M I Ronden1, J R van Sörnsen de Koste2, C Johnson3, B J Slotman1, F O B Spoelstra1, C J A Haasbeek1, G Blom1, E M Bongers1, A Warner3, A Ward4, D Palma4, S Senan1. 1. Department of Radiation Oncology, VU Medical Center, Amsterdam, The Netherlands. 2. Department of Radiation Oncology, VU Medical Center, Amsterdam, The Netherlands. Electronic address: j.vansornsendekoste@vumc.nl. 3. London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada. 4. Departments of Oncology and Medical Biophysics, University of Western Ontario, London, Ontario, Canada.
Abstract
PURPOSE: To investigate, in the setting of stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer, the incidence and patterns of change in high-risk radiologic features (HRFs) in patients known to have no local recurrence. METHODS AND MATERIALS: Computed tomography (CT) scans of patients treated using volumetric modulated arc therapy SABR between 2008 and 2013 were eligible if follow-up scans were available for 2 years and no local recurrences were diagnosed. All scans were reviewed at a workstation using an add-on tool for ClearCanvas (Synaptive Medical). Five clinicians who were blinded to clinical outcomes scored the presence of HRFs: enlarging opacity (EO), sequential enlarging opacity, enlarging opacity after 12 months (EO12), bulging margin, loss of linear margins, cranio-caudal growth, and loss of air bronchogram. After each review, clinicians recommended follow-up procedures based on published recommendations. RESULTS: A total of 88 patients (747 CT scans) were evaluated. The HRFs most frequently recorded by ≥3 observers on at least 1 follow-up scan were EO (64.8%), EO12 (50.0%), and sequential enlarging opacity (13.6%). Fifty-six patients developed EO within the first year after SABR, and of these, 46 also developed subsequent EO (EO12). In 76 patients who developed EO after 1 year of follow-up, 30 had not manifested EO previously. Three or more HRFs have been associated with recurrences, and this was observed on CT scan in 22.7% of patients. In their routine care, 6 patients had undergone a positron emission tomography scan because of a suspected local recurrence, and 4 underwent an attempt at biopsy. CONCLUSIONS: More than 50% of patients without a local recurrence after SABR develop HRFs. Because ≥3 HRFs were present in nearly 25% of patients, further refinement of follow-up recommendations are necessary.
PURPOSE: To investigate, in the setting of stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer, the incidence and patterns of change in high-risk radiologic features (HRFs) in patients known to have no local recurrence. METHODS AND MATERIALS: Computed tomography (CT) scans of patients treated using volumetric modulated arc therapy SABR between 2008 and 2013 were eligible if follow-up scans were available for 2 years and no local recurrences were diagnosed. All scans were reviewed at a workstation using an add-on tool for ClearCanvas (Synaptive Medical). Five clinicians who were blinded to clinical outcomes scored the presence of HRFs: enlarging opacity (EO), sequential enlarging opacity, enlarging opacity after 12 months (EO12), bulging margin, loss of linear margins, cranio-caudal growth, and loss of air bronchogram. After each review, clinicians recommended follow-up procedures based on published recommendations. RESULTS: A total of 88 patients (747 CT scans) were evaluated. The HRFs most frequently recorded by ≥3 observers on at least 1 follow-up scan were EO (64.8%), EO12 (50.0%), and sequential enlarging opacity (13.6%). Fifty-six patients developed EO within the first year after SABR, and of these, 46 also developed subsequent EO (EO12). In 76 patients who developed EO after 1 year of follow-up, 30 had not manifested EO previously. Three or more HRFs have been associated with recurrences, and this was observed on CT scan in 22.7% of patients. In their routine care, 6 patients had undergone a positron emission tomography scan because of a suspected local recurrence, and 4 underwent an attempt at biopsy. CONCLUSIONS: More than 50% of patients without a local recurrence after SABR develop HRFs. Because ≥3 HRFs were present in nearly 25% of patients, further refinement of follow-up recommendations are necessary.
Authors: Alexander N Hanania; Walker Mainwaring; Yohannes T Ghebre; Nicola A Hanania; Michelle Ludwig Journal: Chest Date: 2019-04-15 Impact factor: 9.410
Authors: Pino Alcantara; Beatriz Cabeza Martínez; Marta García García-Esquinas; Laura G Belaústegui; Ana Bustos Journal: J Clin Transl Res Date: 2020-10-06
Authors: Chris Dickhoff; Pedro M Rodriguez Schaap; Rene H J Otten; Martijn W Heymans; David J Heineman; Max Dahele Journal: Ther Adv Med Oncol Date: 2018-07-13 Impact factor: 8.168
Authors: Noah S Kalman; Geoffrey D Hugo; Jenna M Kahn; Sherry S Zhao; Nuzhat Jan; Rebecca N Mahon; Elisabeth Weiss Journal: Adv Radiat Oncol Date: 2018-05-25