Predictive Factors For Local Control Research Articles

Two fractions staged Gammaknife radiosurgery for “large” cerebral metastases

BackgroundGammaknife radiosurgery (GKRS) is a valuable option to control cerebral metastases. However, the risk (adverse radiation effect (ARE))-benefit (local control (LC)) ratio switches when the target is too large. ObjectiveIn order to balance this ratio, two fractions staged GKRS protocol was conducted for “large” cerebral metastases. The aim of this study is to evaluate the outcome (LC, ARE). MethodsA total of 39 large cerebral metastases in 35 patients were treated. The initial mean tumor volume was 14.6 cc [6.1; 35.8]. The prescription margin dose was 12 Gy on the 50% isodose line, with 2 weeks between them. A majority of primary cancer were from lung (43%), melanoma (20%) or breast (17%) origin. The mean age was 63 years old (31–89). Mean Graded Prognostic Assessment (GPA) was 2. ResultsAt the second fraction, mean tumor volume was 10.3 cc [1.9–27.4]. The mean percentage of volume variation for decreasing lesions was 29%. At last follow-up, mean tumor volume was 7.4 cc [0–25.2]; 34 lesions decreased volume (mean 35%). A decreased volume of more than 45% after first stage GKRS was able to predict a long-term local response to staged GKRS treatment. Local control rate at 6 months and 1 year was 87.3% and 75% respectively. The rate of ARE was 7.7%. No predictive factor of local control or ARE was found in a univariate analysis. ConclusionThe new 2-fractions-dose-staged GKRS concept seems to be a well-tolerated and effective treatment option for large cerebral metastases.

IMRT-VMAT in Locally Advanced Rectal Adenocarcinoma: An Observational Multicenter Prospectic Study on Total Neoadiuvant Radiotherapy According Rapido Trial

Background: The phase III multicenter randomized RAPIDO trial (Rectal Cancer And Preoperative Induction therapy followed by Dedicated Operation) has shown the advantege of Total Neoadjuvant treatment (TNT) with short course radiotherapy (RT). However, data on local control have not been confirmed at 5.6 years median follow-up in favor of the TNT arm because patients from the experimental (EXP) group received more often 3D-CRT (p=0.029). The primary end-point of this multicentric observational prospectic study is to assess the real life safety and efficacy of RAPIDO trial protocol using VMAT and IMRT treatment in all enrolled patients. Moreover FDG-PET and MRI images for predictive features compared with cancer phenotype (status of K-ras and EGFR) and study on tumor microenviroment response to short course RT will be also provided. Methods: Locally advanced rectal cancer patients undergoing TNT as defined in RAPIDO trial will be enrolled and prospectively included in this study. MRI and FDG-PET will be performed to staging and restaging the disease. The tumor microenviroment changes assessment with immunophenotype and soluble PDL1 and on EVCs will be done. For sample size calculation, using OR 0.5, 100 patients will be enrolled into two years. Kaplan -model and proportional Cox method will be adopoted for OS, DFS and predictive factors for local control. Conclusions: The results of this study will be useful to assess prospectively the safety and effectiveness of VMAT and IMRT in short course TNT assuming predictive factors for response through radiomics, metabolomics and immunological features. Trial Registration: COMITATO ETICO UNICO REGIONALE ( CEUR ) N.50/2022; San Carlo Hospital, Potenza, Italy.

Laser interstitial thermal therapy in the treatment of brain metastases: the relationship between changes in postoperative magnetic resonance imaging characteristics and tumor recurrence.

