Stereotactic Radiotherapy For Stage Research Articles

Stereotactic radiotherapy for stage I renal cell carcinoma: Overall survival and treatment trends compared to thermal ablation and surgical resection.

e16111 Background: Stereotactic radiotherapy (SRT) is a non-invasive treatment modality that is currently evaluated for use in renal cell cancer (RCC). We aimed to evaluate current utilization of SRT for stage I RCC and compare associated overall survival with thermal ablation (TA) and partial nephrectomy (PN). Methods: The 2004-2015 United States National Cancer Database was searched for histopathologically approved stage I RCC treated with PN, cryoablation (CRA), radiofrequency- or microwave-ablation (RFA/MWA) or SRT. Patients were propensity score matched to account for potential confounders. Overall survival (OS) was evaluated with Kaplan-Meier plots, log-rank tests and Cox proportional hazards models. Results: A total of 91,965 patients were included (SRT n = 174; PN n = 82,913; CRA n = 5,446; RFA/MWA n = 3,432).Stage I SRT patients tended to be older females with fewer comorbidities and treated at non-academic centers in New England states. After propensity score matching, a cohort of n = 660 patients was obtained with well-balanced distribution of confounders between the different treatment strategies. In the matched cohort, OS following SRT was inferior to PN and thermal ablation (PN vs. SRT HR = 0.33, 95% CI: 0.22-0.50, p < 0.001; CRA vs. SRT HR = 0.44, 95% CI: 0.30 – 0.66, p < 0.001; RFA/MWA vs. SRT HR = 0.53, 95% CI: 0.36-0.77, p < 0.001). OS following CRA was comparable to PN (HR = 1.35, 95% CI: 0.84-2.18, p = 0.216), while OS following RFA/MWA was inferior to PN (HR = 1.61, 95% CI: 1.01-2.56, p = 0.046). OS rates are summarized in table 1. Conclusions: Only a minority of RCC patients receive SRT. In stage I RCC, current renal SRT protocols yield lower overall survival compared to thermal ablation and resection, while CRA and PN show comparable outcomes. Based on the current body of evidence, SRT for RCC should be reserved for clinical trials or exceptional clinical circumstances.[Table: see text]

Early PET-CT After Stereotactic Radiotherapy for Stage 1 Non-small Cell Lung Carcinoma Is Predictive of Local Control.

Radiological evaluation after stereotactic-body-radiotherapy (SBRT) for non-small-cell lung carcinoma (NSCLC) is often difficult due to lung radiation-induced image modifications on computed tomographic (CT) scan. The aim of this study was to evaluate positron-emission tomography-computed tomography (PET-CT) using fluorodeoxyglucose after SBRT in primary lung cancer. Eighteen patients with histologically proven NSCLC were treated with SBRT. All had PET-CT evaluations before treatment, at 2 to 3 months and at 1 year post SBRT during the follow-up. Early PET-CT in 12/18 patients who did not experience local failure did not show any progression. No conclusion could be drawn in four cases because early PET-CT was disturbed by inflammatory reaction. Early PET-CT was not predictive of late outcome for two patients, as it showed a significant response followed by disease progression on late evaluation. Early PET response appears to correlate with local control at 1 year post SBRT.

Stereotactic radiotherapy for stage I non-small cells lung cancer at a major teaching hospital : A three-year experience of stereotactic radiotherapy

Purpose Following past studies, stereotactic radiotherapy has become standard practice for stage I non-small cells lung cancer in patients not being able to undergo surgery. We aimed at reviewing over a three-year period the evolution of patients treated with this modality, the estimated survival based on a three-year record at 1 and 2 years, and cancer-related mortality. Material and method The number of patients treated with lung stereotactic radiotherapy from January 2014 to December 2016 was retrieved from the department radiotherapy data. Treatment was performed according to the stereotactic radiotherapy UK consortium guidelines. Almost all patients were scanned with a 4D CT, except those whose breathing could not allow to, and treated with a Truebeam ® . The regimen used were eight fractions of 7 Gy, five fractions of 11 Gy, three fractions of 18 Gy. An overall estimated analysis based on a three-year record was performed using the Kaplan–Meier method. An additional analysis identified cancer-related mortality. Results Seventy-seven patients who had stereotactic radiotherapy were identified. Median age was 78. Our data shows an increasing trend for lung stereotactic radiotherapy : 21, 24 and 32 patients were treated respectively in 2014, 2015 and 2016. Out of 77 patients, 63 were alive at the time of analysis - January 2017. Five out of 14 deaths were lung cancer-related, 7 out of 14 due to another cancer or systemic condition and 2 out of 14 were not specified. Primary was controlled in 75 out of 77 patients. Estimated survival at one year was 85.4 % [93.6–77.0] and 72.9 [87.5–64.6] at two years. Conclusion The increase in number of patients treated for stage I non-small cells lung cancer with stereotactic radiotherapy may be explained by the growing experience with this modality, which is well tolerated and with minor side effects. These numbers could also account for a shift toward treatment rather than active surveillance. In addition, excellent primary tumor control and low cancer-related mortality are promising for the development of this modality.

