Poor Pulmonary Function is not Associated with Increased Rates of Toxicity or Decreased Overall Survival after Stereotactic Body Radiotherapy for Early Stage Non-small Cell Lung Cancer: Results of a Multi-Institutional Analysis (original) (raw)
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International Journal of Radiation Oncology*Biology*Physics, 2008
Purpose: To examine the effect of baseline forced expiratory volume in 1 second (FEV 1) and diffusion capacity for carbon monoxide (DL co) on posttreatment survival and pulmonary function decrease after stereotactic body radiotherapy (SBRT) for patients with early-stage non-small-cell lung cancer (NSCLC). Methods and Materials: Seventy medically inoperable patients with Stage I NSCLC were treated with definitive SBRT to a dose of 6,000 (Stage IA) or 6,600 cGy (Stage IB), given in three equal fractions. Baseline and serial posttreatment pulmonary function data were collected. Results: Median age was 70.5 years, and median follow-up was 2.17 years. Median pretreatment FEV 1 and DL co were 1.05 L and 10.06 mg/min/mm Hg, respectively. There was no significant decrease in survival in patients with baseline FEV 1 and DL co less than the median value and less than the lowest quartile, whereas patients with values greater than the highest quartile of baseline FEV 1 had significantly inferior survival. There was no significant effect of pretreatment FEV 1 or DL co on posttreatment levels. There was a statistically significant decrease in DL co of 1.11 mg/min/mm Hg/y. Conclusions: Poor baseline pulmonary function did not predict decreased survival or pulmonary function after treatment. A statistically significant decrease in DL co after treatment was seen, similar to decreases seen in studies delivering standard thoracic radiotherapy. We conclude that low pretreatment FEV 1 and/or DL co alone should not be used to exclude patients with NSCLC from treatment with SBRT.
Supportive Care in Cancer, 2012
Purpose The study seeks to prospectively evaluate pulmonary function and quality of life (QOL) in medically inoperable early-stage lung cancer patients undergoing stereotactic body radiotherapy (SBRT). Methods QOL was assessed by Functional Assessment of Cancer Therapy-Lung (FACT-L) and the UCSD Medical Center Pulmonary Rehabilitation Program Shortness-of-Breath Questionnaire before and after SBRT at 6 weeks, and every 3 months until 12 months. Clinical investigations included pulmonary functions tests and blood profile and chemistries. SBRT was delivered on a Novalis/BrainLab system. Results Twenty-one analyzable patients were enrolled between July 2008 to April 2009. There were 12 males (52.4 %), 14 patients (66.7 %) had Zubrod performance 1, the median age was 77 years (range 61-90), and 87 % was inoperable because of pulmonary impairment. Median tumor size was 3.0 cm (range 1-4.6). Median follow-up was 17.6 months. One-year local control was 100 %. There were no significant changes in the median total FACT-L scores: 109 at baseline compared to 112 at 1 year. Mean UCSD scores were not significant for the year. No significant changes in mean baseline compared to 1-year FEV1 and 6-min walks as % predicted were seen but a significant DLCO change (p00.012) was attributed to the decreased range in the standard deviations.
Journal of Thoracic Oncology, 2009
Background: To assess for variables predicting pulmonary function test (PFT) changes after stereotactic body radiotherapy (SBRT) for medically inoperable stage I lung cancer. Methods: We reviewed 92 consecutive patients undergoing SBRT for stage I lung cancer between February 2004 and August 2007. A total of 102 lesions were treated using prescriptions of 20 Gy ϫ 3 (n ϭ 40), 10 Gy ϫ 5 (n ϭ 56), and 5 Gy ϫ 10 (n ϭ 6). Institutional practice was 10 Gy ϫ 5 before March 1, 2006 before changing to 20 Gy ϫ 3 to conform to RTOG 0236 unless otherwise dictated clinically. Results: Median pretreatment forced expiratory volume at 1 second (FEV 1) was 1.21 liter (50% of predicted) and median diffusion capacity to carbon monoxide (DLCO) was 56.5. There was no significant overall change in PFT's after SBRT. Individual patients experienced both substantial improvements and declines (10% declined at least 14% predicted FEV 1 % and 19% predicted DLCO). The mean change in FEV 1 was Ϫ0.05 liter (range, Ϫ0.98 to ϩ1.29 liter; p ϭ 0.22) representing Ϫ1.88% predicted baseline FEV 1 (range, Ϫ33 to ϩ 43%; p ϭ 0.62). DLCO declined 2.59% of predicted (range, Ϫ37 to ϩ33%; p ϭ 0.27). Conformality index, V5 and V10 were associated with individual patient changes in FEV 1 % (p ϭ 0.033, p ϭ 0.0036, p ϭ 0.025, respectively), however, correlations were small and overall treatment dose did not predict for changes (p ϭ 0.95). There was no significant difference in FEV 1 (p ϭ 0.55) or FEV 1 % (p ϭ 0.37) changes for central versus peripheral locations. No factors predicted for individual changes in DLCO. Patients with FEV 1 % below the median of the study population had significantly longer overall survival (p ϭ 0.0065). Although patients dying of cardiac disease died earlier than those dying of other causes, FEV 1 % below median was not associated with a lower risk of dying of cardiac disease or with lower Charlson comorbidity index. Conclusions: (1) SBRT was well tolerated and PFT changes were minimal. (2) Central lesions were safely treated with 50 Gy.
