Abstract
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.
| Original language | English (US) |
|---|---|
| Journal | Clinical Lung Cancer |
| DOIs | |
| State | Accepted/In press - Jan 1 2019 |
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Keywords
- Metastasis
- SABR
- SBRT
- Stereotactic body ablative radiotherapy
- Stereotactic body radiation therapy
ASJC Scopus subject areas
- Oncology
- Pulmonary and Respiratory Medicine
- Cancer Research
Cite this
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; Zellars, Richard; Kong, Feng Ming; Wan, Jun; Lautenschlaeger, Tim.
In: Clinical Lung Cancer, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Predictors of Nodal and Metastatic Failure in Early Stage Non–small-cell Lung Cancer After Stereotactic Body Radiation Therapy
AU - Cerra-Franco, Alberto
AU - Liu, Sheng
AU - Azar, Michella
AU - Shiue, Kevin
AU - Freije, Samantha
AU - Hinton, Jason
AU - Deig, Christopher R.
AU - Edwards, Donna
AU - Estabrook, Neil C.
AU - Ellsworth, Susannah G.
AU - Huang, Ke
AU - Diab, Khalil
AU - Langer, Mark
AU - Zellars, Richard
AU - Kong, Feng Ming
AU - Wan, Jun
AU - Lautenschlaeger, Tim
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Metastasis
KW - SABR
KW - SBRT
KW - Stereotactic body ablative radiotherapy
KW - Stereotactic body radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85060722365&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85060722365&partnerID=8YFLogxK
U2 - 10.1016/j.cllc.2018.12.016
DO - 10.1016/j.cllc.2018.12.016
M3 - Article
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
SN - 1525-7304
ER -