Laser interstitial thermal therapy (LITT) has been used to treat brain metastases (BMs) in several countries, and its safety and effectiveness have been confirmed. In most cases, magnetic resonance imaging (MRI) reveals an increase in tumor volume with an enhanced margin after LITT. However, little is known about the relationship between this MRI change and tumor recurrence. We report the first case series of BMs treated by LITT in China to evaluate the clinical characteristics and predictive factors of tumor recurrence. Patients with less than four brain metastatic lesions and a Karnofsky performance status (KPS) > 70 were eligible for study inclusion. Standard LITT procedures were performed, and a follow-up MRI was performed to analyze the radiographic changes, especially the volume ratio of the enhanced margin and the whole lesion on MRI at 30days postoperatively. All the volume-related data were delineated and calculated using 3D Slicer software. Related predictors were also collected to evaluate the correlation with local tumor control. Eighteen patients with nineteen lesions were enrolled for treatment and follow-up. Primary tumor histology included pulmonary carcinoma (n = 11) and breast cancer (n = 4). On average, the tumor size measured 3.01 cm3 (range, 0.40-7.40 cm3), the total ablation time was 13.58min (range, 2.88-37.15min), and the complete ablation rate was 92.4% (range, 29.2-100%). Comparing 3s0-day follow-up MRI results with preoperative MRI findings, 18 lesions showed a 2.28-fold (range, 1.21-4.88) volume increase; all the lesions displayed an enhanced component with a volume ratio of 42.35% (range, 10.14-100%). Five patients experienced tumor recurrence, and the local tumor control rates at 90days and 180days of follow-up were 68.4% and 66.7%, respectively. Univariate analysis indicated that the primary tumor, ablation rate, and enhanced volume ratio (EVR) > 40% in the 30-day MRI were associated with tumor recurrence, whereas multivariate analysis showed that only EVR > 40% was a predictive factor of local control. LITT is a minimally invasive method used to ablate brain metastases which can be used as the first-line treatment for BM patients under certain indications. After LITT, most tumors showed volume enlargement on the 30-day MRI scan, and EVR > 40% on the 30-day MRI may indicate late tumor recurrence.

Local tumour control after radiofrequency or microwave ablation for colorectal liver metastases in relation to histopathological growth patterns.

Regrowth after ablation is common, but predictive factors for local control are scarce. This study investigates whether histopathological growth patterns (HGP) can be used as a predictive biomarker for local control after ablation of colorectal liver metastases (CRLM). Patients who received simultaneous resection and ablation as first treatment for CRLM between 2000 and 2019 were considered eligible. HGPs were determined on resected CRLM according to international guidelines and were classified as desmoplastic or non-desmoplastic. As minimal inter-tumoural heterogeneity has been demonstrated, the HGP of resected and ablated CRLM were presumed to be identical. Local tumour progression (LTP) was assessed on postoperative surveillance imaging. Uni- and multivariable competing risk methods were used to compare LTP. In total 221 patients with 443 ablated tumours were analysed. A desmoplastic HGP was found in 60 (27.1%) patients who had a total of 159 (34.7%) ablated lesions. Five-year LTP [95%CI] was significantly higher for ablated CRLM with a presumed non-desmoplastic HGP (37% [30-43] vs 24% [17-32], Gray's-test p=0.014). On multivariable analysis, a non-desmoplastic HGP (adjusted HR [95%CI]; 1.55 [1.03-2.35]) was independently associated with higher LTP rates after ablation. HGP is an independent predictor of local tumour progression following ablation of CRLM.

Results of computer tomography-based adaptive brachytherapy in combination with whole-pelvic- and central-shielding-external beam radiotherapy for cervical cancer