Stereotactic body radiotherapy is not replacing surgery in the treatment of early stage lung cancer yet.

Recently, an article entitled “Video-assisted thoracoscopic lobectomy versus stereotactic radiotherapy for stage I lung cancer” was published on the Annals of Thoracic Surgery . This is a retrospective comparison of video-assisted thoracoscopic surgery (VATS) lobectomy vs. stereotactic body radiotherapy (SBRT) in biopsy-proven clinical stage I non-small cell lung cancer (NSCLC) (1). The authors’ study showed that surgery was superior to SBRT in various aspects including overall survival (OS), cause-specific survival (CSS), recurrence-free survival (RFS), local control and distant control. SBRT as a treatment for early stage lung cancer has been a hot topic recently. Prior to this article, there had been several published studies claiming that SBRT was not inferior to or even better than surgery. The contention thus ensued between thoracic surgeons and radiation therapists could not be easily settled.

Hypofractionated Stereotactic Radiotherapy for Stage III Non-small Cell Lung Cancer: A Dosimetric Feasibility Study

Hypofractionated Stereotactic Radiotherapy for Stage III Non-small Cell Lung Cancer: A Dosimetric Feasibility Study

Radiological Changes After Stereotactic Radiotherapy for Stage I Lung Cancer

Stereotactic body radiation therapy (SBRT) is entering routine clinical use for selected patients with early-stage non-small cell lung cancer. Post-SBRT radiological changes are commonly seen on follow-up computed tomography (CT) imaging and can cause diagnostic dilemmas. The aim of this study is to describe the incidence, radiological severity, and long-term morphology of these changes. CT scans from patients treated between 2003 and June 2008 were eligible for evaluation if radiological follow-up had been performed at our center for at least 2 years, and there was no definite evidence of local recurrence. Timing, incidence, morphology, and severity of lung changes were determined. CT scans from 61 patients (68 lesions) with a median follow-up of 2.5 years were evaluated. Within 6 months, 54% of lesions were associated with additional radiological abnormalities, and this figure reached 99% after 36 months. Most changes were scored as mild to moderate, and although the median time to first observation was 17 weeks, 25% appeared ≥ 1 year post-SBRT. In 47% of lesions, the morphology or severity of changes continued to evolve more than 2 years posttreatment. Mild-moderate radiological changes are common after lung SBRT. Some degree of late change is nearly universal, and it often continues to evolve more than 2 years post-SBRT. Clinicians should be aware of these radiological findings, which need to be distinguished from the uncommon cases of local failure post-SBRT.

Stereotactic radiotherapy for stage I lung cancer: Current results and new developments

In early stage non-small cell lung cancer (NSCLC), recent data from both prospective clinical trials and single institutions indicate that local control rates in excess of 88% can be achieved using stereotactic radiotherapy (SRT). Treatment-related toxicity is uncommon when “risk-adapted” fractionation schemes are applied, with lower dose per fraction used for larger tumors and when the planning target volume is in the proximity of critical structures. Both the superior outcome and convenience of fewer visits have led to a preference for SRT over conventional radiotherapy in countries such as Japan and the Netherlands. Reports on outcomes of SRT in patients unfit to undergo surgery may underestimate late toxicity as such patients have significant non-cancer related mortality. The evolution of technology has allowed for further improvements in the accuracy and speed of SRT delivery. Recent advances such as on-board imaging and intensity-modulated arc delivery techniques have improved treatment accuracy and tolerability, as well as the confidence of clinicians in applying SRT outside the setting of specialized tertiary institutions. Studies comparing primary surgery with SRT are underway, but the available data are compelling enough to allow SRT to be considered an established treatment option in patients who are aged 75 years and older, and in whom the estimated risks of postoperative mortality rates are high. The clinical development of SRT will be greatly facilitated by improvements in diagnostic procedures for peripheral pulmonary nodules. However, treatment without pathological confirmation may be justified in medically inoperable patients if the risk of malignancy is sufficiently high as to warrant an invasive diagnostic procedure.

Quality of Life After Stereotactic Radiotherapy for Stage I Non-Small-Cell Lung Cancer

To determine the impact of stereotactic radiotherapy on the quality of life of patients with inoperable early-stage non-small-cell lung cancer (NSCLC). Overall survival, local tumor control, and toxicity were also evaluated in this prospective study. From January 2006 to February 2008, quality of life, overall survival, and local tumor control were assessed in 39 patients with pathologically confirmed T1 to 2N0M0 NSCLC. These patients were treated with stereotactic radiotherapy. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30 and the QLQ LC13 lung cancer-specific questionnaire were used to investigate changes in quality of life. Assessments were done before treatment, at 3 weeks, and at 2, 4, 6, 9, and 12 months after treatment, until death or progressive disease. Toxicity was evaluated using common terminology criteria for adverse events version 3.0. Emotional functioning improved significantly after treatment. Other function scores and QLQ C30 and QLQ LC13 lung symptoms (such as dyspnea and coughing) showed no significant changes. The overall 2-year survival rate was 62%. After a median follow-up of 17 months, 1 patient had a local recurrence (3%). No grade 4 or 5 treatment-related toxicity occurred. Grade 3 toxicity consisted of thoracic pain, which occurred in 1 patient within 4 months of treatment, while it occurred thereafter in 2 patients. Quality of life was maintained, and emotional functioning improved significantly after stereotactic radiotherapy for stage I NSCLC, while survival was acceptable, local tumor control was high, and toxicity was low.

