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1.
Sung Jun Ma Michael Cummings Lucas M. Serra Yusef A. Syed Gregory M. Hermann Yuhchyau Chen Michael T. Milano Anurag K. Singh Jorge A. Gomez-Suescun Deepinder P. Singh 《Clinical lung cancer》2018,19(3):e297-e302
Purpose
To evaluate differences in outcomes of early-stage peripheral non–small-cell lung cancer (NSCLC) treated with either 3- or 5-fraction stereotactic body radiotherapy (SBRT) at 2 institutions.Patients and Methods
Patients diagnosed with peripherally located early-stage NSCLC who received either a median dose of 60 Gy (interquartile range [IQR], 60-60, biologically effective dose, 151-151) in 3 fractions or a median dose of 50 Gy (IQR, 50-50, biologically effective dose, 94-94) in 5 fractions were included in this study. All data were retrospectively collected and reviewed in an institutional review board–approved database.Results
A total of 192 lesions in 192 patients were identified: 94 received 3-fraction SBRT and 98 received 5-fraction SBRT. Patients in the 5-fraction cohort had significantly smaller tumors (P = .0021). Larger tumor size was associated with worse overall survival (hazard ratio, 1.40, P = .0013) for all patients. A single grade 3 toxicity was reported in each cohort. A propensity score–matched cohort of 94 patients was constructed with a median follow-up of 29.3 months (IQR, 17.3-44.6) for the 3-fraction cohort and 31.0 months (IQR, 17.0-48.5) for the 5-fraction cohort (P = .84). There were no statistically significant differences between these 2 cohorts in overall survival (P = .33), progression-free survival (P = .40), local failure (P = .86), and nodal or distant failure (P = .57) at 2 years.Conclusion
The 3- and 5-fraction SBRT regimens for early-stage peripheral NSCLC had comparable clinical outcomes. Both regimens were well tolerated. A large tumor size was an adverse prognostic factor for worse survival. 相似文献2.
Zachary D. Horne Michael J. Dohopolski David A. Clump Steven A. Burton Dwight E. Heron 《Practical radiation oncology》2018,8(3):e117-e123
Purpose
Local failure following concurrent chemoradiation and in-lobe failures following stereotactic body radiation therapy (SBRT) are common. We evaluated our institutional experience using SBRT as salvage in this setting.Methods and materials
Seventy-two patients were reirradiated with SBRT for residual, locally recurrent, or new primary non-small cell lung cancer within or adjacent to a high-dose external beam radiation therapy or SBRT field. Kaplan-Meier analysis with log-rank test were used to estimate endpoints and differentiate cohorts.Results
Median follow-up was 17.9 months. Patients had residual or recurrent disease (54.2%); 45.8% had new lung primaries. Median reirradiated T size was 2.5 cm (range, 0.8-7.8 cm). Median pre-retreatment maximum standardized uptake value (SUVmax) was 7.15 (range, 1.2-37.6). The most common SBRT reirradiation regimen was 48 Gy in 4 fractions (range, 17-60 Gy in 1-5 fractions). Median progression-free survival was 15.2 months, and median overall survival was 20.8 months. Two-year local failure was 21.6%. Patients with SUVmax at reirradiation <7.0 had a 2-year local control of 93.1% versus 61.1% above the median (P < .001). The 2-year rate of distant metastases was 10.4% versus 54.1% in patients treated for a new primary versus residual or recurrent disease (P < .001). Median progression-free survival was 31.9 months versus 8.4 months, respectively (P = .037). Median survival of patients treated for new primary was 25.2 months versus 16.2 months with residual or recurrent disease (P = .049), and median survival for patients with reirradiation SUVmax below the median was 42.0 months versus 9.8 months above the median (P < .001). Acute any-grade toxicity was seen in 29.2% of patients, acute grade 3 toxicity in 11.1%, and late grade 3 toxicity in 1.4% with no treatment-related deaths.Conclusions
SBRT appears to be a safe and effective means of salvaging recurrent, residual, or new primary NSCLC in or adjacent to a previous high-dose radiation field. 相似文献3.