To evaluate treatment results and investigate predictors of local control. In this retrospective study of 236 patients with cervical cancer, we administered CT-based adaptive brachytherapy (BT) in combination with whole- pelvic (WP)- and central shielding (CS)- external beam radiotherapy (EBRT) with or without chemotherapy. The study cohort comprised patients with cervical cancer treated with definitive radiotherapy (RT) or concurrent chemoradiotherapy between June 2013 and March 2019. Local control (LC), overall survival (OS), and late toxicity were evaluated. Predictive factors for LC were analyzed by univariate and multivariate analyses. Median doses of WP- and CS-EBRT and BT were 30.6 GyEQD2, 19.8 GyEQD2, and 40.3 GyEQD2, respectively. The 3-year LC rates for T1b2, T2a, T2b, T3b, and T4 were 100%, 100%, 97.3%, 86.9%, and 91.7%, respectively (p = 0.346). The 3-year OS for Stages IB, IIB, IIIB, IIIC, and IVA were 100%, 94.8%, 82.5%, 81.7%, and 74.6%, respectively (p = 0.037). Rates of Grade 3-4 gastrointestinal and genitourinary toxicities were 3.8% and 1.7%, respectively. Multivariate analysis showed that T3-4, nonsquamous cell histology, and high-risk clinical target volume (CTVHR) D90 of BT < 36GyEQD2 were independently associated with significantly poorer LC. The combination of WP- and CS-EBRT and CT-based IGBT with or without concurrent chemotherapy produced favorable LC outcomes with low rates of late toxicities for patients with small or medium-sized tumors. However, LC was less favorable for patients who had large T3 disease, and the use of CS requires caution in these patients.

Radiotherapy and hyperthermia for breast cancer patients at high risk of recurrence

Purpose To evaluate the long-term efficacy of combined radiotherapy (RT) and hyperthermia (HT) in a large mono-institutional cohort of breast cancer (BC) patients affected by recurrent, newly diagnosed non-resectable or high risk resected tumor. Materials and methods Records of BC patients treated with RT + HT between 1995 and 2018 were retrospectively analyzed. RT doses of 50–70 Gy concurrent to a twice per week superficial HT were applied. For HT, a temperature between 41 and 42 °C was applied for approximately 1 h. Primary endpoint was local control (LC), secondary endpoints comprised toxicity, overall survival (OS), and progression-free survival (PFS). Results A total of 191 patients and 196 RT + HT treatments were analyzed. In 154 cases (78.6%) RT + HT was performed for patients with recurrent BC. Among these, 93 (47.4% of the entire cohort) had received RT prior to RT + HT. Median follow up was 12.7 years. LC at 2, 5, and 10 years was 76.4, 72.8, and 69.5%, respectively. OS at 2, 5, and 10 years was 73.5, 52.3, and 35.5%, respectively. PFS at 2, 5, and 10 years was 55.6, 41, and 33.6%, respectively. Predictive factors for LC were tumor stage, distant metastases, estrogen/progesterone receptor expression, resection status and number of HT fractions. At multivariate analysis tumor stage and receptor expression were significant. No acute or late toxicities higher than grade 3 were observed. Conclusion Combined RT + HT offers long-term high LC rates with acceptable toxicity for patients with recurrent, newly diagnosed non-resectable or resected BC at high risk of relapse.

Endoscopic resection as an independent predictive factor of local control in patients with T1bN0M0 esophageal squamous cell carcinoma treated with chemoradiotherapy: a retrospective study

BackgroundAlthough chemoradiotherapy (CRT) is one of the curative treatments for thoracic esophageal squamous cell carcinoma (ESCC) with submucosal invasion, the risk of local recurrence after CRT remains a clinical problem. This retrospective study aimed to analyze the predictive factors for local recurrence after CRT.MethodsNinety-one patients with clinical or pathological (c/p) T1bN0M0 thoracic ESCC who underwent CRT from 2004 to 2017 in our institution were analyzed retrospectively. Sixty-three patients were diagnosed with pathological T1b after undergoing initial endoscopic resection (ER) and treated with additional CRT; meanwhile, 28 patients were clinically diagnosed with T1b and underwent definitive CRT. We investigated the predictors of disease–specific survival (DSS) and local recurrence–free survival (LRFS) by performing univariate and multivariate analyses.ResultsThe median observation period was 59.8 months. The 5-year DSS and LRFS rates were 84.3% (95% confidence interval [CI]: 76.1–92.5) and 87.1% (95% CI: 79.1–95.1), respectively. The multivariate analysis revealed no significant predictors associated with DSS. On the contrary, ER (hazard ratio [HR]: 0.11, 95% CI: 0.02–0.48, p = 0.003) and tumor length (HR: 6.78, 95% CI: 1.28–36.05, p = 0.025) were recognized as independent predictive factors for LRFS. During follow-up, recurrence was observed in 18 patients (19.8%). With regard to the patterns of relapse, local recurrence was the most common in 11 patients, and salvage ER was performed in 9 of 11 patients.ConclusionsER and tumor length were independent predictive factors for LRFS. Our study suggested that performance of ER prior to CRT improved the local control in patients with c/p T1bN0M0 ESCC. In addition, most of the patients who experienced local recurrence were treated with salvage ER, which contributed to preserving the organs.

