Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy

Kevin Shiue, Alberto Cerra-Franco, Ronald Shapiro, Neil Estabrook, Edward M. Mannina, Christopher R. Deig, Sandra Althouse, Sheng Liu, Jun Wan, Yong Zang, Namita Agrawal, Pericles Ioannides, Yongmei Liu, Chen Zhang, Colleen DesRosiers, Greg Bartlett, Marvene Ewing, Mark Langer, Gordon Watson, Richard ZellarsFeng Ming Kong, Tim Lautenschlaeger

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Introduction: It remains unclear if histology should be independently considered when choosing stereotactic ablative body radiotherapy dose prescriptions for NSCLC. Methods: The study population included 508 patients with 561 lesions between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. Eligible patients had histologically or clinically diagnosed early-stage NSCLC and were treated with 3 to 5 fractions. The primary endpoint was in-field tumor control censored by either death or progression. Involved lobe control was also assessed. Results: At 6.7 years median follow-up, 3-year in-field control, involved lobe control, overall survival, and progression-free survival rates were 88.1%, 80.0%, 49.4%, and 37.2%, respectively. Gross tumor volume (GTV) (hazard ratio [HR] = 1.01 per mL, p = 0.0044) and histology (p = 0.0225) were independently associated with involved lobe failure. GTV (HR = 1.013, p = 0.001) and GTV dose (cutoff of 110 Gy, biologically effective dose with α/β = 10 [BED10], HR = 2.380, p = 0.0084) were independently associated with in-field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in-field control (12 Gy × 4 or 10 Gy × 5 versus 18 Gy or 20 Gy × 3: HR = 3.530, p = 0.0447, confirmed by propensity score matching) and was independent of GTV (HR = 1.014 per mL, 95% confidence interval: 1.005–1.022, p = 0.0012). For adenocarcinomas, there were no differences in in-field control observed using the above dose groupings (p = 0.12 and p = 0.31, respectively). Conclusions: In the absence of level I data, GTV and histology should be considered to personalize radiation dose for stereotactic ablative body radiotherapy. We suggest lower prescription doses (i.e., 12 Gy × 4 or 10 G × 5) should be avoided for squamous cell carcinomas if normal tissue tolerances are met.

Original languageEnglish (US)
JournalJournal of Thoracic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Tumor Burden
Histology
Radiotherapy
Radiation
Prescriptions
Radiosurgery
Squamous Cell Carcinoma
Propensity Score
Disease-Free Survival
Adenocarcinoma
Survival Rate
Confidence Intervals
Survival
Population
Neoplasms

Keywords

  • Histology
  • NSCLC
  • Stereotactic ablative radiotherapy
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Shiue, K., Cerra-Franco, A., Shapiro, R., Estabrook, N., Mannina, E. M., Deig, C. R., ... Lautenschlaeger, T. (Accepted/In press). Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy. Journal of Thoracic Oncology. https://doi.org/10.1016/j.jtho.2018.06.007

Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy. / Shiue, Kevin; Cerra-Franco, Alberto; Shapiro, Ronald; Estabrook, Neil; Mannina, Edward M.; Deig, Christopher R.; Althouse, Sandra; Liu, Sheng; Wan, Jun; Zang, Yong; Agrawal, Namita; Ioannides, Pericles; Liu, Yongmei; Zhang, Chen; DesRosiers, Colleen; Bartlett, Greg; Ewing, Marvene; Langer, Mark; Watson, Gordon; Zellars, Richard; Kong, Feng Ming; Lautenschlaeger, Tim.

