T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer
Purpose: : Five-fraction stereotactic ablative radiotherapy (SABR) regimens are frequently used to treat centrally located early-stage non-small cell lung cancer or disease in the proximity of the chest wall as a means of optimizing tumor control and reducing treatment toxicity. However, increasing...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | Advances in Radiation Oncology |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2452109422001026 |
| _version_ | 1811221762616066048 |
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| author | Eric J. Hsu, PhD Jameson T. Mendel, MD Kristin A. Ward, MD Mariam El-Ashmawy, MD Minjae Lee, PhD Hak Choy, MD Kenneth D. Westover, MD, PhD Dat T. Vo, MD, PhD Robert D. Timmerman, MD David J. Sher, MD Puneeth Iyengar, MD, PhD |
| author_facet | Eric J. Hsu, PhD Jameson T. Mendel, MD Kristin A. Ward, MD Mariam El-Ashmawy, MD Minjae Lee, PhD Hak Choy, MD Kenneth D. Westover, MD, PhD Dat T. Vo, MD, PhD Robert D. Timmerman, MD David J. Sher, MD Puneeth Iyengar, MD, PhD |
| author_sort | Eric J. Hsu, PhD |
| collection | DOAJ |
| description | Purpose: : Five-fraction stereotactic ablative radiotherapy (SABR) regimens are frequently used to treat centrally located early-stage non-small cell lung cancer or disease in the proximity of the chest wall as a means of optimizing tumor control and reducing treatment toxicity. However, increasing these SABR regimens to 5 fractions may reduce tumor control outcomes. We sought to identify the clinical parameters predictive of treatment failures with these 5-fraction courses. Methods: : Ninety patients with T1-2 non-small cell lung cancer were treated with 50 or 60 Gy in 5 fractions. Failure over time was modeled using cumulative incidences of local, regional, or distant failure, with death as a competing risk. Cox proportional hazards analysis for incidences of failure was performed to control for patient variables. Results: Of 90 patients, 24 of 53 patients with T1 tumors and 19 of 37 patients with T2 tumors received 50 Gy SABR, and the other 47 patients received 60 Gy. Two-year overall survival and progression-free survival for the whole cohort were 75.8% and 59.3%, respectively. Total SABR dose (50 vs 60 Gy) did not influence survival nor failure rates at 2 and 5 years. Within 2 years of treatment, 7.8% of all patients developed local failure. For all patient and tumor characteristics evaluated, only T stage and pretreatment positron emission tomography standardized uptake values served as predictors of local, regional, and distant failure at 2 and 5 years posttreatment on univariate and multivariable analysis. Conclusions: Five-fraction SABR provides excellent in-field control. T2 and high fluorodeoxyglucose uptake tumors have increased failure rates, suggesting the potential need for adjuvant therapies, which are being assessed in randomized phase 3 trials. |
| first_indexed | 2024-04-12T08:06:00Z |
| format | Article |
| id | doaj.art-b74d8f81cb8a41bfa5b27c2798aa74a3 |
| institution | Directory Open Access Journal |
| issn | 2452-1094 |
| language | English |
| last_indexed | 2024-04-12T08:06:00Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Advances in Radiation Oncology |
| spelling | doaj.art-b74d8f81cb8a41bfa5b27c2798aa74a32022-12-22T03:41:11ZengElsevierAdvances in Radiation Oncology2452-10942022-09-0175100995T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung CancerEric J. Hsu, PhD0Jameson T. Mendel, MD1Kristin A. Ward, MD2Mariam El-Ashmawy, MD3Minjae Lee, PhD4Hak Choy, MD5Kenneth D. Westover, MD, PhD6Dat T. Vo, MD, PhD7Robert D. Timmerman, MD8David J. Sher, MD9Puneeth Iyengar, MD, PhD10Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasRio Grande Urology, El Paso, TexasDepartment of Radiation Oncology, University of Virginia, Charlottesville, VirginiaDivision of Hematology/Oncology, Department of Medicine at Columbia University Medical Center, New York, New YorkDepartment of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDepartment of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas; Corresponding author: Puneeth Iyengar, MD, PhDPurpose: : Five-fraction stereotactic ablative radiotherapy (SABR) regimens are frequently used to treat centrally located early-stage non-small cell lung cancer or disease in the proximity of the chest wall as a means of optimizing tumor control and reducing treatment toxicity. However, increasing these SABR regimens to 5 fractions may reduce tumor control outcomes. We sought to identify the clinical parameters predictive of treatment failures with these 5-fraction courses. Methods: : Ninety patients with T1-2 non-small cell lung cancer were treated with 50 or 60 Gy in 5 fractions. Failure over time was modeled using cumulative incidences of local, regional, or distant failure, with death as a competing risk. Cox proportional hazards analysis for incidences of failure was performed to control for patient variables. Results: Of 90 patients, 24 of 53 patients with T1 tumors and 19 of 37 patients with T2 tumors received 50 Gy SABR, and the other 47 patients received 60 Gy. Two-year overall survival and progression-free survival for the whole cohort were 75.8% and 59.3%, respectively. Total SABR dose (50 vs 60 Gy) did not influence survival nor failure rates at 2 and 5 years. Within 2 years of treatment, 7.8% of all patients developed local failure. For all patient and tumor characteristics evaluated, only T stage and pretreatment positron emission tomography standardized uptake values served as predictors of local, regional, and distant failure at 2 and 5 years posttreatment on univariate and multivariable analysis. Conclusions: Five-fraction SABR provides excellent in-field control. T2 and high fluorodeoxyglucose uptake tumors have increased failure rates, suggesting the potential need for adjuvant therapies, which are being assessed in randomized phase 3 trials.http://www.sciencedirect.com/science/article/pii/S2452109422001026 |
| spellingShingle | Eric J. Hsu, PhD Jameson T. Mendel, MD Kristin A. Ward, MD Mariam El-Ashmawy, MD Minjae Lee, PhD Hak Choy, MD Kenneth D. Westover, MD, PhD Dat T. Vo, MD, PhD Robert D. Timmerman, MD David J. Sher, MD Puneeth Iyengar, MD, PhD T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer Advances in Radiation Oncology |
| title | T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer |
| title_full | T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer |
| title_fullStr | T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer |
| title_full_unstemmed | T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer |
| title_short | T Stage and Pretreatment Standardized Uptake Values Predict Tumor Recurrence With 5-Fraction SABR in Early-Stage Non-Small Cell Lung Cancer |
| title_sort | t stage and pretreatment standardized uptake values predict tumor recurrence with 5 fraction sabr in early stage non small cell lung cancer |
| url | http://www.sciencedirect.com/science/article/pii/S2452109422001026 |
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