Cargando…
Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS)
OBJECTIVE: To identify potentially actionable dosimetric predictors of local control (LC) for non-small cell lung cancer (NSCLC) brain metastases treated with single-fraction stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Patients with NSCLC brain metastases treated with single-fraction SRS...
Autores principales: | , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2017
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000027/ https://www.ncbi.nlm.nih.gov/pubmed/29904739 http://dx.doi.org/10.1016/j.adro.2017.11.003 |
_version_ | 1783331594154541056 |
---|---|
author | Abraham, Christopher Garsa, Adam Badiyan, Shahed N. Drzymala, Robert Yang, Deshan DeWees, Todd Tsien, Christina Dowling, Joshua L. Rich, Keith M. Chicoine, Michael R. Kim, Albert H. Leuthardt, Eric C. Robinson, Cliff |
author_facet | Abraham, Christopher Garsa, Adam Badiyan, Shahed N. Drzymala, Robert Yang, Deshan DeWees, Todd Tsien, Christina Dowling, Joshua L. Rich, Keith M. Chicoine, Michael R. Kim, Albert H. Leuthardt, Eric C. Robinson, Cliff |
author_sort | Abraham, Christopher |
collection | PubMed |
description | OBJECTIVE: To identify potentially actionable dosimetric predictors of local control (LC) for non-small cell lung cancer (NSCLC) brain metastases treated with single-fraction stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Patients with NSCLC brain metastases treated with single-fraction SRS were identified. Eligible patients had at least 1 follow-up magnetic resonance imaging scan and were without prior metastasectomy or SRS to the same lesion. LC and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate (UVA) and multivariate analysis (MVA). Receiver operating characteristic (ROC) analysis was used to identify optimal cut points for dose-volume histogram metrics relative to LC. RESULTS: A total of 612 NSCLC brain metastasis were identified in 299 patients with single-fraction SRS between 1999 and 2014. Median follow-up was 10 months. Median OS from time of SRS was 11 months. Overall LC was 75% and 66% at 1 and 2 years, respectively. On UVA, increasing dose by any measure was associated with improved LC. On MVA, volume receiving at least 32 Gy (V32; hazard ratio [HR], 0.069; P < .000), along with higher prescription isodose (HR, 0.953; P = .031) and lower volume (HR, 1.359; P < .000), were independent predictors of improved LC. ROC analysis demonstrated a V32 of 24% to be most predictive for LC. For the entire cohort, 1-year LC for V32 ≥24% was 89% versus 67% for V32 <24% (P = .000). Stratifying by volume, lesions ≤2 cm (n = 323) had a 1-year LC of 95% versus 82% (P = .005) for V32 above and below 24%, respectively. For lesions 2.1 to 3 cm (n = 211), 1-year LC was 79% versus 59% (P = .003) for V32 above and below 24%, respectively. Total tumor volume alone was predictive for OS. CONCLUSIONS: Volume, prescription isodose line, and V32 are independent predictors of LC. V32 represents an actionable SRS treatment planning parameter for NSCLC brain metastases. |
format | Online Article Text |
id | pubmed-6000027 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-60000272018-06-14 Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) Abraham, Christopher Garsa, Adam Badiyan, Shahed N. Drzymala, Robert Yang, Deshan DeWees, Todd Tsien, Christina Dowling, Joshua L. Rich, Keith M. Chicoine, Michael R. Kim, Albert H. Leuthardt, Eric C. Robinson, Cliff Adv Radiat Oncol Lung Cancer OBJECTIVE: To identify potentially actionable dosimetric predictors of local control (LC) for non-small cell lung cancer (NSCLC) brain metastases treated with single-fraction stereotactic radiosurgery (SRS). METHODS AND MATERIALS: Patients with NSCLC brain metastases treated with single-fraction SRS were identified. Eligible patients had at least 1 follow-up magnetic resonance imaging scan and were without prior metastasectomy or SRS to the same lesion. LC and overall survival (OS) were estimated using the Kaplan-Meier method. The Cox proportional hazards model was used for univariate (UVA) and multivariate analysis (MVA). Receiver operating characteristic (ROC) analysis was used to identify optimal cut points for dose-volume histogram metrics relative to LC. RESULTS: A total of 612 NSCLC brain metastasis were identified in 299 patients with single-fraction SRS between 1999 and 2014. Median follow-up was 10 months. Median OS from time of SRS was 11 months. Overall LC was 75% and 66% at 1 and 2 years, respectively. On UVA, increasing dose by any measure was associated with improved LC. On MVA, volume receiving at least 32 Gy (V32; hazard ratio [HR], 0.069; P < .000), along with higher prescription isodose (HR, 0.953; P = .031) and lower volume (HR, 1.359; P < .000), were independent predictors of improved LC. ROC analysis demonstrated a V32 of 24% to be most predictive for LC. For the entire cohort, 1-year LC for V32 ≥24% was 89% versus 67% for V32 <24% (P = .000). Stratifying by volume, lesions ≤2 cm (n = 323) had a 1-year LC of 95% versus 82% (P = .005) for V32 above and below 24%, respectively. For lesions 2.1 to 3 cm (n = 211), 1-year LC was 79% versus 59% (P = .003) for V32 above and below 24%, respectively. Total tumor volume alone was predictive for OS. CONCLUSIONS: Volume, prescription isodose line, and V32 are independent predictors of LC. V32 represents an actionable SRS treatment planning parameter for NSCLC brain metastases. Elsevier 2017-11-24 /pmc/articles/PMC6000027/ /pubmed/29904739 http://dx.doi.org/10.1016/j.adro.2017.11.003 Text en © 2017 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Lung Cancer Abraham, Christopher Garsa, Adam Badiyan, Shahed N. Drzymala, Robert Yang, Deshan DeWees, Todd Tsien, Christina Dowling, Joshua L. Rich, Keith M. Chicoine, Michael R. Kim, Albert H. Leuthardt, Eric C. Robinson, Cliff Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) |
title | Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) |
title_full | Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) |
title_fullStr | Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) |
title_full_unstemmed | Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) |
title_short | Internal dose escalation is associated with increased local control for non-small cell lung cancer (NSCLC) brain metastases treated with stereotactic radiosurgery (SRS) |
title_sort | internal dose escalation is associated with increased local control for non-small cell lung cancer (nsclc) brain metastases treated with stereotactic radiosurgery (srs) |
topic | Lung Cancer |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6000027/ https://www.ncbi.nlm.nih.gov/pubmed/29904739 http://dx.doi.org/10.1016/j.adro.2017.11.003 |
work_keys_str_mv | AT abrahamchristopher internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT garsaadam internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT badiyanshahedn internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT drzymalarobert internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT yangdeshan internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT deweestodd internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT tsienchristina internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT dowlingjoshual internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT richkeithm internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT chicoinemichaelr internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT kimalberth internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT leuthardtericc internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs AT robinsoncliff internaldoseescalationisassociatedwithincreasedlocalcontrolfornonsmallcelllungcancernsclcbrainmetastasestreatedwithstereotacticradiosurgerysrs |