Stereotactic body radiation therapy for spinal metastases: a novel local control stratification by spinal region.

This study evaluated a large cohort of patients treated with stereotactic body radiation therapy for spinal metastases and investigated predictive factors for local control, local progression-free survival (LPFS), overall survival, and pain response between the different spinal regions. The study was undertaken via retrospective review at a single institution. Patients with a tumor metastatic to the spine were included, while patients with benign tumors or primary spinal cord cancers were excluded. Statistical analysis involved univariate analysis, Cox proportional hazards analysis, the Kaplan-Meier method, and machine learning techniques (decision-tree analysis). A total of 165 patients with 190 distinct lesions met all inclusion criteria for the study. Lesions were distributed throughout the cervical (19%), thoracic (43%), lumbar (19%), and sacral (18%) spines. The most common treatment regimen was 24 Gy in 3 fractions (44%). Via the Kaplan-Meier method, the 24-month local control was 80%. Sacral spine lesions demonstrated decreased local control (p = 0.01) and LPFS (p < 0.005) compared with those of the thoracolumbar spine. The cervical spine cases had improved local control (p < 0.005) and LPFS (p < 0.005) compared with the sacral spine and trended toward improvement relative to the thoracolumbar spine. The 36-month local control rates for cervical, thoracolumbar, and sacral tumors were 86%, 73%, and 44%, respectively. Comparably, the 36-month LPFS rates for cervical, thoracolumbar, and sacral tumors were 85%, 67%, and 35%, respectively. A planning target volume (PTV) > 50 cm3 was also predictive of local failure (p = 0.04). Fewer cervical spine cases had disease with PTV > 50 cm3 than the thoracolumbar (p = 5.87 × 10-8) and sacral (p = 3.9 × 10-3) cases. Using decision-tree analysis, the highest-fidelity models for predicting pain-free status and local failure demonstrated the first splits as being cervical and sacral location, respectively. This study presents a novel risk stratification for local failure and LPFS by spinal region. Patients with metastases to the sacral spine may have decreased local control due to increased PTV, especially with a PTV of > 50 cm3. Multidisciplinary care should be emphasized in these patients, and both surgical intervention and radiotherapy should be strongly considered.

Imaging-Based Local Control Outcomes Specific To Spine Stereotactic Body Radiotherapy (SBRT) For Prostate Cancer Metastases

