Tumor Volume Change With Stereotactic Body Radiotherapy (SBRT) for Early-stage Lung Cancer

Bhatt, Aashish D.; El-Ghamry, Moataz N.; Bhatt, Geetika; Harkenrider, Matthew M.; Schuler, John; Zacarias, Albert; Civelek, A. Cahid; Pan, Jianmin; Shesh, N.; Woo, Shiao Y.

doi:10.1097/coc.0b013e318287bd7f

Cited by 19 publications

(19 citation statements)

References 19 publications

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“…These data strongly support the idea that tumor size is a key predictor of outcome in NSCLC patients treated with SBRT 13 . Bhatt et al 32 observed that T-stage was associated with tumor shrinkage during SBRT treatment, with T1 tumors showing greater decrease than T2 tumors. These data imply that patients with larger tumors might benefit from dose escalation (if normal tissue constraints allow).…”

Section: Discussionmentioning

confidence: 99%

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Kim

Balagurunathan

et al. 2017

Medical Physics

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Purpose To investigate whether imaging features from pre-treatment planning CT scans are associated with overall survival (OS), recurrence-free survival (RFS), and loco-regional recurrence-free survival (LR-RFS) after stereotactic body radiotherapy (SBRT) among non-small-cell lung cancer (NSCLC) patients. Patients and methods A total of 92 patients (median age: 73 years) with stage I or IIA NSCLC were qualified for this study. A total dose of 50 Gy in 5 fractions was the standard treatment. Besides clinical characteristics, 24 “semantic” image features were manually scored based on a point scale (up to 5) and 219 computer-derived “radiomic” features were extracted based on whole tumor segmentation. Statistical analysis was performed using Cox proportional hazards model and Harrell’s C-index, and the robustness of final prognostic model was assessed using ten-fold cross validation by dichotomizing patients according to the survival or recurrence status at 24 months. Results Two-year OS, RFS and LR-RFS were 69.95%, 41.3% and 51.85%, respectively. There was an improvement of Harrell’s C-index when adding imaging features to a clinical model. The model for OS contained the Eastern Cooperative Oncology Group (ECOG) performance status (Hazard Ratio [HR] = 2.78, 95% Confidence Interval [CI]: 1.37 – 5.65), pleural retraction (HR = 0.27, 95% CI: 0.08 – 0.92), F2 (short axis × longest diameter, HR = 1.72, 95% CI: 1.21 – 2.44) and F186 (Hist-Energy-L1, HR = 1.27, 95% CI: 1.00 - 1.61); The prognostic model for RFS contained vessel attachment (HR = 2.13, 95% CI: 1.24 – 3.64) and F2 (HR = 1.69, 95% CI: 1.33 – 2.15); and the model for LR-RFS contained the ECOG performance status (HR = 2.01, 95% CI: 1.12 – 3.60) and F2 (HR = 1.67, 95% CI: 1.29 – 2.18). Conclusions Imaging features derived from planning CT demonstrate prognostic value for recurrence following SBRT treatment, and might be helpful in patient stratification.

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Section: Discussionmentioning

confidence: 99%

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Kim

Balagurunathan

et al. 2017

Medical Physics

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“…using dose fractionation similar to our study also concluded that most patients experience significant volume reduction after three fractions of treatment. The median OTT for their patients was 15 days …”

Section: Discussionmentioning

confidence: 99%

Volume changes with stereotactic body radiation therapy in early lung cancer: Time trends and outcomes

et al. 2016

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“…Chest wall toxicity was significantly related to dose-volume parameters 9,10) and in our study, V30 Gy and V32 Gy of the chest wall were significantly reduced in the adaptive plan. Bhatt et al 14) reported that the doses of the chest wall and left ventricle were reduced in adaptive plans compared with initial plans. And, in our study, V20 Gy, D1500 cc, and D1000 cc of the lung, which are related to lung toxicity, were also significantly decreased in the adaptive plan.…”

Section: Discussionmentioning

confidence: 99%

“…12,13) TVC has also been reported even in SBRT despite its short overall treatment time. [14][15][16][17][18] …”

Section: Introductionmentioning

confidence: 99%

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

2015

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The purpose of this study is to evaluate efficacy and feasibility of adaptive radiotherapy according to tumor volume change (TVC) in early stage non-small cell lung cancer (NSCLC) using stereotactic body radiotherapy (SBRT). Twenty-two lesions previously treated with SBRT were selected. SBRT was usually performed with a total dose of 48 Gy or 60 Gy in four fractions with an interval of three to four days between treatments. For evaluation of TVC, gross tumor volume (GTV) was contoured on each cone-beam computed tomography (CBCT) image used for image guidance. Intensity modulated radiotherapy (IMRT) planning was performed in the first CBCT (CBCT1) using a baseline plan. For ART planning (ART), re-optimization was performed at 2 nd , 3 rd , and 4 th CBCTs (CBCT2, CBCT3, and CBCT4) using the same angle and constraint used for the baseline plan. The ART plan was compared with the non-ART plan, which generated copying of the baseline plan to other CBCTs. Average GTV volume was 10.7 cc. Average TVC was -1.5%, 7.3%, and -25.1% in CBCT2, CBCT3, and CBCT4 and the TVC after CBCT3 was significant (p＜0.05). However, the nine lesions were increased GTV in CBCT2. In the ART plan, V20 Gy, D1500 cc, and D1000 cc of lung were significantly decreased (p＜0.05), and V30 Gy and V32 Gy of the chest wall were also decreased (p＜0.05). While D min of planning target volume (PTV) decreased by 8.3% in the non-ART plan of CBCT2 compared with the baseline plan in lesions with increased tumor size (p=0.021), PTV coverage was not compromised in the ART plan. Based on this result, use of the ART plan may improve target coverage and OAR saving. Thus ART using CBCT should be considered in early stage NSCLC with SBRT.

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Tumor Volume Change With Stereotactic Body Radiotherapy (SBRT) for Early-stage Lung Cancer

Abstract: Significant decrease in GTV volume based on daily CBCT was demonstrated during SBRT treatment. Adaptive SBRT has the potential to minimize integral dose to the surrounding normal tissues without compromising GTV coverage.

Cited by 19 publications

References 19 publications

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Imaging features from pretreatment CT scans are associated with clinical outcomes in nonsmall‐cell lung cancer patients treated with stereotactic body radiotherapy

Volume changes with stereotactic body radiation therapy in early lung cancer: Time trends and outcomes

Feasibility and Efficacy of Adaptive Intensity Modulated Radiotherapy Planning according to Tumor Volume Change in Early Stage Non-small Cell Lung Cancer with Stereotactic Body Radiotherapy

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