Stereotactic boost on residual disease after external-beam irradiation in clinical stage III non-small cell lung cancer: mature results of stereotactic body radiation therapy post radiation therapy (SBRTpostRT) study.
Non-small cell lung cancer
Residual disease
Stereotactic body radiation therapy
Stereotactic boost
Journal
La Radiologia medica
ISSN: 1826-6983
Titre abrégé: Radiol Med
Pays: Italy
ID NLM: 0177625
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
12
09
2022
accepted:
25
05
2023
medline:
5
7
2023
pubmed:
9
6
2023
entrez:
9
6
2023
Statut:
ppublish
Résumé
To evaluate the role of stereotactic body radiation therapy (SBRT) delivered after external-beam fractionated irradiation in non-small-cell lung cancer (NSCLC) patients with clinical stage III A, B. All patients received three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) (60-66 Gy/30-33 fractions of 2 Gy/5 days a week) with or without concomitant chemotherapy. Within 60 days from the end of irradiation, a SBRT boost (12-22 Gy in 1-3 fractions) was delivered on the residual disease. Here we report the mature results of 23 patients homogeneously treated and followed up for a median time of 5.35 years (range 4.16-10.16). The rate of overall clinical response after external beam and stereotactic boost was 100%. No treatment-related mortality was recorded. Radiation-related acute toxicities with a grade ≥ 2 were observed in 6/23 patients (26.1%): 4/23 (17.4%) had esophagitis with mild esophageal pain (G2); in 2/23 (8.7%) clinical radiation pneumonitis G2 was observed. Lung fibrosis (20/23 patients, 86.95%) represented a typical late tissue damage, which was symptomatic in one patient. Median disease-free survival (DFS) and overall survival (OS) were 27.8 (95% CI, 4.2-51.3) and 56.7 months (95% CI, 34.9-78.5), respectively. Median local progression-free survival (PFS) was 17 months (range 11.6-22.4), with a median distant PFS of 18 months (range 9.6-26.4). The 5-year actuarial DFS and OS rates were 28.7% and 35.2%, respectively. We confirm that a stereotactic boost after radical irradiation is feasible in stage III NSCLC patients. All fit patients who have no indication to adjuvant immunotherapy and presenting residual disease after curative irradiation could benefit from stereotactic boost because outcomes seem to be better than might be historically assumed.
Identifiants
pubmed: 37294366
doi: 10.1007/s11547-023-01659-w
pii: 10.1007/s11547-023-01659-w
doi:
Substances chimiques
Etoposide
6PLQ3CP4P3
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
877-885Informations de copyright
© 2023. Italian Society of Medical Radiology.
Références
Cheema PK, Rothenstein J, Melosky B et al (2019) Perspectives on treatment advances for stage iii locally advanced unresectable non-small-cell lung cancer. Curr Oncol 26:37–42. https://doi.org/10.3747/co.26.4096
doi: 10.3747/co.26.4096
pubmed: 30853796
pmcid: 6380636
Bradley JD, Paulus R, Komaki R et al (2015) Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial p. Lancet Oncol 16:187–199. https://doi.org/10.1016/S1470-2045(14)71207-0
doi: 10.1016/S1470-2045(14)71207-0
pubmed: 25601342
pmcid: 4419359
Antonia SJ, Villegas A, Daniel D et al (2017) Durvalumab after Chemoradiotherapy in stage III Non–small-cell lung cancer. N Engl J Med 377:1919–1929. https://doi.org/10.1056/nejmoa1709937
doi: 10.1056/nejmoa1709937
pubmed: 28885881
Faivre-Finn C, Vicente D, Kurata T et al (2021) Four-year survival with Durvalumab after Chemoradiotherapy in stage III NSCLC—an update from the Pacific trial. J Thorac Oncol 16:860–867. https://doi.org/10.1016/j.jtho.2020.12.015
doi: 10.1016/j.jtho.2020.12.015
pubmed: 33476803
Perez CA, Stanley K, Rubin P et al (1980) A prospective randomized study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Preliminary report by the radiation therapy oncology group. Cancer 45:2744–2753. https://doi.org/10.1002/1097-0142(19800601)45:11%3c2744::AID-CNCR2820451108%3e3.0.CO;2-U
doi: 10.1002/1097-0142(19800601)45:11<2744::AID-CNCR2820451108>3.0.CO;2-U
pubmed: 6991092