We report the first dedicated series of spine SBRT specific to prostate cancer metastases. A prospective database was retrospectively reviewed identifying 183 spinal segments in 93 prostate cancer patients treated with SBRT. All patients were followed regularly post-SBRT with both a clinical exam and full spine MRI. The primary endpoint was imaging-based local control rates and secondary outcomes included overall survival (OS) and vertebral compression fracture (VCF). Of the 183 treated spine segments, 130 (71%) had no prior radiation, 18 (10%) were post-operative, and 35 (19%) were re-irradiated after conventional RT. The median follow-up was 16 months (range 2-70 months). 67 patients were oligometastatic (<5 metastases) of which 36 had a solitary spinal metastasis. 44 patients (47%) had castrate resistant disease at the time of SBRT, while 10 of the 49 patients with hormone sensitive disease at the time of SBRT developed castrate resistance during follow up at a median time of 15 months after SBRT (range 7 – 37 months). Of the 183 spinal lesions, 120 (65%) were sclerotic, 32 (18%) were lytic, and 31 (17%) were mixed. The median spinal instability neoplastic score (SINS) was 5 (range 0-13). The majority of spinal segments (75%) were treated with 24-28 Gy/2 fractions while the rest (25%) were treated with 25-30 Gy/4-5 fractions. Actuarial local control (LC) rates at 1 and 2 years were 97% and 92%, respectively. The median OS was 61 months (range 43-77 months) and the 1- and 2-year OS rates were 91% and 81%, respectively. The cumulative risk of VCF was 5% at 1-year and 13% at 2 years. Excellent local control rates were observed in this cohort of patients with spinal metastases from prostate cancer with an acceptable risk of VCF. The high rate of OS in prostate cancer supports the need for excellent LC of spinal disease. Whether similar rates could be observed with conventional palliative radiation remains to be proven. Further work will identify predictive factors for local control and fracture rate after SBRT.

Predictive value of CD8/FOXP3 ratio combined with PD-L1 expression for radiosensitivity in patients with squamous cell carcinoma of the larynx receiving definitive radiation therapy.

Little is known about immune-related radiosensitivity in patients with squamous cell carcinoma of the larynx (SCC-L) treated with radiation therapy (RT). We retrospectively reviewed 91 patients with SCC-L treated with RT or chemoradiation therapy and performed immunohistochemical examination to analyze PD-L1 level on tumor cells, CD4+ tumor-infiltrating lymphocytes (TILs), CD8+ TIL, and FOXP3+ TIL using pretreated biopsy specimens. The association between these immune-related parameters and radiosensitivity was evaluated. Multivariate analyses showed that high CD8/FOXP3 ratio combined with negative PD-L1 expression was an independent and significant favorable predictive factor for local control, compared with the other groups. We showed that high CD8/FOXP3 ratio combined with negative PD-L1 expression might be a useful biomarker of radiosensitivity in patients with SCC-L receiving definitive RT. We propose that coassessment of CD8/FOXP3 ratio and PD-L1 expression level in tumor cells can help predict potential radiosensitivity in patients with SCC-L.

Predictive factors for local control of early glottic squamous cell carcinomas after definitive radiotherapy.

The aim of the present study was to retrospectively investigate the risk factors of local failure for T1 glottic carcinoma irradiated with a prescription dose of 66 Gy. Between July 2006 and December 2017, 64 patients with T1 glottic squamous cell carcinoma treated with 66 Gy/33 fractions were analyzed for risk factors of local failure. The sex, age, performance status, T stage, overall treatment time, anterior commissure involvement, smoking status during/after treatment, histological tumor grade and pretreatment hemoglobin level were investigated. The maximum, mean and minimum doses, and the homogeneity index for the glottic larynx were calculated for dosimetric risk factors of local failure. The median follow-up duration was 51 months. Local failure was observed in 6 patients (9.5%). Among all risk factors, only the minimum dose to the glottic larynx was found to be significantly associated with local failure (P=0.025). The 5-year local control rates for a minimum dose to the glottic larynx of <65 and ≥65 Gy were 79 and 95%, respectively, with a statistically significant difference (P=0.015). No patients exhibited grade ≥3 late adverse effects. The minimum dose to the glottic larynx was the only factor significantly associated with local failure. Thus, local control of T1 glottic carcinoma may improve with a minimum dose of ≥65 Gy to the glottic larynx. In conclusion, radiotherapy with a minimum prescription dose of ≥65 Gy to the glottic larynx appears to be safe and achieves a high local control rate for T1 glottic carcinoma.

Treatment outcomes according to the macroscopic tumor type in locally advanced esophageal squamous cell carcinoma treated by chemoradiotherapy.

