Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume

Abstract Background We evaluated whether pre- and mid-treatment metabolic tumor volume (MTV) predicts per lesion local recurrence (LR) in patients treated with definitive radiation therapy (RT, dose≥60 Gy) for locally advanced non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed r...

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Main Authors: Michael S. Binkley, Julie L. Koenig, Mehr Kashyap, Michael Xiang, Yufei Liu, Quaovi Sodji, Peter G. Maxim, Maximilian Diehn, Billy W. Loo, Michael F. Gensheimer
Format: Article
Language:English
Published: BMC 2020-05-01
Series:Radiation Oncology
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13014-020-01546-y
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author Michael S. Binkley
Julie L. Koenig
Mehr Kashyap
Michael Xiang
Yufei Liu
Quaovi Sodji
Peter G. Maxim
Maximilian Diehn
Billy W. Loo
Michael F. Gensheimer
author_facet Michael S. Binkley
Julie L. Koenig
Mehr Kashyap
Michael Xiang
Yufei Liu
Quaovi Sodji
Peter G. Maxim
Maximilian Diehn
Billy W. Loo
Michael F. Gensheimer
author_sort Michael S. Binkley
collection DOAJ
description Abstract Background We evaluated whether pre- and mid-treatment metabolic tumor volume (MTV) predicts per lesion local recurrence (LR) in patients treated with definitive radiation therapy (RT, dose≥60 Gy) for locally advanced non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed records of patients with stage III NSCLC treated from 2006 to 2018 with pre- and mid-RT PET-CT. We measured the MTV of treated lesions on the pre-RT (MTVpre) and mid-RT (MTVmid) PET-CT. LR was defined per lesion as recurrence within the planning target volume. Receiver operating characteristic (ROC) curves, cumulative incidence rates, and uni- and multivariable (MVA) competing risk regressions were used to evaluate the association between MTV and LR. Results We identified 111 patients with 387 lesions (112 lung tumors and 275 lymph nodes). Median age was 68 years, 69.4% were male, 46.8% had adenocarcinoma, 39.6% had squamous cell carcinoma, and 95.5% received concurrent chemotherapy. Median follow-up was 38.7 months. 3-year overall survival was 42.3%. 3-year cumulative incidence of LR was 26.8% per patient and 11.9% per lesion. Both MTVpre and MTVmid were predictive of LR by ROC (AUC = 0.71 and 0.76, respectively) and were significantly associated with LR on MVA (P = 0.004 and P = 7.1e-5, respectively). Among lesions at lower risk of LR based on MTVpre, higher MTVmid was associated with LR (P = 0.001). Conclusion Per-lesion, larger MTVpre and MTVmid predicted for increased risk of LR. MTVmid was more highly predictive of LR than MTVpre and if validated may allow for further discrimination of high-risk lesions at mid-RT informing dose painting strategies.
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spelling doaj.art-6878bacfde12430b8d93de8076ff71b22022-12-22T00:00:47ZengBMCRadiation Oncology1748-717X2020-05-0115111010.1186/s13014-020-01546-yPredicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volumeMichael S. Binkley0Julie L. Koenig1Mehr Kashyap2Michael Xiang3Yufei Liu4Quaovi Sodji5Peter G. Maxim6Maximilian Diehn7Billy W. Loo8Michael F. Gensheimer9Department of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Indiana University School of MedicineDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteDepartment of Radiation Oncology, Stanford University School of Medicine and Stanford Cancer InstituteAbstract Background We evaluated whether pre- and mid-treatment metabolic tumor volume (MTV) predicts per lesion local recurrence (LR) in patients treated with definitive radiation therapy (RT, dose≥60 Gy) for locally advanced non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed records of patients with stage III NSCLC treated from 2006 to 2018 with pre- and mid-RT PET-CT. We measured the MTV of treated lesions on the pre-RT (MTVpre) and mid-RT (MTVmid) PET-CT. LR was defined per lesion as recurrence within the planning target volume. Receiver operating characteristic (ROC) curves, cumulative incidence rates, and uni- and multivariable (MVA) competing risk regressions were used to evaluate the association between MTV and LR. Results We identified 111 patients with 387 lesions (112 lung tumors and 275 lymph nodes). Median age was 68 years, 69.4% were male, 46.8% had adenocarcinoma, 39.6% had squamous cell carcinoma, and 95.5% received concurrent chemotherapy. Median follow-up was 38.7 months. 3-year overall survival was 42.3%. 3-year cumulative incidence of LR was 26.8% per patient and 11.9% per lesion. Both MTVpre and MTVmid were predictive of LR by ROC (AUC = 0.71 and 0.76, respectively) and were significantly associated with LR on MVA (P = 0.004 and P = 7.1e-5, respectively). Among lesions at lower risk of LR based on MTVpre, higher MTVmid was associated with LR (P = 0.001). Conclusion Per-lesion, larger MTVpre and MTVmid predicted for increased risk of LR. MTVmid was more highly predictive of LR than MTVpre and if validated may allow for further discrimination of high-risk lesions at mid-RT informing dose painting strategies.http://link.springer.com/article/10.1186/s13014-020-01546-yFDG-PETMetabolic tumor volumeLung cancer
spellingShingle Michael S. Binkley
Julie L. Koenig
Mehr Kashyap
Michael Xiang
Yufei Liu
Quaovi Sodji
Peter G. Maxim
Maximilian Diehn
Billy W. Loo
Michael F. Gensheimer
Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume
Radiation Oncology
FDG-PET
Metabolic tumor volume
Lung cancer
title Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume
title_full Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume
title_fullStr Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume
title_full_unstemmed Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume
title_short Predicting per-lesion local recurrence in locally advanced non-small cell lung cancer following definitive radiation therapy using pre- and mid-treatment metabolic tumor volume
title_sort predicting per lesion local recurrence in locally advanced non small cell lung cancer following definitive radiation therapy using pre and mid treatment metabolic tumor volume
topic FDG-PET
Metabolic tumor volume
Lung cancer
url http://link.springer.com/article/10.1186/s13014-020-01546-y
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