Postmus PE, Kerr KM, Oudkerk M et al (2017) Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 28:21. https://doi.org/10.1093/annonc/mdx222
doi: 10.1093/annonc/mdx222
Aupérin A, Le Péchoux C, Rolland E et al (2010) Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced Non-small-cell lung cancer. J Clin Oncol 28:2181–2190. https://doi.org/10.1200/JCO.2009.26.2543
doi: 10.1200/JCO.2009.26.2543
pubmed: 20351327
MacHtay M, Bae K, Movsas B et al (2012) Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: An analysis of the radiation therapy oncology group. Int J Radiat Oncol Biol Phys 82:425–434. https://doi.org/10.1016/j.ijrobp.2010.09.004
doi: 10.1016/j.ijrobp.2010.09.004
pubmed: 20980108
Vyfhuis MAL, Rice S, Remick J et al (2018) Reirradiation for locoregionally recurrent non-small cell lung cancer. J Thorac Dis 10:S2522–S2536. https://doi.org/10.21037/jtd.2017.12.50
doi: 10.21037/jtd.2017.12.50
pubmed: 30206496
pmcid: 6123190
Raben D, Rimner A, Senan S et al (2019) Patterns of disease progression with Durvalumab in stage III Non-small cell lung cancer (PACIFIC). Int J Radiat Oncol 105:683. https://doi.org/10.1016/j.ijrobp.2019.08.034
doi: 10.1016/j.ijrobp.2019.08.034
Tateishi Y, Takeda A, Horita N et al (2021) Stereotactic body radiation therapy with a high maximum dose improves local control, cancer-specific death, and overall survival in peripheral early-stage Non-small cell lung cancer. Int J Radiat Oncol Biol Phys 111:143–151. https://doi.org/10.1016/j.ijrobp.2021.04.014
doi: 10.1016/j.ijrobp.2021.04.014
pubmed: 33891980
Alcibar OL, Nadal E, Palomar IR, Navarro-Martin A (2021) Systematic review of stereotactic body radiotherapy in stage III non-small cell lung cancer. Transl Lung Cancer Res 10:529–538. https://doi.org/10.21037/tlcr-2020-nsclc-04
doi: 10.21037/tlcr-2020-nsclc-04
pubmed: 33569334
pmcid: 7867744
Vadalà RE, Santacaterina A, Sindoni A et al (2016) Stereotactic body radiotherapy in non-operable lung cancer patients. Clin Transl Oncol 18:1158–1159. https://doi.org/10.1007/s12094-016-1552-7
doi: 10.1007/s12094-016-1552-7
pubmed: 27686231
Kong FM, Ritter T, Quint DJ et al (2011) Consideration of dose limits for organs at risk of thoracic radiotherapy: atlas for lung, proximal bronchial tree, Esophagus, spinal cord, ribs, and brachial plexus. Int J Radiat Oncol 81:1442–1457. https://doi.org/10.1016/j.ijrobp.2010.07.1977
doi: 10.1016/j.ijrobp.2010.07.1977
Eisenhauer EA, Therasse P, Bogaerts J et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026
doi: 10.1016/j.ejca.2008.10.026
pubmed: 19097774
Wahl RL, Jacene H, Kasamon Y, Lodge MA (2009) From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 50:122–150. https://doi.org/10.2967/jnumed.108.057307
doi: 10.2967/jnumed.108.057307
Ponce MC, Sharma S (2022) Pulmonary Function Tests
Ramella S, Maranzano E, Frata P et al (2012) Radiotherapy in Italy for non-small cell lung cancer: patterns of care survey. Tumori 98:66–78. https://doi.org/10.1700/1053.11502
doi: 10.1700/1053.11502
pubmed: 22495704
Remon J, Soria JC, Peters S (2021) Early and locally advanced non-small-cell lung cancer: an update of the ESMO Clinical practice guidelines focusing on diagnosis, staging, systemic and local therapy. Ann Oncol 32:1637–1642. https://doi.org/10.1016/j.annonc.2021.08.1994
doi: 10.1016/j.annonc.2021.08.1994
pubmed: 34481037
Feddock J, Arnold SM, Shelton BJ et al (2013) Stereotactic body radiation therapy can be used safely to boost residual disease in locally advanced non-small cell lung cancer: a prospective study. Int J Radiat Oncol Biol Phys 85:1325–1331. https://doi.org/10.1016/j.ijrobp.2012.11.011
doi: 10.1016/j.ijrobp.2012.11.011
pubmed: 23265574
Higgins KA, Pillai RN, Chen Z et al (2017) Concomitant chemotherapy and radiotherapy with SBRT boost for Unresectable stage III Non-small cell lung cancer: a phase I study. J Thorac Oncol 12:1687–1695. https://doi.org/10.1016/j.jtho.2017.07.036
doi: 10.1016/j.jtho.2017.07.036
pubmed: 28919394
Hepel JT, Leonard KL, Safran H et al (2016) Stereotactic body radiation therapy boost after concurrent Chemoradiation for locally advanced non-small cell lung cancer: a phase 1 dose escalation study. Int J Radiat Oncol Biol Phys 96:1021–1027. https://doi.org/10.1016/j.ijrobp.2016.08.032