Nitin Ohri Wolfgang Tomé Shalom Kalnicki Madhur Garg 《Practical radiation oncology》2018,8(2):e33-e39
Background
Stereotactic body radiation therapy (SBRT) is increasingly used to treat early-stage non-small cell lung cancer (NSCLC). A previous report introduced the term size-adjusted biologically effective dose (sBED), which accounts for tumor diameter and biologically effective dose (BED) and may be used to predict the likelihood of local control following SBRT. Here we seek to replicate those findings using a separate dataset.Methods and materials
We queried the RSSearch Patient Registry for patients treated with SBRT for stage I NSCLC. Kaplan-Meier survival curves, log-rank testing, and Cox proportional hazards modeling were used to evaluate tumor diameter, BED, and treatment planning algorithm as predictors of local control. sBED was defined as BED minus 10 times the tumor diameter (in centimeters). Tumor control probability (TCP) modeling was performed to characterize the relationship between sBED and the likelihood of local control 2 years after SBRT.Results
A total of 928 patients met inclusion criteria. Median BED was 115.5 Gy, and 59% of patients had T1 tumors. Local control rates following treatments planned using a pencil beam algorithm were inferior to those observed following treatments planned using a Monte Carlo algorithm (89% vs 96% at 2 years, log-rank P = .022). In a multivariable Cox model adjusted for tumor diameter and BED, the use of a pencil beam planning algorithm was associated with increased risk of local failure (hazard ratio, 2.39; 95% confidence interval, 1.08-5.29; P = .032). TCP modeling, restricted to patients treated using a Monte Carlo algorithm, demonstrated that sBED values of 60, 80, and 100 Gy yield predicted TCP rates of 91%, 95%, and 97%, respectively.Conclusions
Using a large, multi-institutional database, we found a strong association between treatment planning algorithm and local control rates following SBRT for early-stage NSCLC. sBED is a useful tool for predicting the likelihood of local control following SBRT in this setting. 相似文献4.
Stefan S. Jeppesen Lars-Erik Matzen Carsten Brink Rasa Bliucukiene Søren Kasch Tine Schytte Charlotte Kristiansen Olfred Hansen 《Journal of Geriatric Oncology》2018,9(6):575-582
Objectives
Overall survival ?OS? for patients with localized non-small cell lung cancer ?NSCLC? treated with stereotactic body radiotherapy ?SBRT? is poorer than for patients undergoing surgery. Patients who undergo SBRT are often ineligible for surgery due to significant comorbidities that can impact their mortality. A comprehensive geriatric assessment (CGA) that identifies and treats aging related comorbidities could improve OS and quality of life (QoL). This randomized study investigated if a CGA added to SBRT impacts QoL, survival, and unplanned admissions.Materials and Methods
From January 2015 to June 2016, 51 patients diagnosed with T1-2N0M0 NSCLC treated with SBRT were enrolled. The patients were randomized 1:1 to receive SBRT +/? CGA. EuroQoL Group 5D (EQ-5D) health index and visual analogue scale (VAS) scores were assessed at start of SBRT, at five weeks, and every third month for a year after SBRT.Results
There were 26 and 25 patients randomized to receive ± CGA, respectively. The repeated measures one-way analysis of variance (ANOVA) test of the EQ-5D health index and VAS scores did not show statistically significant differences between groups. For the EQ-5D VAS scores at twelve months follow-up there was a small difference between the groups although not statistically significant. Even though more patients deceased in the no-CGA group, no statistically significant difference in survival rates and unplanned admission rate was observed between groups.Conclusion
In patients with localized NSCLC treated with SBRT, a CGA did not impact the overall QoL, the prevalence/length of unplanned admissions, or survival. There was an indication of small differences in QoL and survival in the data, but such differences can only be validated in larger studies. 相似文献5.
Toshiya Maebayashi Naoya Ishibashi Takuya Aizawa Masakuni Sakaguchi Tsutomu Saito Jiro Kawamori Yoshiaki Tanaka 《Journal of Geriatric Oncology》2018,9(6):594-599
Objectives
Our aim was to investigate long-term treatment outcomes in older patients with early stage non-small cell lung cancer (NSCLC) and the presence or absence of therapeutic benefits, using the G8 screening tool.Methods
We retrospectively studied 43 older patients (median age 78?years, range 65–89?years) with stage I lung tumors (T1 and T2 tumors in 34 and 9 patients, respectively), who underwent stereotactic body radiotherapy (SBRT). This study assessed outcomes in a cohort of patients who received geriatric assessments, performed between 2004 and 2011, before the start of their SBRT regimen. Any questions asked to patients before undergoing treatment were applied to the G8 screening tool.Results
G8 scores ranged from 8 to 16 (median, 12) in all patients (n?=?43), while G8 scores in the T1 and T2 groups ranged from 9 to 16 (median, 13) and 8 to 15 (median, 12), respectively. In patients with G8 scores ≤12, the 2-year and 5-year survival rates were 56.1% and 28% respectively, while the rates were 94.1% and 68.4%, respectively, in patients with G8 scores ≥13 (P?=?0.0014). During long-term follow-up, 25.9% of the patients (n?=?43) died of the primary disease, NSCLC, and 34.9% of patients died of other diseases or other types of cancer.Conclusion
SBRT may be effective, even in older adults. Regardless of age, SBRT improved the long-term survival of patients only with G8 scores ≥13. The G8 screening tool may aid in determining whether older patients with comorbidities would benefit from SBRT. 相似文献6.