To identify predictive factors for local control of locally advanced esophageal cancer by chemoradiotherapy, the relationship between clinical features, including macroscopic tumor type, and treatment outcome was analyzed in 83 patients. Macroscopic tumor type was defined by endoscopy as follows: type 1: protruding type; type 2: ulcerative and localized type; type 3: ulcerative and infiltrative type; type 4: diffusely infiltrative type; and type 5: unclassifiable type. We analyzed the overall survival, cause-specific survival, local progression-free rate, and predictive factors for locally advanced esophageal cancer after chemoradiotherapy. The median follow-up period at the time of evaluation was 59months among survivors. The 5-year overall survival, cause-specific survival, and local progression-free rates for type 1 and other types were 37.0% and 23.3% (P = 0.4255), 71.8% and 30.3% (P = 0.0325), and 100% and 63.3% (P = 0.0246), respectively. Macroscopic tumor type (type 1) was the most significant predictive factor of cause-specific survival and local progression-free rates. Macroscopic tumor type 1 was the significant favorable predictive factor for local control. The study results suggested that the macroscopic tumor type was useful in predicting tumor responses.

Additional chemotherapy improved local control and overall survival after stereotactic body radiation therapy for patients with oligo-recurrence

BackgroundOligo-recurrence has been considered to confer improved prognosis than other oligometastatic conditions, and stereotactic body radiation therapy (SBRT) is considered as an option of local therapy for lung or liver metastases. The purpose of this study was to investigate the efficacy and safety of SBRT for lung and liver oligo-recurrent lesions and evaluate predictive factors for local control and prognosis.MethodsThis retrospective study included patients who presented with 1–3 matachronous lung or liver metastases, and treated with SBRT between May 2013 and March 2016 at a single institution. All patients harbored a controlled primary lesion. Patients with < 6 months of follow-up were excluded. Local control, progression free survival, and overall survival rates were analyzed according to the Kaplan–Meier product limit method. Univariable log-rank and multivariable Cox regression analyses were performed to clarify predictive factors for local control and prognosis. Toxicity was graded according to the Common Terminology Criteria for Adverse Events, version 4.0.ResultsSeventy-six patients with a total of 70 and 44 lung and liver lesions were included. The median follow-up period was 21 (range, 7–43) months. The 1-year local control, progression-free survival and overall survival rates were 89, 38 and 96%, respectively. Smaller gross tumor volume and additional chemotherapy after SBRT were significant predictive factors for better local control (p = 0.005 and p = 0.047), and the presence of a single metastatic lesion was a significant factor of good progression free survival (p = 0.008). Additional chemotherapy after SBRT was not a significant predictive factor but conferred to better overall survival (p = 0.078). Among colorectal cancer patients, post SBRT chemotherapy was significantly associated with better OS (p = 0.025). Over grade 3 adverse event was seen in only one patient.ConclusionSBRT is a safe and effective treatment for patients with lung and liver oligo-recurrence. Additional chemotherapy after SBRT improved local control, and single metastatic lesion was a significant predictive factor of better PFS in this study. Among colorectal cancer patients, additional chemotherapy after SBRT significantly associated better OS.

Predictive Factors for Local Control and Survival in Patients with Cancer of Unknown Primary (CUP) Irradiated for Cerebral Metastases.

To identify predictors of local control and survival after whole-brain irradiation (WBI) for cerebral metastases from cancer of unknown primary (CUP). In 140 patients receiving WBI alone or following resection, seven factors were investigated including treatment approach, WBI-regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extra-cerebral metastases. On univariate analysis, resection plus WBI and boost (p=0.002), ECOG 0-1 (p<0.001) and a single lesion (p<0.001) were positively associated with local control. On Cox regression, ECOG-score remained significant (p=0.002). On univariate analysis of survival, surgery plus WBI and boost (p=0.009), ECOG 0-1 (p<0.001), a single lesion (p=0.024) and no extra-cerebral metastases (p<0.001) were associated with better outcomes. On Cox regression, ECOG-score (p<0.001) and extra-cerebral lesions (p<0.001) were significant. Significant predictors of local control and survival were identified that contribute to treatment personalization and design of prospective trials in patients with cerebral metastases from CUP.

