Michael Frelinghuysen1, Jesse Fest2, Noelle C Van der Voort Van Zyp3, Bronno Van der Holt4, Mischa Hoogeman5, Joost Nuyttens5. 1. Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. Electronic address: mfrelinghuysen@yahoo.com. 2. Departement of Surgery, Erasmus MC, Rotterdam, The Netherlands. 3. Department of Radiation Oncology, Haaglanden Medisch Centrum, The Hague, The Netherlands. 4. Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands. 5. Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Abstract
BACKGROUND: Inoperable patients with early stage lung cancer are referred late. The purpose was to calculate the referral time and the volume doubling time (VDT), and to investigate its consequence with regard to staging and survival in 117 inoperable patients with early stage lung cancer treated with stereotactic body radiotherapy. MATERIALS AND METHODS: Tumor VDT was calculated using the modified Schwartz formula of exponential growth model and was on the basis of volumes measured on initial diagnostic computed tomography (CT) scans and the planning CT scan. VDT was defined as fast (<100 days), moderate (100-249 days), slow (250-399 days), and no growth (≥400 days). The referral time is the time between the diagnostic CT scan and the radiotherapy planning CT scan. RESULTS: The median referral time was 86 days. The VDT was fast in 53 patients [45%] of tumors. No significant difference in VDT was found between different tumor or patient characteristics. Patients with T1 tumors that progressed to T2 had a significant worse median survival (P = .01). The overall survival at 5 years according to VDT was 21% for fast-growing tumors, 19% for moderate growth, 31% for slow, and 46% for no growth. CONCLUSION: The median referral time was almost 3 months. VDT was considered as fast in almost half of tumors examined. This resulted in significant growth and upstaging in 35% of the tumors, with a significant worse survival if T1 tumors progressed to T2 tumors. Therefore, medically inoperable patients should also be offered a fast workup and referral.
BACKGROUND: Inoperable patients with early stage lung cancer are referred late. The purpose was to calculate the referral time and the volume doubling time (VDT), and to investigate its consequence with regard to staging and survival in 117 inoperable patients with early stage lung cancer treated with stereotactic body radiotherapy. MATERIALS AND METHODS:Tumor VDT was calculated using the modified Schwartz formula of exponential growth model and was on the basis of volumes measured on initial diagnostic computed tomography (CT) scans and the planning CT scan. VDT was defined as fast (<100 days), moderate (100-249 days), slow (250-399 days), and no growth (≥400 days). The referral time is the time between the diagnostic CT scan and the radiotherapy planning CT scan. RESULTS: The median referral time was 86 days. The VDT was fast in 53 patients [45%] of tumors. No significant difference in VDT was found between different tumor or patient characteristics. Patients with T1 tumors that progressed to T2 had a significant worse median survival (P = .01). The overall survival at 5 years according to VDT was 21% for fast-growing tumors, 19% for moderate growth, 31% for slow, and 46% for no growth. CONCLUSION: The median referral time was almost 3 months. VDT was considered as fast in almost half of tumors examined. This resulted in significant growth and upstaging in 35% of the tumors, with a significant worse survival if T1 tumors progressed to T2 tumors. Therefore, medically inoperable patients should also be offered a fast workup and referral.
Authors: Helen Hall; Adam Tocock; Sarah Burdett; David Fisher; William M Ricketts; John Robson; Thomas Round; Sarita Gorolay; Emma MacArthur; Donna Chung; Sam M Janes; Michael D Peake; Neal Navani Journal: Thorax Date: 2021-08-17 Impact factor: 9.102
Authors: William W Phillips; Jessica Copeland; Sophie C Hofferberth; Julee R Armitage; Sam Fox; Margaret Kruithoff; Claire de Forcrand; Paul J Catalano; Christopher S Lathan; Joel S Weissman; David D Odell; Yolonda L Colson Journal: Healthc (Amst) Date: 2021-06-26