Patterns of Failure and Predictive Value of PET-CT after Stereotactic Radiotherapy for Stage I Lung Cancer

Patterns of Failure and Predictive Value of PET-CT after Stereotactic Radiotherapy for Stage I Lung Cancer

Stereotactic radiotherapy for stage I non-small-cell lung cancer—the triumph of technology over biology?

Should patients with stage I non-small-cell lung cancer who are unsuitable for surgery receive hypofractionated stereotactic radiotherapy? In the rush to implement new technology, there could be a danger of overlooking refinements important to ensure safety, according to the author of this Viewpoint.

Time trends in target volumes for stage I non–small-cell lung cancer after stereotactic radiotherapy

To identify potential time trends in target volumes and tumor mobility after stereotactic radiotherapy (SRT) for Stage I non-small-cell lung cancer. Repeat planning computed tomography (CT) scans were performed for 40 tumors during fractionated SRT delivered in either three (n = 21), five (n = 14), or eight fractions (n = 5). The planning CT scans used to define internal target volumes (ITVs) consisted of either six multislice CT scans or a single four-dimensional CT scan. All repeat CT scans were coregistered with the initial (D0) scan to determine volumetric or spatial changes in target volume, and tumor mobility vectors were determined from each scan. A significant decrease in target volumes (ITVs and gross tumor volumes) relative to baseline values was observed starting at the fourth week of SRT (p = 0.015). No trends in tumor mobility were detected during SRT. Significant positional shifts in the ITV, of more than 5 mm, were seen in 26-43% of patients at different times during SRT. Significant changes in target volumes can occur during SRT for Stage I non-small-cell lung cancer. A failure to account for such changes e.g., by repeat CT planning or verification using on-board volumetric imaging can lead to inadequate target coverage.

O-140 Quality of life after 4D stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

O-140 Quality of life after 4D stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

Four-dimensional CT scans for treatment planning in stereotactic radiotherapy for stage I lung cancer

Hypofractionated stereotactic radiotherapy (SRT) for Stage I non-small-cell lung cancer requires that meticulous attention be paid toward ensuring optimal target definition. Two computed tomography (CT) scan techniques for defining internal target volumes (ITV) were evaluated. Ten consecutive patients treated with SRT underwent six "standard" rapid multislice CT scans to generate an ITV(6 CT) and one four-dimensional CT (4DCT) scan that generated volumetric datasets for 10 phases of the respiratory cycle, all of which were used to generate an ITV(4DCT). Geometric and dosimetric analyses were performed for (1) PTV(4DCT), derived from the ITV(4DCT) with the addition of a 3-mm margin; (2) PTV(6 CT), derived from the ITV(6 CT) with the addition of a 3-mm margin; and (3) 6 PTV(10 mm), derived from each separate GTV(6 CT), to which a three-dimensional margin of 10 mm was added. The ITV(4DCT) was not significantly different from the ITV(6 CT) in 8 patients, but was considerably larger in 2 patients whose tumors exhibited the greatest mobility. On average, the ITV(6 CT) missed on average 22% of the volume encompassing both ITVs, in contrast to a corresponding mean value of only 8.3% for ITV(4DCT). Plans based on PTV(4DCT) resulted in coverage of the PTV(6 CT) by the 80% isodose in all patients. However, plans based on use of PTV(6 CT) led to a mean PTV(4DCT) coverage of only 92.5%, with a minimum of 77.7% and 77.5% for the two most mobile tumors. PTVs derived from a single multislice CT expanded with a margin of 10 mm were on average twice the size of PTVs derived using the other methods, but still led to an underdosing in the two most mobile tumors. Individualized ITVs can improve target definition for SRT of Stage I non-small-cell lung cancer, and use of only a single CT scan with a 10-mm margin is inappropriate. A single 4D scan generates comparable or larger ITVs than are generated using six unmonitored rapid CT scans, a finding related to the ability to account for all respiration-correlated mobility.

62 oral Time trends in target volumes during stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

62 oral Time trends in target volumes during stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

Time trends in target volumes during stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

Time trends in target volumes during stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

Time trends in target volumes during stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

Time trends in target volumes during stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

O-20 Stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)

O-20 Stereotactic radiotherapy for stage I non-small cell lung cancer (NSCLC)