Patrick Wald1, Xiaokui Mo2, Christian Barney1, Daniel Gunderson1, A Karl Haglund1, Jose Bazan1, John Grecula1, Arnab Chakravarti1, Terence Williams1, David P Carbone3, Meng Xu-Welliver4. 1. Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio. 2. Center For Biostatistics, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio. 3. Department of Internal Medicine, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio. 4. Department of Radiation Oncology, Division of Medical Oncology, The Ohio State University Wexner Medical Center, Arthur G. James Comprehensive Cancer Center and Richard J. Solove Research Institute, Columbus, Ohio. Electronic address: meng.welliver@osumc.edu.
Abstract
INTRODUCTION: Kilovoltge cone beam computed tomography (kV-CBCT) allows for tumor localization and response assessment during definitive chemoradiotherapy for locally advanced NSCLC. We hypothesize that significant tumor volume loss occurs early during radiotherapy and that the extent of volume loss correlates with clinical outcomes. METHODS: A total of 52 patients with locally advanced NSCLC treated with definitive chemoradiotherapy were reviewed. kV-CBCT images were used to contour primary gross tumor volumes at four time points during treatment. Patients were dichotomized according to absolute and relative volume changes at each time point. Statistical analyses were performed to evaluate correlations between volume changes and clinical outcomes. RESULTS: The median gross tumor volumes were 77.1, 48.3, 42.5, and 29.9 cm3 for fractions 1, 11, 21, and final, respectively. Greater relative volume loss between fractions 1 and 21 correlated with improved distant control (hazard ratio [HR] = 0.35, 95% confidence interval [CI]: 0.13-0.94, p = 0.038) and overall survival (HR = 0.40, 95% CI: 0.16-0.98, p = 0.046). Greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.17-0.88, p = 0.02) and trended toward improved overall survival (HR = 0.43, 95% CI: 0.17-1.06, p = 0.07). On multivariate analysis, greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.16-0.97, p = 0.041) and overall survival (HR = 0.31, 95% CI: 0.11-0.88, p = 0.027). CONCLUSIONS: Significant primary tumor volume loss occurs early during radiotherapy for locally advanced NSCLC. Greater relative tumor volume loss during treatment correlates with improved disease control and overall survival. Thus, kV-CBCT has potential to be used as a practical prognostic imaging marker.
INTRODUCTION: Kilovoltge cone beam computed tomography (kV-CBCT) allows for tumor localization and response assessment during definitive chemoradiotherapy for locally advanced NSCLC. We hypothesize that significant tumor volume loss occurs early during radiotherapy and that the extent of volume loss correlates with clinical outcomes. METHODS: A total of 52 patients with locally advanced NSCLC treated with definitive chemoradiotherapy were reviewed. kV-CBCT images were used to contour primary gross tumor volumes at four time points during treatment. Patients were dichotomized according to absolute and relative volume changes at each time point. Statistical analyses were performed to evaluate correlations between volume changes and clinical outcomes. RESULTS: The median gross tumor volumes were 77.1, 48.3, 42.5, and 29.9 cm3 for fractions 1, 11, 21, and final, respectively. Greater relative volume loss between fractions 1 and 21 correlated with improved distant control (hazard ratio [HR] = 0.35, 95% confidence interval [CI]: 0.13-0.94, p = 0.038) and overall survival (HR = 0.40, 95% CI: 0.16-0.98, p = 0.046). Greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.17-0.88, p = 0.02) and trended toward improved overall survival (HR = 0.43, 95% CI: 0.17-1.06, p = 0.07). On multivariate analysis, greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.16-0.97, p = 0.041) and overall survival (HR = 0.31, 95% CI: 0.11-0.88, p = 0.027). CONCLUSIONS: Significant primary tumor volume loss occurs early during radiotherapy for locally advanced NSCLC. Greater relative tumor volume loss during treatment correlates with improved disease control and overall survival. Thus, kV-CBCT has potential to be used as a practical prognostic imaging marker.
Authors: Benedict Osorio; Nikhil Yegya-Raman; Sinae Kim; Charles B Simone; Christina Theodorou Ross; Matthew P Deek; Dakim Gaines; Wei Zou; Liyong Lin; Jyoti Malhotra; Ke Nie; Joseph Aisner; Salma K Jabbour Journal: Ann Transl Med Date: 2019-03
Authors: Dakim K Gaines; Nikhil Yegya-Raman; Sinae Kim; Charles B Simone; Christina Theodorou Ross; Matthew P Deek; Sarah Lam; Steven J Feigenberg; Benedict Osorio; Ke Nie; Wei Zou; Malini Patel; Jyoti Malhotra; John Langenfeld; Joseph Aisner; Salma K Jabbour Journal: J Thorac Dis Date: 2020-05 Impact factor: 3.005
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