the SUVs in the surrounding regions; (b) Partial Response (PR) — SUV post was smaller than previous max SUV (SUV pre), but was greater than the SUVs in the surrounding regions; (c) No Response (NR) — SUV post was the same as or greater than SUV pre. Some SUV post reported as mild or favorable responses were classified as CR/PR. BED calculated using α/β of 10 Gy were analyzed with assessments of tumor responses for SBRT prescriptions.ResultsFor the prescriptions (9 Gy × 5, 10 Gy × 5, 11 Gy × 5, and 12 Gy × 4) historically recommended by RTOG, we observed that higher BED 10 and lower tumor volume would achieve a higher complete response rate. The highest complete response rate was observed for smallest tumor volume (PTV ave = 6.8 cc) with higher BED 10 (105.6) of 12 Gy × 4 prescription. For 11 Gy × 5 prescription, the BED 10 (115.5) was the highest, but its complete response rate (58%) was lower than 79% of 12 Gy × 4 prescription. We observed the PTV ave of 11 Gy × 5 prescription was more than double of the PTV ave of 12 Gy × 4 prescription. For the same lung SBRT prescription (BED 10 > 100) earlier staging tumor had more favorable local control.ConclusionWe demonstrated post max SUV read from PET/CT could efficiently and accurately assess tumor response after lung SBRT. Although SBRT with prescriptions resulting in a BED 10 > 100 experienced favorable tumor responses for early staging cancer, escalation of BED 10 to higher levels would be beneficial for lung cancer patients with later staging and larger volume tumors.

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The Effect of Biologically Effective Dose and Radiation Treatment Schedule on Overall Survival in Stage I Non-Small Cell Lung Cancer Patients Treated With Stereotactic Body Radiation Therapy

Cited by 30 publications

References 20 publications

Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases

Outcomes after hypofractionated stereotactic radiotherapy for colorectal cancer oligometastases

Predicting 5-Year Progression and Survival Outcomes for Early Stage Non-small Cell Lung Cancer Treated with Stereotactic Ablative Radiation Therapy: Development and Validation of Robust Prognostic Nomograms

Using max standardized uptake value from positron emission tomography to assess tumor responses after lung stereotactic body radiotherapy for different prescriptions

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