David E. Long Mark Tann Ke Huang Gregory Bartlett James O. Galle Yukie Furukawa Mary Maluccio John A. Cox Feng-Ming Kong Susannah G. Ellsworth 《Practical radiation oncology》2018,8(6):429-436
Purpose
Hepatobiliary iminodiacetic acid (HIDA) scans provide global and regional assessments of liver function that can serve as a road map for functional avoidance in stereotactic body radiation therapy (SBRT) planning. Functional liver image guided hepatic therapy (FLIGHT), an innovative planning technique, is described and compared with standard planning using functional dose-volume histograms. Thresholds predicting for decompensation during follow up are evaluated.Methods and materials
We studied 17 patients who underwent HIDA scans before SBRT. All SBRT cases were replanned using FLIGHT. The following dosimetric endpoints were compared for FLIGHT versus standard SBRT planning: functional residual capacity <15 Gy (FRC15HIDA), mean liver dose (MLD), equivalent uniform dose (EUD), and functional EUD (FEUD). Receiver operating characteristics curves were used to evaluate whether baseline HIDA values, standard cirrhosis scoring, and/or dosimetric data predicted clinical decompensation.Results
Compared with standard planning, FLIGHT significantly improved FRC15HIDA (mean improvement: 5.3%) as well as MLD, EUD, and FEUD (P < .05). Considerable interindividual variations in the extent of benefit were noted. Decompensation during follow-up was associated with baseline global HIDA <2.915%/min/m2, FRC15HIDA <2.11%/min/m2, and MELD ≥11 (P < .05).Conclusions
FLIGHT with HIDA-based parameters may complement blood chemistry-based assessments of liver function and facilitate individualized, adaptive liver SBRT planning. 相似文献7.
Govind Raghavan Narek Shaverdian Shawna Chan Fang-I. Chu Percy Lee 《Clinical lung cancer》2018,19(5):e759-e766
Introduction
Frailty of surgical patients has been associated with worse outcomes. There is limited literature discussing frailty in patients with lung cancer treated with stereotactic body radiotherapy (SBRT). This study assesses the relationship between frailty and overall survival (OS), tumor control, and toxicity in patients with early-stage non–small-cell lung cancer (NSCLC) treated with SBRT.Patients and Methods
A retrospective review of patients with early-stage NSCLC treated with SBRT at a single institution between February 2009 and September 2014 was performed. A modified frailty index (mFI) of 8 variables was created, and patients were categorized as nonfrail (mFI ≤ 2) and frail (mFI > 2). OS, recurrence-free survival (RFS), local control (LC), regional control, and distant control (DC) were compared between frail and nonfrail patients by Kaplan-Meier analysis and log-rank tests. Univariate and multivariable analyses were conducted.Results
One hundred forty cases of early-stage NSCLC were included, with 49 frail (35.0%) and 91 nonfrail (65.0%) subjects. OS was significantly lower in frail than nonfrail patients (P = .01) with 3-year OS of 59.3% versus 82.0%. LC and DC were significantly lower in frail than nonfrail patients (LC: P = .02, 3-year LC of 85.3% vs. 97.0%; DC: P = .03, 3-year DC of 80.6% vs. 93.4%), as was RFS (P = .01, 3-year RFS of 53.4% vs. 74.5%). Frailty remained a significant predictor for shorter OS on multivariable analysis (hazard ratio = 1.98; 95% confidence interval, 1.02-3.85; P = .04).Conclusion
Frailty is associated with reduced OS in early-stage NSCLC patients treated with SBRT. Characterizing frailty using an mFI before treatment could help guide treatment decision making and patient counseling. 相似文献8.
