Benedict Osorio1, Nikhil Yegya-Raman1, Sinae Kim2,3, Charles B Simone4, Christina Theodorou Ross1, Matthew P Deek1,5, Dakim Gaines1, Wei Zou6, Liyong Lin6, Jyoti Malhotra7, Ke Nie1, Joseph Aisner7, Salma K Jabbour1. 1. Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA. 2. Department of Biostatistics, School of Public Health, Rutgers University, New Brunswick, NJ, USA. 3. Biometrics Division, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA. 4. Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA. 5. Department of Radiation Oncology & Molecular Radiation Sciences, the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA. 6. Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA. 7. Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
Abstract
BACKGROUND: Locally advanced non-small cell lung cancer (NSCLC) may exhibit significant tumor growth before the initiation of definitive chemoradiation therapy (CRT). We thus investigated the prognostic value of pretreatment tumor growth rate as measured by specific growth rate (SGR). METHODS: We conducted a retrospective review of 42 patients with locally advanced NSCLC treated with definitive concurrent CRT. For each patient, we contoured the primary gross tumor volume (GTV) on the pretreatment diagnostic chest computed tomography (CT) scan and the radiation therapy (RT) planning CT scan. We then calculated SGR based on the primary GTV from each scan and the time interval between scans. We used log-rank tests and univariate Cox regression models to quantify differences in progression-free survival (PFS), overall survival (OS) and recurrence based on SGR. RESULTS: We divided patients into two groups for analysis: those with an SGR greater than or equal to the upper tercile value of 0.94%/day (high SGR) and those with SGR less than 0.94%/day (low SGR). Patients with high SGRs versus low SGRs experienced inferior PFS (median, 5.6 vs. 13.6 months, P=0.016), without a significant difference in OS. The inferior PFS in the high SGR group persisted on multivariate analysis [adjusted hazard ratio (HR) 2.37, 95% confidence interval (CI): 1.07-5.25, P=0.034]. The risk of distant recurrence was higher in the high SGR group (HR 2.62, 95% CI: 1.08-6.38, P=0.033), but there was no difference in the risk of locoregional recurrence between groups. CONCLUSIONS: Pretreatment SGR was associated with inferior PFS and distant control among patients with locally advanced NSCLC treated with concurrent CRT. Further studies in larger populations may aid in elucidating optimal SGR cut-off points for risk stratification.
BACKGROUND: Locally advanced non-small cell lung cancer (NSCLC) may exhibit significant tumor growth before the initiation of definitive chemoradiation therapy (CRT). We thus investigated the prognostic value of pretreatment tumor growth rate as measured by specific growth rate (SGR). METHODS: We conducted a retrospective review of 42 patients with locally advanced NSCLC treated with definitive concurrent CRT. For each patient, we contoured the primary gross tumor volume (GTV) on the pretreatment diagnostic chest computed tomography (CT) scan and the radiation therapy (RT) planning CT scan. We then calculated SGR based on the primary GTV from each scan and the time interval between scans. We used log-rank tests and univariate Cox regression models to quantify differences in progression-free survival (PFS), overall survival (OS) and recurrence based on SGR. RESULTS: We divided patients into two groups for analysis: those with an SGR greater than or equal to the upper tercile value of 0.94%/day (high SGR) and those with SGR less than 0.94%/day (low SGR). Patients with high SGRs versus low SGRs experienced inferior PFS (median, 5.6 vs. 13.6 months, P=0.016), without a significant difference in OS. The inferior PFS in the high SGR group persisted on multivariate analysis [adjusted hazard ratio (HR) 2.37, 95% confidence interval (CI): 1.07-5.25, P=0.034]. The risk of distant recurrence was higher in the high SGR group (HR 2.62, 95% CI: 1.08-6.38, P=0.033), but there was no difference in the risk of locoregional recurrence between groups. CONCLUSIONS: Pretreatment SGR was associated with inferior PFS and distant control among patients with locally advanced NSCLC treated with concurrent CRT. Further studies in larger populations may aid in elucidating optimal SGR cut-off points for risk stratification.
Entities:
Keywords:
Chemoradiation therapy (CRT); metastases; non-small cell lung cancer (NSCLC); specific growth rate (SGR); tumor volume
Authors: Salma K Jabbour; Sinae Kim; Syed A Haider; Xiaoting Xu; Alson Wu; Sujani Surakanti; Joseph Aisner; John Langenfeld; Ning J Yue; Bruce G Haffty; Wei Zou Journal: Int J Radiat Oncol Biol Phys Date: 2015-04-15 Impact factor: 7.038
Authors: Sarah Everitt; Alan Herschtal; Jason Callahan; Nikki Plumridge; David Ball; Tomas Kron; Michal Schneider-Kolsky; David Binns; Rodney J Hicks; Michael MacManus Journal: Cancer Date: 2010-11-01 Impact factor: 6.860
Authors: Soha Atallah; B C John Cho; Zishan Allibhai; Mojgan Taremi; Meredith Giuliani; Lisa W Le; Anthony Brade; Alexander Sun; Andrea Bezjak; Andrew J Hope Journal: Int J Radiat Oncol Biol Phys Date: 2014-07-01 Impact factor: 7.038
Authors: Walter J Curran; Rebecca Paulus; Corey J Langer; Ritsuko Komaki; Jin S Lee; Stephen Hauser; Benjamin Movsas; Todd Wasserman; Seth A Rosenthal; Elizabeth Gore; Mitchell Machtay; William Sause; James D Cox Journal: J Natl Cancer Inst Date: 2011-09-08 Impact factor: 13.506
Authors: Jeffrey D Bradley; Rebecca Paulus; Ritsuko Komaki; Gregory Masters; George Blumenschein; Steven Schild; Jeffrey Bogart; Chen Hu; Kenneth Forster; Anthony Magliocco; Vivek Kavadi; Yolanda I Garces; Samir Narayan; Puneeth Iyengar; Cliff Robinson; Raymond B Wynn; Christopher Koprowski; Joanne Meng; Jonathan Beitler; Rakesh Gaur; Walter Curran; Hak Choy Journal: Lancet Oncol Date: 2015-01-16 Impact factor: 41.316
Authors: Klaus L Prenzel; Stefan P Mönig; Jan M Sinning; Stephan E Baldus; Hans-Georg Brochhagen; Paul M Schneider; Arnulf H Hölscher Journal: Chest Date: 2003-02 Impact factor: 9.410
Authors: Geoffrey A Geiger; Miranda B Kim; Eric P Xanthopoulos; Daniel A Pryma; Surbhi Grover; John P Plastaras; Corey J Langer; Charles B Simone; Ramesh Rengan Journal: Clin Lung Cancer Date: 2013-10-08 Impact factor: 4.785