Timothy K Nguyen1, Suresh Senan2, Jeffery D Bradley3, Kevin Franks4, Meredith Giuliani5, Matthias Guckenberger6, Mark Landis1, Billy W Loo7, Alexander V Louie1, Hiroshi Onishi8, Heidi Schmidt9, Robert Timmerman10, Gregory M M Videtic11, David A Palma12. 1. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. 2. Department of Radiation Oncology, VU Medical Center, Amsterdam, the Netherlands. 3. Department of Radiation Oncology, Washington University School of Medicine, Saint Louis, Missouri. 4. Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, United Kingdom. 5. Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada. 6. Department of Radiation Oncology, University Hospital Zurich, Zurich, Switzerland. 7. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California. 8. Department of Radiation Oncology, University of Yamanashi, Yamanashi, Japan. 9. Department of Medical Imaging, Women's College Hospital, Toronto, Ontario, Canada. 10. Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas. 11. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio. 12. Department of Radiation Oncology, London Health Sciences Centre, London, Ontario, Canada. Electronic address: David.Palma@lhsc.on.ca.
Abstract
PURPOSE: Imaging after stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer can detect recurrences and second primary lung cancers; however, the optimal follow-up practice of these patients remains unclear. We sought to establish consensus recommendations for surveillance after SABR. METHODS AND MATERIALS: International opinion leaders in thoracic radiation oncology and radiology were invited to participate (n = 31), with 11 accepting (9 radiation oncologists, 2 radiologists). Consensus-building was achieved using a 3-round Delphi process. Participants rated their agreement/disagreement with statements using a 5-point Likert scale. An a priori threshold of ≥75% agreement/disagreement was required for consensus. RESULTS: A 100% response rate was achieved and final consensus statements were approved by all participants. The consensus statements were: (1.1) thoracic computed tomography (CT) scans should be ordered routinely in follow-up; (1.2) if there is a suspicion for local recurrence (LR), fludeoxyglucose positron emission tomography/CT scans are strongly recommended. Otherwise, there is limited evidence to guide routine use of fludeoxyglucose positron emission tomography /CT; (1.3) CT imaging is not recommended at 6 weeks, but is recommended at months 3, 6, and 12 in year 1 and then every 6 months in year 2 and annually in years 3 through 5; (1.4) after 5 years, CT imaging should continue, although no consensus was reached regarding the frequency. (2.1) Response Evaluation Criteria in Solid Tumors 1.1 criteria are not sufficient for detecting LR; (2.2) a formal scoring system, informed by validated data, should be used to classify high-risk imaging features predictive of LR; (2.3) CT findings suspicious for LR include: infiltration into adjacent structures, bulging margins, sustained growth, mass-like growth, spherical growth, craniocaudal growth, and loss of air bronchograms. (3) Salvage therapy without pathologic confirmation of recurrence is acceptable if imaging findings are highly suspicious and a biopsy is not safe/feasible or if an attempted biopsy was nondiagnostic. CONCLUSIONS: These guidelines provide international expert consensus on areas of uncertainty in the management of early-stage non-small cell lung cancer patients after SABR.
PURPOSE: Imaging after stereotactic ablative radiation therapy (SABR) for early-stage non-small cell lung cancer can detect recurrences and second primary lung cancers; however, the optimal follow-up practice of these patients remains unclear. We sought to establish consensus recommendations for surveillance after SABR. METHODS AND MATERIALS: International opinion leaders in thoracic radiation oncology and radiology were invited to participate (n = 31), with 11 accepting (9 radiation oncologists, 2 radiologists). Consensus-building was achieved using a 3-round Delphi process. Participants rated their agreement/disagreement with statements using a 5-point Likert scale. An a priori threshold of ≥75% agreement/disagreement was required for consensus. RESULTS: A 100% response rate was achieved and final consensus statements were approved by all participants. The consensus statements were: (1.1) thoracic computed tomography (CT) scans should be ordered routinely in follow-up; (1.2) if there is a suspicion for local recurrence (LR), fludeoxyglucose positron emission tomography/CT scans are strongly recommended. Otherwise, there is limited evidence to guide routine use of fludeoxyglucose positron emission tomography /CT; (1.3) CT imaging is not recommended at 6 weeks, but is recommended at months 3, 6, and 12 in year 1 and then every 6 months in year 2 and annually in years 3 through 5; (1.4) after 5 years, CT imaging should continue, although no consensus was reached regarding the frequency. (2.1) Response Evaluation Criteria in Solid Tumors 1.1 criteria are not sufficient for detecting LR; (2.2) a formal scoring system, informed by validated data, should be used to classify high-risk imaging features predictive of LR; (2.3) CT findings suspicious for LR include: infiltration into adjacent structures, bulging margins, sustained growth, mass-like growth, spherical growth, craniocaudal growth, and loss of air bronchograms. (3) Salvage therapy without pathologic confirmation of recurrence is acceptable if imaging findings are highly suspicious and a biopsy is not safe/feasible or if an attempted biopsy was nondiagnostic. CONCLUSIONS: These guidelines provide international expert consensus on areas of uncertainty in the management of early-stage non-small cell lung cancerpatients after SABR.
Authors: David A Palma; Timothy K Nguyen; Alexander V Louie; Richard Malthaner; Dalilah Fortin; George B Rodrigues; Brian Yaremko; Joanna Laba; Keith Kwan; Stewart Gaede; Ting Lee; Aaron Ward; Andrew Warner; Richard Inculet Journal: JAMA Oncol Date: 2019-05-01 Impact factor: 31.777
Authors: Pino Alcantara; Beatriz Cabeza Martínez; Marta García García-Esquinas; Laura G Belaústegui; Ana Bustos Journal: J Clin Transl Res Date: 2020-10-06