Yukinori Matsuo Takamasa Mitsuyoshi Takashi Shintani Yusuke Iizuka Takashi Mizowaki 《Journal of Geriatric Oncology》2018,9(6):589-593
Purpose
The purpose of the present study was to retrospectively evaluate impact of pre-treatment skeletal muscle mass (SMM) on overall survival and non-lung cancer mortality after stereotactic body radiotherapy (SBRT) for patients with stage I non-small cell lung cancer (NSCLC).Methods and Materials
One-hundred and eighty-six patients whose abdominal CT before the treatment was available were enrolled into this study. The patients were divided into two groups of SMM according to gender-specific thresholds for unilateral psoas area. Operability was judged by the treating physician or thoracic surgeon after discussion in a multi-disciplinary tumor board.Results
Patients with low SMM tended to be elderly and underweight in body mass index compared with the high SMM. Overall survival in patients with the low SMM tended to be worse than that in the high SMM (41.1% and 55.9% at 5?years, P?=?0.115). Cumulative incidence of non-lung cancer death was significantly worse in the low SMM (31.3% at 5?years compared with 9.7% in the high SMM, P?=?0.006). Multivariate analysis identified SMM and operability as significant factors for non-lung cancer mortality. Impact of SMM on lung cancer death was not significant. No difference in rate of severe treatment-related toxicity was observed between the SMM groups.Conclusion
Low SMM is a significant risk factor for non-lung cancer death, which might lead to worse overall survival, after SBRT for stage I NSCLC. However, the low SMM does not increase lung cancer death or severe treatment-related toxicity. 相似文献9.
Michael A. Cummings Sung Jun Ma Gregory Hermann Lucas Serra Yusef Syed Harish K. Malhotra Yuhchyau Chen Michael T. Milano Jorge A. Gomez-Suescun Deepinder P. Singh Anurag K. Singh 《Clinical lung cancer》2018,19(6):511-517
Purpose
To evaluate differences in local control (LC), disease-specific (DC), and overall survival (OS) of patients with early-stage non–small-cell lung cancer (NSCLC) treated with single- (SF) versus 5-fraction (FF) stereotactic body radiation therapy (SBRT) at 2 institutions.Patients and Methods
Peripheral early-stage NSCLC cases treated with a median dose of 30 Gy in SF or a median dose of 50 Gy in FF were included per institutional practice. Kaplan-Meier and Cox models were used to assess survival. A matched-pair analysis was performed to account for imbalances. Toxicities including Common Terminology Criteria for Adverse Events (CTCAE) grade 3 pneumonitis, chest wall pain requiring long-acting narcotics, and hospitalization for respiratory events 6 months posttreatment were recorded.Results
A total of 163 lesions were treated between 2007 and 2015; 65 received SF SBRT and 98 received FF SBRT. Most tumors were T1 (n = 92) and T2 (n = 34) lesions and had adenocarcinoma (n = 77) and squamous cell carcinoma (n = 46) histologies, respectively. In the matched cohort, there were no differences in OS, LC, DC, or progression-free survival between the groups. LC and OS at 1 year in the matched cohort was 95% and 88%, and 87% and 84% in the SF and FF cohorts, respectively. There was 1 grade 3 pneumonitis in the FF group, and 9 total hospitalizations post-SBRT, 3 (5%) in the SF group and 6 (6%) in the FF group.Conclusions
No statistically significant differences were seen in LC or DC following SF or FF SBRT in this matched cohort of peripheral lesions. No grade 4 or higher toxicities were reported. 相似文献10.
Alexander V. LouieGeorge Rodrigues Malek HannoufFrank Lagerwaard David Palma Gregory S. Zaric Cornelis HaasbeekSuresh Senan 《Radiotherapy and oncology》2011,99(2):161-165
Background and purpose
To model outcomes of SBRT versus best supportive care (BSC) in elderly COPD patients with stage I NSCLC.Material and methods
A Markov model was constructed to simulate the quality-adjusted and overall survival (OS) in patients ?75 years undergoing either SBRT or BSC for a five-year timeframe. SBRT rates of local, regional and distant recurrences were obtained from 247 patients treated at the VUMC, Amsterdam. Recurrence rates were converted into transition probabilities and stratified into four groups according to T stage (1, 2) and COPD GOLD score (I-II, III-IV). Data for untreated patients were obtained from the California Cancer Registry. Tumor stage and GOLD score utilities were adapted from the literature.Results
Our model correlated closely with the source OS data for SBRT treated and untreated patients. After SBRT, our model predicted for 6.8-47.2% five-year OS and 14.9-27.4 quality adjusted life months (QALMs). The model predicted for 9.0% and 2.8% five-year OS, and 10.1 and 6.1 QALMs for untreated T1 and T2 patients, respectively. The benefit of SBRT was the least for T2, GOLD III-IV patients.Conclusion
Our model indicates that SBRT should be considered in elderly stage I NSCLC patients with COPD. 相似文献11.