Stereotactic radiotherapy following surgery for brain metastasis: Predictive factors for local control and radionecrosis

PurposeTo evaluate local control and adverse effects after postoperative hypofractionated stereotactic radiosurgery in patients with brain metastasis. MethodsWe reviewed patients who had hypofractionated stereotactic radiosurgery (7.7Gy×3 prescribed to the 70% isodose line, with 2mm planning target volume margin) following resection from March 2008 to January 2014. The primary endpoint was local failure defined as recurrence within the surgical cavity. Secondary endpoints were distant failure rates and the occurrence of radionecrosis. ResultsOut of 95 patients, 39.2% had metastatic lesions from a non-small cell lung cancer primary tumour. The median Graded Prognostic Assessment score was 3 (48% of patients). One-year local control rates were 84%. Factors associated with improved local control were no cavity enhancement on pre-radiation MRI (P<0.00001), planning target volume less than 12cm3 (P=0.005), Graded Prognostic Assessment score 2 or above (P=0.009). One-year distant cerebral control rates were 56%. Thirty-three percent of patients received whole brain radiation therapy. Histologically proven radionecrosis of brain tissue occurred in 7.2% of cases. The size of the preoperative lesion and the volume of healthy brain tissue receiving 21Gy (V21) were both predictive of the incidence of radionecrosis (P=0.010 and 0.036, respectively). ConclusionAdjuvant hypofractionated stereotactic radiosurgery to the postoperative cavity in patients with brain metastases results in excellent local control in selected patients, helps delay the use of whole brain radiation, and is associated with a relatively low risk of radionecrosis.

A comparison between accelerated hypofractionation and stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer (NSCLC): Results of a propensity score-matched analysis

Background and purposeStereotactic ablative radiotherapy (SABR) has become standard for inoperable early-stage non-small cell lung cancer (NSCLC). However, there is no randomized evidence demonstrating benefit over more fractionated radiotherapy. We compared accelerated hypofractionation (AH) and SABR using a propensity score-matched analysis. Materials and methodsFrom 1997–2007, 119 patients (T1–3N0M0 NSCLC) were treated with AH (48–60Gy, 12–15 fractions). Prior to SABR, this represented our institutional standard. From 2008–2012, 192 patients (T1–3N0M0 NSCLC) were treated with SABR (48–52Gy, 4–5 fractions). A total of 114 patients (57 per cohort) were matched (1:1 ratio, caliper: 0.10) using propensity scores. ResultsMedian follow-up (range) for the AH cohort was 36.3 (2.5–109.1) months, while that for the SABR group was 32.5 (0.3–62.6)months. Three-year overall survival (OS) and local control (LC) rates were 49.5% vs. 72.4% [p=0.024; hazard ratio (HR): 2.33 (1.28, 4.23), p=0.006] and 71.9% vs. 89.3% [p=0.077; HR: 5.56 (1.53, 20.2), p=0.009], respectively. On multivariable analysis, tumour diameter and PET staging were predictive for OS, while the only predictive factor for LC was treatment cohort. ConclusionsOS and LC were improved with SABR, although OS is more closely related to non-treatment factors. This represents one of the few studies comparing AH to SABR for early-stage lung cancer.

