The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer

Guerrero, Eduardo; Ahmed, Merina

doi:10.1016/j.lungcan.2015.11.015

Cited by 22 publications

(14 citation statements)

References 72 publications

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“…Taken together, our data are consistent with the perception that most SCNAs and cancer gene mutations accumulate in the primary tumor before metastatic dissemination, thereby challenging the view of a high degree of CIN during metastatic evolution. Furthermore, our observation that metastases served as the source of further metastatic spread in three of the four patients with oligometastatic disease might have clinical implications, whereby the removal of the metastatic lesions has the potential to prevent further metastatic progression . Additional approaches in larger matched cohorts are needed to better understand how CIN and ITH impact the biology of LUADs and how this interplay eventually influences cancer evolution.…”

Section: Discussionmentioning

confidence: 99%

Exploring the spatiotemporal genetic heterogeneity in metastatic lung adenocarcinoma using a nuclei flow‐sorting approach

Lorber

Andor

Dietsche

et al. 2018

The Journal of Pathology

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Variable tumor cellularity can limit sensitivity and precision in comparative genomics because differences in tumor content can result in misclassifying truncal mutations as region‐specific private mutations in stroma‐rich regions, especially when studying tissue specimens of mediocre tumor cellularity such as lung adenocarcinomas (LUADs). To address this issue, we refined a nuclei flow‐sorting approach by sorting nuclei based on ploidy and the LUAD lineage marker thyroid transcription factor 1 and applied this method to investigate genome‐wide somatic copy number aberrations (SCNAs) and mutations of 409 cancer genes in 39 tumor populations obtained from 16 primary tumors and 21 matched metastases. This approach increased the mean tumor purity from 54% (range 7–89%) of unsorted material to 92% (range 79–99%) after sorting. Despite this rise in tumor purity, we detected limited genetic heterogeneity between primary tumors and their metastases. In fact, 88% of SCNAs and 80% of mutations were propagated from primary tumors to metastases and low allele frequency mutations accounted for much of the mutational heterogeneity. Even though the presence of SCNAs indicated a history of chromosomal instability (CIN) in all tumors, metastases did not have more SCNAs than primary tumors. Moreover, tumors with biallelic TP53 or ATM mutations had high numbers of SCNAs, yet they were associated with a low interlesional genetic heterogeneity. The results of our study thus provide evidence that most macroevolutionary events occur in primary tumors before metastatic dissemination and advocate for a limited degree of CIN over time and space in this cohort of LUADs. Sampling of primary tumors thus may suffice to detect most mutations and SCNAs. In addition, metastases but not primary tumors had seeded additional metastases in three of four patients; this provides a genomic rational for surgical treatment of such oligometastatic LUADs. Copyright © 2018 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Exploring the spatiotemporal genetic heterogeneity in metastatic lung adenocarcinoma using a nuclei flow‐sorting approach

Lorber

Andor

Dietsche

et al. 2018

The Journal of Pathology

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“…In lung cancer, several retrospective and a few prospective studies have suggested a potential benefit of using locoregional therapy for metastasis [7,[18][19][20]. Furthermore, prior studies focusing on a single extrathoracic metastasis, especially brain metastasis, have demonstrated better prognostic outcome with local therapy using surgery or stereotactic radiation therapy [4,5,15,18,[21][22][23][24]. Given these data in the local therapy for oligometastatic disease, the newly defined M1b category with frequent involvement of brain consists of a unique subset of patients who can be considered as potential candidates for further studies to optimize locoregional treatment approaches.…”

Section: Discussionmentioning

confidence: 99%

M1b Disease in the 8th Edition of TNM Staging of Lung Cancer: Pattern of Single Extrathoracic Metastasis and Clinical Outcome