L. Ceniceros J. Aristu E. Castañón C. Rolfo J. Legaspi A. Olarte G. Valtueña M. Moreno I. Gil-Bazo 《Clinical & translational oncology》2016,18(3):259-268
Introduction
Lung cancer is the most frequent neoplasm in humans. Surgery is considered the best therapeutic approach for stage I non-small lung cell cancer (NSCLC). However, a remarkable amount of patients are considered as inoperable. Stereotactic body radiotherapy (SBRT) has risen as an option for those patients, rendering excellent results in quality of life and survival.Materials and methods
We analyzed clinical studies published between 2002 and 2015 which included SBRT as a treatment modality. Our own clinical series was analyzed as well. The patterns of failure following SBRT were investigated, together with the outcomes and the toxicity observed.Results
SBRT has proven to maintain an excellent local control. The analysis showed the tumor size and the histology as determinant factors for the response to treatment.Conclusion
According to the published evidence as well as our own experience, SBRT is a safe and feasible approach for early NSCLC. Its results may be comparable with surgery treatment.12.
Henri B. Wolff Leonie Alberts Elisabeth A. Kastelijn Birgit I. Lissenberg-Witte Jos W. Twisk Frank J. Lagerwaard Suresh Senan Sherif Y. El Sharouni Franz M.N.H. Schramel Veerle M.H. Coupé 《Journal of thoracic oncology》2018,13(5):689-698
Introduction
There is an ongoing debate on the optimal treatment for stage I NSCLC, with increasing evidence for comparable health outcomes after surgery and stereotactic body radiation therapy (SBRT). For clinical decision making, the experienced quality of life, summarized as health utility, is of importance to choosing between treatments. In this study, we evaluated differences in longitudinal health utility in stage I NSCLC in the first year after surgical resection versus after SBRT before any recurrence of disease. We also assessed the impact of potential prognostic variables on health utility.Methods
Prospectively collected databases containing data on patients with stage I NSCLC treated with either SBRT or surgery were pooled from two large hospitals in the Netherlands. Quality of life data were measured by the Quality of Life Questionnaire–Core 30 questionnaire at baseline and 3, 6, and 12 months after treatment. Health utility (measured using the European Quality of Life Five-Dimension questionnaire) was calculated from the Quality of Life Questionnaire–Core 30 questionnaire by using a mapping algorithm. Propensity score matching was used to adjust for selection bias. Treatment effects were estimated for the matched patients by using a longitudinal mixed model approach.Results
After correction for Eastern Cooperative Oncology Group score, sex, and age, the difference in 1-year averaged health utility between the SBRT and surgery groups was 0.026 (95% confidence interval: 0.028–0.080). Differences in health utility decreased over time.Conclusions
A small but not statistically significant difference in health utility was found between patients with stage I NSCLC treated with surgery and those treated with SBRT. Current analysis strengthens existing evidence that SBRT is an equivalent treatment option for early-stage NSCLC. Comparative cost-effectiveness remains to be determined. 相似文献13.