In: Journal of Thoracic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Shiue, K, Cerra-Franco, A, Shapiro, R, Estabrook, N, Mannina, EM, Deig, CR, Althouse, S, Liu, S, Wan, J, Zang, Y, Agrawal, N, Ioannides, P, Liu, Y, Zhang, C, DesRosiers, C, Bartlett, G, Ewing, M, Langer, M, Watson, G, Zellars, R, Kong, FM & Lautenschlaeger, T 2018, 'Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy', Journal of Thoracic Oncology. https://doi.org/10.1016/j.jtho.2018.06.007
Shiue, Kevin ; Cerra-Franco, Alberto ; Shapiro, Ronald ; Estabrook, Neil ; Mannina, Edward M. ; Deig, Christopher R. ; Althouse, Sandra ; Liu, Sheng ; Wan, Jun ; Zang, Yong ; Agrawal, Namita ; Ioannides, Pericles ; Liu, Yongmei ; Zhang, Chen ; DesRosiers, Colleen ; Bartlett, Greg ; Ewing, Marvene ; Langer, Mark ; Watson, Gordon ; Zellars, Richard ; Kong, Feng Ming ; Lautenschlaeger, Tim. / Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy. In: Journal of Thoracic Oncology. 2018.
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abstract = "Introduction: It remains unclear if histology should be independently considered when choosing stereotactic ablative body radiotherapy dose prescriptions for NSCLC. Methods: The study population included 508 patients with 561 lesions between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. Eligible patients had histologically or clinically diagnosed early-stage NSCLC and were treated with 3 to 5 fractions. The primary endpoint was in-field tumor control censored by either death or progression. Involved lobe control was also assessed. Results: At 6.7 years median follow-up, 3-year in-field control, involved lobe control, overall survival, and progression-free survival rates were 88.1{\%}, 80.0{\%}, 49.4{\%}, and 37.2{\%}, respectively. Gross tumor volume (GTV) (hazard ratio [HR] = 1.01 per mL, p = 0.0044) and histology (p = 0.0225) were independently associated with involved lobe failure. GTV (HR = 1.013, p = 0.001) and GTV dose (cutoff of 110 Gy, biologically effective dose with α/β = 10 [BED10], HR = 2.380, p = 0.0084) were independently associated with in-field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in-field control (12 Gy × 4 or 10 Gy × 5 versus 18 Gy or 20 Gy × 3: HR = 3.530, p = 0.0447, confirmed by propensity score matching) and was independent of GTV (HR = 1.014 per mL, 95{\%} confidence interval: 1.005–1.022, p = 0.0012). For adenocarcinomas, there were no differences in in-field control observed using the above dose groupings (p = 0.12 and p = 0.31, respectively). Conclusions: In the absence of level I data, GTV and histology should be considered to personalize radiation dose for stereotactic ablative body radiotherapy. We suggest lower prescription doses (i.e., 12 Gy × 4 or 10 G × 5) should be avoided for squamous cell carcinomas if normal tissue tolerances are met.",
keywords = "Histology, NSCLC, Stereotactic ablative radiotherapy, Stereotactic body radiation therapy",
author = "Kevin Shiue and Alberto Cerra-Franco and Ronald Shapiro and Neil Estabrook and Mannina, {Edward M.} and Deig, {Christopher R.} and Sandra Althouse and Sheng Liu and Jun Wan and Yong Zang and Namita Agrawal and Pericles Ioannides and Yongmei Liu and Chen Zhang and Colleen DesRosiers and Greg Bartlett and Marvene Ewing and Mark Langer and Gordon Watson and Richard Zellars and Kong, {Feng Ming} and Tim Lautenschlaeger",
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T1 - Histology, Tumor Volume, and Radiation Dose Predict Outcomes in NSCLC Patients After Stereotactic Ablative Radiotherapy

AU - Shiue, Kevin

AU - Cerra-Franco, Alberto

AU - Shapiro, Ronald

AU - Estabrook, Neil

AU - Mannina, Edward M.

AU - Deig, Christopher R.