et al. 2019

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Background The 8th edition of TNM staging of non‐small cell lung cancer (NSCLC) has revised M classification and defined M1b disease with single extrathoracic metastasis, which is distinguished from M1c with multiple extrathoracic metastases. We investigated the prevalence, characteristics, and overall survival (OS) of M1b disease in patients with stage IV NSCLC. Methods The study reviewed the medical records and imaging studies of 567 patients with stage IV NSCLC to determine M stage using the 8th edition of TNM staging. Clinical characteristics and OS were compared according to M stages. Results Among 567 patients, 57 patients (10%) had M1b disease, whereas 119 patients (21%) had M1a disease and 391 patients (69%) had M1c disease. Squamous histology was more common in M1b (16%) than in M1a (6%) and M1c (6%; p = .03). The median OS of patients with M1b disease was 14.8 months, compared with 22.6 months for patients with M1a and 13.4 months for those with M1c disease (p < .0001). Significant OS differences of M1b compared with single‐organ M1c and multiorgan M1c groups were noted (single‐organ M1c vs. M1b: hazard ratio [HR], 1.49; p = .02; multiorgan M1c vs. M1b: HR, 1.57; p = .01) in multivariable analyses adjusting for smoking and systemic therapy types. Among patients with M1b disease, the brain was the most common site of single metastasis (28/57; 49%), followed by bone (16/57; 28%). Single brain metastasis was more frequently treated with local treatment (p < .0001). Conclusion M1b disease was noted in 10% of patients with stage IV NSCLC. Squamous histology was more common in M1b group than others. The brain was the most common site of single metastasis and was often treated locally. Implications for Practice The newly defined group of M stage consists of a unique subset among patients with stage IV non‐small cell lung cancer that can be studied further to optimize treatment approaches.

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“…Utvrđeno je da oligometastatska bolest ima bolju prognozu i duže ukupno preživljenje u odnosu na diseminiranu tzv. polimetastatsku bolest i stoga je lokalna kontrola malobrojnih metastatskih depozita preporučena [28][29][30][31][32][33].…”

Section: Diskusijaunclassified

Zaštita Od Zračenja Pacijenata U Toku Radioterapijskog Tretmana Primjenom Modernih Tehnika Zračenja

Trokić¹,

Marosevic²,

Jaroš³

et al. 2018

Zaštita Od Jonizirajućeg Zračenja Kod Medicinske Ekspozicije

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ApstraktCilj: prikazati metodologiju rada primjenom modernih tehnika zračenja. Pozadina: Tehnološki razvoj rezultirao je implementacijom novih tehnika zračenja i omogućio preciznu isporuku visokih doza zračenja na ciljni volumen uz maksimalnu poštedu okolnih zdravih tkiva. Metodologija: priprema pacijenta na 4DCT-simulatoru uz adekvatnu imobilizaciju, fuzija simulacione CT slike s dijagnostičkim CT/MRI/PET, delineacija volumena zračenja i zdravih organa. Planiranje zračenja provodi se prema VMAT/RapidArc: Eclipse TPS protokolu s ciljem eskalacije doze u targetu i maksimalnom poštedom zdravih tkiva strmim padom doze. To se postiže izocentričnom isporukom doze iz više sekvencijalnih malih snopova zračenja nejednakog intenziteta (IMRT) ili Arc-tehnikom iz izvora koji kruži oko pacijenta za 360 o , dok je volumen zračenja moduliran dinamičkim pomjeranjem listova kolimatora (VMAT SRS/SRT, SBRT). Preciznost isporuke doze provjerom pozicije targeta osigurava se slikovnim vođenjem radioterapije (IGRT) tokom isporuke doze (OBI CBCT). Diskusija: primjena modernih tehnika zračenja zahtijeva visokosofisticiranu opremu i educirano osoblje, što omogućava isporuku visokih doza zračenja na tumorsko tkivo. Pošteda zdravih tkiva je značajna u odnosu na ranije tehnike, ali istovremeno se malim dozama ozrači veći volumen zdravog tkiva. Zaključak: Isporuka visokih doza zračenja na tumorsko tkivo je u direktnoj korelaciji s boljom tumorskom kontrolom, uz doze na zdrava tkiva ispod granice doze koja ne dovodi do značajnijeg poremećaja funkcije (<5% komplikacija). Provođenje QA procedura u cilju kontrole visokih terapijskih doza na target i niskih doza na zdrava tkiva u cilju prevencije ranih i kasnih nusefekata.Ključne riječi: zaštita, zračenje, SRT/SBRT, IMRT.* Studija prikazana u članku provedena je u Affidea IMC Centru za radioterapiju Banja Luka

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The role of stereotactic ablative radiotherapy (SBRT) in the management of oligometastatic non small cell lung cancer

Cited by 22 publications

References 72 publications

Exploring the spatiotemporal genetic heterogeneity in metastatic lung adenocarcinoma using a nuclei flow‐sorting approach

Exploring the spatiotemporal genetic heterogeneity in metastatic lung adenocarcinoma using a nuclei flow‐sorting approach

M1b Disease in the 8th Edition of TNM Staging of Lung Cancer: Pattern of Single Extrathoracic Metastasis and Clinical Outcome

Zaštita Od Zračenja Pacijenata U Toku Radioterapijskog Tretmana Primjenom Modernih Tehnika Zračenja

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