Journal of Thoracic Oncology, 2012
Introduction: To evaluate the influence of pretreatment pulmonary function (PF) on survival, early and late pulmonary toxicity after stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung cancer. Methods: Four hundred eighty-three patients with 505 tumors of early-stage non-small cell lung cancer cT1-3 cN0 were treated with image-guided SBRT at five international institutions (1998-2010). Sixty-four percent of the tumors were biopsy-proven and 18Ffluorodeoxyglucose-positron emission tomography was performed for staging in 84%. Image-guided SBRT was performed with a median of three fractions to a median total dose of 54 Gy. Pretreatment PF was available for 423 patients, and 617 posttreatment PF tests from 270 patients were available. Results: A large variability of pretreatment PF was observed: the 90% range of forced expiratory volume in 1 second and diffusing capacity for carbon monoxide was 29 to 109% and 5.5 to 19.1 ml/min/mmHg, respectively. PF was significantly correlated with overall survival but not cause-specific survival: diffusing capacity for carbon monoxide of 11.2 ml/min/mmHg differentiated between 3-year overall survival of 66% and 42%. Radiation-induced pneumonitis grade ՆII occurred in 7% of patients and was not increased in patients with lower PF. A significant and progressive change of PF was observed after SBRT: PF decreased by 3.6% and 6.8% on average within 6 and 6 to 24 months after SBRT, respectively. Changes of PF after SBRT were significantly correlated with pre-treatment PF: PF improved for worst pretreatment PF and the largest loss was observed for best pretreatment PF. Conclusions: Image-guided SBRT is safe in terms of acute and chronic pulmonary toxicity even for patients with severe pulmonary comorbidities. SBRT should be considered as a curative treatment option for inoperable patients with pretreatment PF as reported in this study.
International Journal of Radiation Oncology*Biology*Physics, 2005
Purpose: Clinical and 3D dosimetric parameters are associated with symptomatic radiation pneumonitis rates in retrospective studies. Such parameters include: mean lung dose (MLD), radiation (RT) dose to perfused lung (via SPECT), and pre-RT lung function. Based on prior publications, we defined pre-RT criteria hypothesized to be predictive for later development of pneumonitis. We herein prospectively test the predictive abilities of these dosimetric/functional parameters on 2 cohorts of patients from Duke and The Netherlands Cancer Institute (NKI).
Journal of Clinical Oncology, 2009
Purpose The impact of stereotactic body radiotherapy (SBRT) on 3-year progression-free survival of medically inoperable patients with stage I non–small-cell lung cancer (NSCLC) was analyzed in a prospective phase II study. Patients and Methods Fifty-seven patients with T1NOMO (70%) and T2N0M0 (30%) were included between August 2003 and September 2005 at seven different centers in Sweden, Norway, and Denmark and observed up to 36 months. SBRT was delivered with 15 Gy times three at the 67% isodose of the planning target volume. Results Progression-free survival at 3 years was 52%. Overall- and cancer-specific survival at 1, 2, and 3 years was 86%, 65%, 60%, and 93%, 88%, 88%, respectively. There was no statistically significant difference in survival between patients with T1 or T2 tumors. At a median follow-up of 35 months (range, 4 to 47 months), 27 patients (47%) were deceased, seven as a result of lung cancer and 20 as a result of concurrent disease. Kaplan-Meier estimated local c...
Radiation and Environmental Biophysics, 2020
The aim of the study is to investigate factors that may cause radiation-induced lung disease (RILD) in patients undergoing stereotactic body radiotherapy (SBRT) for lung tumors. Medical records of patients treated between May 2018 and June 2019 with SBRT were retrospectively evaluated. All patients should have a diagnosis of either primary non-small cell lung cancer (NSCLC) or less than three metastases to lung from another primary. The median treatment dose was 50 Gy in 4-5 fractions. Tumor response and RILD were evaluated in thoracic computer tomography (CT) using RECIST criteria. 82 patients with 97 lung lesions were treated. The median age was 68 years (IQR = 62-76). With a median follow-up of 7.2 months (3-18 months), three patients had grade 3 radiation pneumonitis (RP). RILD was observed in 52% of cases. Patients who had RILD had a higher risk of symptomatic RP (p = 0.007). In multivariate analyses older age, previous lung radiotherapy history, and median planning treatment volume (PTV) D95 value of ≥ 48 Gy were associated with RILD. Local recurrence (LR) was observed in 5.1% of cases. There was no difference in overall survival and LR with the presence of RILD. Older age, previous lung radiotherapy history, and median PTV D95 value of ≥ 48 Gy seems to be associated with post-SBRT RILD.
Toxicity after reirradiation of pulmonary tumours with stereotactic body radiotherapy
Radiotherapy and Oncology, 2011
Link to publication in VU Research Portal citation for published version (APA) Peulen, H. M. U. (2017). Optimization of lung SBRT towards novel applications. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.