Wen-Chi Yang Furen Xiao Jin-Yuan Shih Chao-Chi Ho Ya-Fang Chen Ham-Min Tseng Kuan-Yu Chen Wei-Yu Liao Chong-Jen Yu James Chih-Hsin Yang Sung-Hsin Kuo Jason Chia-Hsien Cheng Pan-Chyr Yang Feng-Ming Hsu 《Radiotherapy and oncology》2018,126(2):368-374
Purpose
The impact of epidermal growth factor receptor (EGFR) mutations on radiotherapy for brain metastases (BM) is undetermined. We evaluated the effects of EGFR mutation status on responses and outcomes in non-small cell lung cancer (NSCLC) patients with BM, treated with upfront or salvage stereotactic radiosurgery (SRS).Methods and materials
From 2008 to 2015, 147 eligible NSCLC patients with 300 lesions were retrospectively analyzed. Patterns of tyrosine kinase inhibitor (TKI) therapy were recorded. Radiographic response was assessed. Brain progression-free survival (BPFS) and overall survival were calculated and outcome prognostic factors were evaluated.Results
Median follow-up time was 13.5?months. Of the EGFR-genotyped patients, 79 (65%) were EGFR mutants, and 42 (35%) were wild type. Presence of EGFR mutations was associated with higher radiographic complete response rates (CRR). Median time to develop new BM after SRS was significantly longer for mutant-EGFR patients (17 versus 10.5 months, p?=?0.02), predominantly for those with adjuvant TKI therapy (26.3 versus 15 months, p?=?0.01). EGFR mutations independently predicted better BPFS (HR?=?0.55, p?=?0.048) in multivariate analysis.Conclusions
In patients with NSCLC treated with SRS for BM, the presence of EGFR mutations is associated with a higher CRR, longer time for distant brain control, and better BPFS. The combination of SRS and TKI in selective patient group can be an effective treatment choice for BM with favorable brain control and little neurotoxicity. 相似文献14.
Wenji Guo Xuan Hui Salem Alfaifi Lori Anderson Scott Robertson Russell Hales Chen Hu Todd McNutt Stephen Broderick Jarushka Naidoo Richard Battafarano Stephen Yang K. Ranh Voong 《Practical radiation oncology》2018,8(4):e239-e248
Purpose
In patients with non-small cell lung cancer (NSCLC) who undergo trimodality therapy (chemoradiation followed by surgical resection), it is unknown whether limiting preoperative radiation dose to the uninvolved lung reduces postsurgical morbidity. This study evaluated whether radiation fall-off dose parameters to the contralateral lung that is unaffected by NSCLC are associated with postoperative complications in NSCLC patients treated with trimodality therapy.Methods and materials
We retrospectively reviewed NSCLC patients who underwent trimodality therapy between March 2008 and October 2016, with available restored digital radiation plans. Fischer's exact test was used to assess associations between patient and treatment characteristics and the development of treatment-related toxicity. Spearman rank correlation was used to measure the strength of association between dosimetric parameters.Results
Forty-six patients were identified who received trimodality therapy with intensity modulated radiation (median, 59.4 Gy; range, 45-70) and concurrent platinum doublet chemotherapy, followed by surgical resection. The median age was 64.9 years (range, 45.6-81.6). The median follow-up time was 1.9 years (range, 0.3-8.4). Twenty-four (52.2%) patients developed any-grade pulmonary toxicity and 14 (30.4%) patients developed grade 2+ pulmonary toxicity. There was an increased incidence of any-grade pulmonary toxicity in patients with contralateral lung volume receiving at least 20 Gy (V20) ≥7% compared with <7% (90%, n = 9 vs 41.7%, n = 15; P = .01). Similarly, contralateral lung V10 ≥20% was associated with an increased rate of any-grade pulmonary toxicity compared with V10 <20% (80%, n = 12 vs 38.7%, n = 12; P = .01). Pneumonectomy/bilobectomy was associated with grade 2+ pulmonary toxicity (P = .04).Conclusions
Patients who received a higher radiation fall-off dose volume parameter (V20 ≥7% and V10 ≥20%) to the contralateral uninvolved lung had a higher incidence of any-grade postoperative pulmonary toxicity. Limiting radiation fall-off dose to the uninvolved lung may be an important modifiable radiation parameter in limiting postoperative toxicity in trimodality patients. 相似文献15.
Purpose
Stereotactic body radiation therapy (SBRT) is increasingly being used for the management of localized prostate cancer. This trend combined with declining use of brachytherapy (BT) has pushed issues and questions regarding the use of SBRT to the forefront. A systematic literature review was conducted to review the current evidence of biochemical disease-free survival (bDFS) and toxicity of SBRT in high-risk (HR) prostate cancer.Methods and materials
A search was carried out on the PubMed and Embase databases. Studies were included if HR patients were treated using SBRT monotherapy or as a boost and bDFS was reported. Selected high-dose-rate (HDR) BT studies including HR patients from published reviews were selected to compare with SBRT results. Data from recent published phase 3 trials involving HR patients were also compared.Results
Our search yielded 8862 articles. Of these, 20 studies with a median follow-up from 1.6 to 7 years were included in this review. The 5-year bDFS was 81% to 91% in monotherapy studies and 90% to 98% in boost studies. For reference, 19 studies that reported treating HR patients with HDR monotherapy or boost were selected. The 5-year bDFS in HDR monotherapy studies and boost studies was 85% to 93% and 72% to 93%, respectively. The incidence of late grade 3 genitourinary toxicity was 0% to 4.4% and 0% to 2.3% in SBRT monotherapy and SBRT boost studies, respectively.Conclusion
The evidence for SBRT in HR patients in this review is based on observational studies with relatively few patients and short follow-up (level III evidence). Based on these data and the principles surrounding treatment, SBRT boost should ideally be validated in clinical trials. SBRT monotherapy should be used cautiously in highly selected HR patients outside of a clinical trial.Summary
Stereotactic body radiation therapy (SBRT) is increasingly being used for the management of clinically localized prostate cancer. This trend, combined with the decline in the use of brachytherapy, has pushed issues and questions regarding the use of SBRT to the forefront. A systematic literature review was conducted to establish the current evidence of biochemical and toxicity outcomes of SBRT in high-risk prostate cancer. 相似文献16.
Background and purpose
To evaluate the safety and efficacy of liver stereotactic body radiotherapy (SBRT), and examine potential factors impacting outcomes including prior liver-directed therapy.Materials and methods
Patients with ECOG 0–1, Child-Pugh Class A or B, and primary hepatocellular carcinoma (HCC) or liver metastases unsuitable for surgical resection or ablation were eligible for a prospective single arm trial. SBRT was delivered with a CyberKnife system to 45?Gy in 3 fractions with a predetermined dose de-escalation scheme. Adverse events, local control, and survival were assessed.Results
A total of 30 patients were enrolled. Eleven patients (37%) had HCC and 19 (63%) patients had liver metastases. Fourteen patients (47%) had prior liver-directed therapies including nine with liver resection, seven with trans-arterial chemoembolization, and six with radiofrequency ablation. Cumulative grade 2 and 3 acute toxicity occurred in 47% and 7% of patients, respectively. Similar rates of ≥grade 2 acute toxicity were observed between patients who had prior liver-directed treatments and those who did not. At a median follow-up of 12.7?months, 1-year local control and overall survival were 81% and 62%, respectively. Prior liver-directed therapy did not affect local control or survival.Conclusions
Liver SBRT is a safe and effective treatment even in the setting of prior liver-directed surgical and ablative therapies. 相似文献17.
David Palma Otto VisserFrank J. Lagerwaard Jose BelderbosBen Slotman Suresh Senan 《Radiotherapy and oncology》2011,101(2):240-244
Background
Elderly patients with stage I NSCLC who undergo surgical resection are at high risk of treatment-related toxicity. Stereotactic body radiation therapy (SBRT) may provide an alternative treatment with a favorable toxicity profile.Methods
A population-based registry in North-Holland was used to conduct a matched-pair analysis of overall survival (OS) after surgery versus SBRT for elderly patients (age ?75) who were diagnosed between 2005 and 2007. Patients were matched by age, stage, gender, and treatment year; co-morbidity data was not available. SBRT was delivered at two centers; 17 centers provided surgery.Results
A total of 120 patients could be matched (60 surgery, 60 SBRT). Median age was 79 years, 67% were male, and 64% had T1 disease. Median follow-up was 43 months. Thirty-day mortality was 8.3% after surgery and 1.7% after SBRT. OS at one- and three-years was 75% and 60% after surgery, and 87% and 42% after SBRT, respectively (log-rank p = 0.22). Limiting the analysis to SBRT patients with pathological confirmation of disease and their matches revealed no significant difference between groups.Conclusion
Similar OS outcomes are achieved with surgery or SBRT for stage I NSCLC in elderly patients. Comorbidity data and outcomes from centralized surgical programs are needed for more robust conclusions. 相似文献18.