AU - Althouse, Sandra

AU - Liu, Sheng

AU - Wan, Jun

AU - Zang, Yong

AU - Agrawal, Namita

AU - Ioannides, Pericles

AU - Liu, Yongmei

AU - Zhang, Chen

AU - DesRosiers, Colleen

AU - Bartlett, Greg

AU - Ewing, Marvene

AU - Langer, Mark

AU - Watson, Gordon

AU - Zellars, Richard

AU - Kong, Feng Ming

AU - Lautenschlaeger, Tim

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Introduction: It remains unclear if histology should be independently considered when choosing stereotactic ablative body radiotherapy dose prescriptions for NSCLC. Methods: The study population included 508 patients with 561 lesions between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. Eligible patients had histologically or clinically diagnosed early-stage NSCLC and were treated with 3 to 5 fractions. The primary endpoint was in-field tumor control censored by either death or progression. Involved lobe control was also assessed. Results: At 6.7 years median follow-up, 3-year in-field control, involved lobe control, overall survival, and progression-free survival rates were 88.1%, 80.0%, 49.4%, and 37.2%, respectively. Gross tumor volume (GTV) (hazard ratio [HR] = 1.01 per mL, p = 0.0044) and histology (p = 0.0225) were independently associated with involved lobe failure. GTV (HR = 1.013, p = 0.001) and GTV dose (cutoff of 110 Gy, biologically effective dose with α/β = 10 [BED10], HR = 2.380, p = 0.0084) were independently associated with in-field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in-field control (12 Gy × 4 or 10 Gy × 5 versus 18 Gy or 20 Gy × 3: HR = 3.530, p = 0.0447, confirmed by propensity score matching) and was independent of GTV (HR = 1.014 per mL, 95% confidence interval: 1.005–1.022, p = 0.0012). For adenocarcinomas, there were no differences in in-field control observed using the above dose groupings (p = 0.12 and p = 0.31, respectively). Conclusions: In the absence of level I data, GTV and histology should be considered to personalize radiation dose for stereotactic ablative body radiotherapy. We suggest lower prescription doses (i.e., 12 Gy × 4 or 10 G × 5) should be avoided for squamous cell carcinomas if normal tissue tolerances are met.

AB - Introduction: It remains unclear if histology should be independently considered when choosing stereotactic ablative body radiotherapy dose prescriptions for NSCLC. Methods: The study population included 508 patients with 561 lesions between 2000 and 2016, of which 442 patients with 482 lesions had complete dosimetric information. Eligible patients had histologically or clinically diagnosed early-stage NSCLC and were treated with 3 to 5 fractions. The primary endpoint was in-field tumor control censored by either death or progression. Involved lobe control was also assessed. Results: At 6.7 years median follow-up, 3-year in-field control, involved lobe control, overall survival, and progression-free survival rates were 88.1%, 80.0%, 49.4%, and 37.2%, respectively. Gross tumor volume (GTV) (hazard ratio [HR] = 1.01 per mL, p = 0.0044) and histology (p = 0.0225) were independently associated with involved lobe failure. GTV (HR = 1.013, p = 0.001) and GTV dose (cutoff of 110 Gy, biologically effective dose with α/β = 10 [BED10], HR = 2.380, p = 0.0084) were independently associated with in-field failure. For squamous cell carcinomas, lower prescription doses were associated with worse in-field control (12 Gy × 4 or 10 Gy × 5 versus 18 Gy or 20 Gy × 3: HR = 3.530, p = 0.0447, confirmed by propensity score matching) and was independent of GTV (HR = 1.014 per mL, 95% confidence interval: 1.005–1.022, p = 0.0012). For adenocarcinomas, there were no differences in in-field control observed using the above dose groupings (p = 0.12 and p = 0.31, respectively). Conclusions: In the absence of level I data, GTV and histology should be considered to personalize radiation dose for stereotactic ablative body radiotherapy. We suggest lower prescription doses (i.e., 12 Gy × 4 or 10 G × 5) should be avoided for squamous cell carcinomas if normal tissue tolerances are met.

KW - Histology

KW - NSCLC

KW - Stereotactic ablative radiotherapy

KW - Stereotactic body radiation therapy

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