Predictors of Nodal and Metastatic Failure in Early Stage Non-small-cell Lung Cancer After Stereotactic Body Radiation Therapy.
Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung
/ diagnosis
Disease Progression
Female
Follow-Up Studies
Humans
Lung Neoplasms
/ diagnosis
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Prognosis
Radiosurgery
/ methods
Radiotherapy Dosage
Retrospective Studies
Risk Factors
Treatment Failure
Tumor Burden
Metastasis
SABR
SBRT
Stereotactic body ablative radiotherapy
Stereotactic body radiation therapy
Journal
Clinical lung cancer
ISSN: 1938-0690
Titre abrégé: Clin Lung Cancer
Pays: United States
ID NLM: 100893225
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
received:
22
08
2018
revised:
21
12
2018
accepted:
23
12
2018
pubmed:
4
2
2019
medline:
4
4
2020
entrez:
4
2
2019
Statut:
ppublish
Résumé
Many patients with early stage non-small-cell lung cancer (ES-NSCLC) undergoing stereotactic body radiation therapy (SBRT) develop metastases, which is associated with poor outcomes. We sought to identify factors predictive of metastases after lung SBRT and created a risk stratification tool. We included 363 patients with ES-NSCLC who received SBRT; the median follow-up was 5.8 years. The following patient and tumor factors were retrospectively analyzed for their association with metastases (defined as nodal and/or distant failure): gender; age; lobe involved; centrality; previous NSCLC; smoking status; gross tumor volume (GTV); T-stage; histology; dose; minimum, maximum, and mean GTV dose; and parenchymal lung failure. A metastasis risk-score linear-model using beta coefficients from a multivariate Cox model was built. A total of 111 (27.3%) of 406 lesions metastasized. GTV and dose were significantly associated with metastases on univariate and multivariate Cox proportional hazards modeling (P < .001 and hazard ratio [HR], 1.02 per mL; P < .05 and HR, 0.99 per Gy, respectively). Histology, T-stage, centrality, lung parenchymal failures, and previous NSCLC were not associated with development of metastasis. A metastasis risk-score model using GTV and prescription dose was built: risk score = (0.01611 × GTV) - (0.00525 × dose [BED GTV and radiation dose are associated with time to metastasis and may be used to identify patients at higher risk of metastasis after lung SBRT.
Sections du résumé
INTRODUCTION/BACKGROUND
Many patients with early stage non-small-cell lung cancer (ES-NSCLC) undergoing stereotactic body radiation therapy (SBRT) develop metastases, which is associated with poor outcomes. We sought to identify factors predictive of metastases after lung SBRT and created a risk stratification tool.
MATERIALS AND METHODS
We included 363 patients with ES-NSCLC who received SBRT; the median follow-up was 5.8 years. The following patient and tumor factors were retrospectively analyzed for their association with metastases (defined as nodal and/or distant failure): gender; age; lobe involved; centrality; previous NSCLC; smoking status; gross tumor volume (GTV); T-stage; histology; dose; minimum, maximum, and mean GTV dose; and parenchymal lung failure. A metastasis risk-score linear-model using beta coefficients from a multivariate Cox model was built.
RESULTS
A total of 111 (27.3%) of 406 lesions metastasized. GTV and dose were significantly associated with metastases on univariate and multivariate Cox proportional hazards modeling (P < .001 and hazard ratio [HR], 1.02 per mL; P < .05 and HR, 0.99 per Gy, respectively). Histology, T-stage, centrality, lung parenchymal failures, and previous NSCLC were not associated with development of metastasis. A metastasis risk-score model using GTV and prescription dose was built: risk score = (0.01611 × GTV) - (0.00525 × dose [BED
CONCLUSION
GTV and radiation dose are associated with time to metastasis and may be used to identify patients at higher risk of metastasis after lung SBRT.
Identifiants
pubmed: 30711394
pii: S1525-7304(18)30353-X
doi: 10.1016/j.cllc.2018.12.016
pmc: PMC6526082
mid: NIHMS1517614
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
186-193.e3Subventions
Organisme : NCI NIH HHS
ID : P30 CA023168
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA082709
Pays : United States
Informations de copyright
Copyright © 2018 Elsevier Inc. All rights reserved.
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