John T. Lucas Jr. Jeffrey G. Kuremsky Mike Soike William W. Hinson William T. Kearns Carnell J. Hampton A. William Blackstock James Urbanic 《Lung cancer (Amsterdam, Netherlands)》2014
Purpose
Stereotactic body radiation therapy (SBRT) and accelerated hypofractionated radiation therapy (AHRT) have favorable local control (LC) relative to conventional fractionation in the treatment of stage I non-small cell lung cancer (NSCLC). We report the results of our single institution experience with the treatment of early stage NSCLC with SBRT or AHRT in cases where SBRT was felt to be suboptimal.Methods
One hundred and sixty patients with Stage 1 and node negative Stage 2 NSCLC were treated with SBRT or AHRT from 2003 to 2011. Median follow-up was 29.4 and 19 months (mo), respectively. The median dose was 54 Gy in 3 fractions (fx) (SBRT) and 70.2 Gy in 26 fx (AHRT). Acute and late toxicities (tox) were graded (G) per CTCAE v4. Time to local (LF), regional (RF) and distant (DF) failure were estimated using the Kaplan–Meier method. The impact of patient and tumor related factors on LF were estimated by multivariate Cox proportional hazard model.Results
Three-year LC rates were 87.7% (SBRT) and 71.7% (AHRT). The 3-year freedom from DF was 73.3% and 68.1%. Median OS was 38.4 (95% CI 29.7–51.6) and 35 (95% CI 22–48.3) mo. No G3 or 4 tox were observed. At 1 year, 30% and 50% of complications resolved, while (5–6%) had persistent chest wall pain.Multivariate analysis demonstrated that increasing dose per fraction and tumor size (>5.5 vs. 4 cm) in the AHRT and SBRT group were found to be associated with a reduced (HR 0.33 95% CI 0.13–0.84, p = 0.021) and increased (HR: 6.372 95% CI 1.23–32.92, p = 0.027) hazard for local failure respectively.Conclusions
Our results compare favorably with other reports of treatment for early stage NSCLC. AHRT patients had comparable LC despite increased size and central disease. Toxicity was limited and overall survival, regional and distant recurrences were similar between groups. 相似文献19.
Idalid Franco Yu-Hui Chen Fallon Chipidza Vishesh Agrawal John Romano Elizabeth Baldini Aileen Chen Yolonda Colson Ying Hou David Kozono Jon Wee Raymond Mak 《Journal of Geriatric Oncology》2018,9(2):130-137
Objectives
Frailty has been shown to increase morbidity and mortality independent of age, but studies are lacking in radiation oncology. This study evaluates a modified frailty index (mFI) in predicting overall survival (OS) and non-cancer death for Stage I/II [N0M0] Non-Small-Cell Lung Cancer (NSCLC) patients treated with Stereotactic Body Radiation Therapy (SBRT).Materials and Methods
Medical records for all patients with Stage I/II NSCLC treated at our institution with SBRT from 2009 to 2014 were reviewed. A validated mFI score, consisting of 11 variables was calculated, classifying patients as non-frail (0–1) or frail (≥ 2). Primary endpoint (OS) was analyzed using Kaplan-Meier method and log-rank. Secondary endpoint, non-cancer death, was analyzed using Fine-Gray's method, with death from lung cancer as a competing risk.Results
Patient cohort consisted of 38 (27.3%) non-frail and 101 (72.7%) frail [median total mFI score 3.0 (range 0–7)]. Median age and pack-year history was 74 and 46 years, respectively. Median follow-up among survivors was 38.5 months (range 4.0–74.1 months). Frailty was associated with a lower 3-year OS (37.3% vs. 74.7%; p = 0.003) and 3-year cumulative incidence of non-cancer death (36.7% vs. 12.5%; p = 0.02). Frailty remained significant in the multivariate model [OS HR for mFI ≥ 2: 2.25 (1.14–4.44); p = 0.02].Conclusion
Frailty is associated with lower OS in older patients with early stage NSCLC treated with SBRT, yet frail patients survived a median 2.5 years, and were more likely to die of causes unrelated to the primary lung cancer, suggesting SBRT should be considered even in older patients deemed unfit for surgery. 相似文献20.
Vieri Scotti Alessio Bruni Giulio Francolini Marco Perna Polina Vasilyeva Mauro Loi Gabriele Simontacchi Domenico Viggiano Biancaluisa Lanfranchi Alessandro Gonfiotti Juljana Topulli Emanuela Olmetto Virginia Maragna Katia Ferrari Viola Bonti Camilla Comin Sara Balduzzi Roberto D’Amico Lorenzo Livi 《Clinical lung cancer》2019,20(1):e53-e61