Predictive Factors for Local Control in Primary and Metastatic Lung Tumours after Four to Five Fraction Stereotactic Ablative Body Radiotherapy: A Single Institution's Comprehensive Experience

AimsWe report the outcomes of a large lung stereotactic ablative body radiotherapy (SABR) programme for primary non-small cell lung cancer (NSCLC) and pulmonary metastases. The primary study aim was to identify factors predictive for local control. Materials and methodsIn total, 311 pulmonary tumours in 254 patients were treated between 2008 and 2011 with SABR using 48–60 Gy in four to five fractions. Local, regional and distant failure data were collected prospectively, whereas other end points were collected retrospectively. Potential clinical and dosimetric predictors of local control were evaluated using univariate and multivariate analyses. ResultsOf the 311 tumours, 240 were NSCLC and 71 were other histologies. The 2 year local control rate was 96% in stage I NSCLC, 76% in colorectal cancer (CRC) metastases and 91% in non-lung/non-CRC metastases. Predictors of better local control on multivariate analysis were non-CRC tumours and a larger proportion of the planning target volume (PTV) receiving ≥100% of the prescribed dose (higher PTV V100). Among the 45 CRC metastases, a higher PTV V100 and previous chemotherapy predicted for better local control. ConclusionsLung SABR of 48–60 Gy/four to five fractions resulted in high local control rates for all tumours except CRC metastases. Covering more of the PTV with the prescription dose (a higher PTV V100) also resulted in superior local control.

Stereotactic Body Radiotherapy (SBRT) for Primary Non-Small Cell Lung Cancer (NSCLC) and Pulmonary Metastases: Analysis of Outcomes and Predictive Factors for Local Control

the oral cavity, oropharynx, nasopharynx, hypopharynx, and larynx, often managed with a combination of surgery, chemotherapy, and radiation therapy. Prognostic factors affecting treatment outcomes in the elderly have not been clearly defined in the literature. Patient-specific factors may be important when considering treatment options for this population in order to maximize patient survival and post-treatment quality of life (QOL). This study aims to explore and clarify the role of key prognostic factors on outcomes in HNC patients over the age of 80 years treated with radiation therapy at the Odette Cancer Centre (OCC). Methods and Materials: From a database of 933 HNC patients treated at OCC between Jan 2007 and December 2012, a sample of 40 eligible patients will be randomly selected. Prognostic factors identified from the literature will be extracted from relevant patient records and recorded in a database in three key categories: disease-related, treatment-related and patient-specific. Patient outcome datadoverall survival and rates of recurrence, treatment completion, and radiation toxicitydwill also be retrieved and recorded. Univariate analysis will be employed to determine which of the patient, disease, and treatment factors significantly predict for outcomes in this population. Results: 92.5% of patients successfully completed their treatment as prescribed. Though palliative patients (mean age 89, median 91) were likely to be older than radical patients (mean age 84.7, median 84), no connection was found between age and outcome measures. Dose, fractionation, and stage were not found to significantly impact outcomes in this sample. Mortality status was unavailable for 25% of patients. Further data collection is ongoing to confirm these and other findings. Conclusions: Preliminary results suggest that choice of treatment regime may be tailored to patient convenience without compromising outcome, and that many older patients are able to successfully complete even aggressive radical therapy. The results of this study and the database from which the sample was drawn may be useful in further studies to inform practices in the HN site group at OCC. Prognostic data may also be utilized to create a medical nomogram, in the form of a visual tool useful in facilitating patient-specific education during the informed consent procedure.

Predictive Factors for Local Control of Brain Metastases After Radiosurgery

Although radiosurgery (SRS) is an established method for the treatment of brain metastases (BM), data regarding prognostic factors that affect local control after the procedure are controversial. Our objective was to evaluate the local control of BM treated with SRS and correlate the outcome with treatment parameters and lesions characteristics.

Stereotactic Body Radiation Therapy (SBRT) for Primary Non-Small Cell Lung Cancer (NSCLC) and Pulmonary Metastases: Analysis of Outcomes and Predictive Factors for Local Control

Stereotactic Body Radiation Therapy (SBRT) for Primary Non-Small Cell Lung Cancer (NSCLC) and Pulmonary Metastases: Analysis of Outcomes and Predictive Factors for Local Control