doi: 10.1016/j.ijrobp.2016.08.032
pubmed: 27745983
Karam SD, Horne ZD, Hong RL et al (2013) Dose escalation with stereotactic body radiation therapy boost for locally advanced non small cell lung cancer. Radiat Oncol 8:1–8. https://doi.org/10.1186/1748-717X-8-179
doi: 10.1186/1748-717X-8-179
Doyen J, Poudenx M, Gal J et al (2018) Stereotactic ablative radiotherapy after concomitant chemoradiotherapy in non-small cell lung cancer: a TITE-CRM phase 1 trial. Radiother Oncol 127:239–245. https://doi.org/10.1016/j.radonc.2018.03.024
doi: 10.1016/j.radonc.2018.03.024
pubmed: 29650404
Kumar S, Feddock J, Li X et al (2017) Update of a prospective study of stereotactic body radiation therapy for post-chemoradiation residual disease in stage II/III Non-small cell lung cancer. Int J Radiat Oncol 99:652–659. https://doi.org/10.1016/j.ijrobp.2017.07.036
doi: 10.1016/j.ijrobp.2017.07.036
Sindoni A, Minutoli F, Pontoriero A et al (2016) Usefulness of four dimensional (4D) PET/CT imaging in the evaluation of thoracic lesions and in radiotherapy planning: review of the literature. Lung Cancer 96:78–86. https://doi.org/10.1016/j.lungcan.2016.03.019
doi: 10.1016/j.lungcan.2016.03.019
pubmed: 27133755
Sindoni A, Minutoli F, Baldari S, Pergolizzi S (2016) Importance of respiratory-gated PET/CT in thoracic Tumors. Radiology 281:321–323. https://doi.org/10.1148/radiol.2016160913
doi: 10.1148/radiol.2016160913
pubmed: 27643773
Meijer TWH, Wijsman R, Usmanij EA et al (2018) Stereotactic radiotherapy boost after definite chemoradiation for non-responding locally advanced NSCLC based on early response monitoring 18F-FDG-PET/CT. Phys Imaging Radiat Oncol 7:16–22. https://doi.org/10.1016/j.phro.2018.08.003
doi: 10.1016/j.phro.2018.08.003
pubmed: 33458400
pmcid: 7807537
Or M, Liu B, Lam J et al (2021) A systematic review and meta-analysis of treatment-related toxicities of curative and palliative radiation therapy in non-small cell lung cancer. Sci Rep 11:5939. https://doi.org/10.1038/s41598-021-85131-7
doi: 10.1038/s41598-021-85131-7
pubmed: 33723301
pmcid: 7971013
Anderson JD, Hu J, Li J et al (2021) Impact of cardiac dose on overall survival in lung stereotactic body radiotherapy (SBRT) compared to conventionally fractionated radiotherapy for locally advanced Non-small cell lung cancer (LA-NSCLC). J Cancer Ther 12:409–423. https://doi.org/10.4236/jct.2021.127036
doi: 10.4236/jct.2021.127036
pubmed: 34367717
pmcid: 8341170
Lucia F, Key S, Dissaux G et al (2019) Inhomogeneous tumor dose distribution provides better local control than homogeneous distribution in stereotactic radiotherapy for brain metastases. Radiother Oncol 130:132–138. https://doi.org/10.1016/j.radonc.2018.06.039
doi: 10.1016/j.radonc.2018.06.039
pubmed: 30017105
Cacciola A, Parisi S, Tamburella C et al (2020) Stereotactic body radiation therapy and radiofrequency ablation for the treatment of liver metastases: How and when? Reports Pract Oncol Radiother 25:299–306. https://doi.org/10.1016/j.rpor.2020.02.010
doi: 10.1016/j.rpor.2020.02.010
Joiner M, Kogel A van der (2009) Basic clinical radiobiology, 4th ed. Hodder Harnold, London (UK)
Parisi S, Napoli I, Lillo S et al (2022) Spine eburnation in a metastatic lung cancer patient treated with immunotherapy and radiotherapy. The first case report of bystander effect on bone. J Oncol Pharm Pract 28:237–241. https://doi.org/10.1177/10781552211027348
doi: 10.1177/10781552211027348
pubmed: 34233544
Ferini G, Valenti V, Tripoli A et al (2021) Lattice or oxygen-guided radiotherapy: what If they converge? Possible future directions in the era of immunotherapy. Cancers Basel 13:3290. https://doi.org/10.3390/cancers13133290
doi: 10.3390/cancers13133290
pubmed: 34209192
pmcid: 8268715
Ferini G, Parisi S, Lillo S et al (2022) Impressive results after metabolism-guided lattice irradiation in patients submitted to palliative radiation therapy: preliminary results of LATTICE_01 multicenter study. Cancers Basel 14:3909. https://doi.org/10.3390/cancers14163909
doi: 10.3390/cancers14163909
pubmed: 36010902
pmcid: 9406022