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Predictors of Nodal and Metastatic Failure in Early Stage Non-small-cell Lung Cancer After Stereotactic Body Radiation Therapy.
Cerra-Franco, Alberto; Liu, Sheng; Azar, Michella; Shiue, Kevin; Freije, Samantha; Hinton, Jason; Deig, Christopher R; Edwards, Donna; Estabrook, Neil C; Ellsworth, Susannah G; Huang, Ke; Diab, Khalil; Langer, Mark P; Zellars, Richard; Kong, Feng-Ming; Wan, Jun; Lautenschlaeger, Tim.
Afiliación
  • Cerra-Franco A; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Liu S; Department of Medical and Molecular Genetics, Collaborative Core for Cancer Bioinformatics, Indianapolis, IN.
  • Azar M; Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN.
  • Shiue K; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Freije S; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Hinton J; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Deig CR; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Edwards D; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Estabrook NC; Department of Radiation Oncology, Indiana University Health Arnett Hospital, Lafayette, IN.
  • Ellsworth SG; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Huang K; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Diab K; Pulmonary, Critical Care, Sleep, and Occupational Medicine, Indiana University School of Medicine, Indianapolis, IN.
  • Langer MP; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Zellars R; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Kong FM; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
  • Wan J; Department of Medical and Molecular Genetics, Collaborative Core for Cancer Bioinformatics, Indianapolis, IN.
  • Lautenschlaeger T; Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN. Electronic address: timlaut@iupui.edu.
Clin Lung Cancer ; 20(3): 186-193.e3, 2019 05.
Article en En | MEDLINE | ID: mdl-30711394
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 [BED10]). Two risk-score cutoffs separating the cohort into low-, medium-, and high-risk subgroups were examined. The risk score identified significant differences in time to metastases between low-, medium-, and high-risk patients (P < .001), with 3-year estimates of 81.1%, 63.8%, and 38%, respectively. 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Radiocirugia / Carcinoma de Pulmón de Células no Pequeñas / Neoplasias Pulmonares Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Lung Cancer Asunto de la revista: NEOPLASIAS Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Radiocirugia / Carcinoma de Pulmón de Células no Pequeñas / Neoplasias Pulmonares Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Lung Cancer Asunto de la revista: NEOPLASIAS Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos