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1. Prognostic factors of local control and disease free survival in centrally located non-small cell lung cancer treated with stereotactic body radiation therapy

Author

Duijm, M, van Zyp, NCV, Granton, P.V., van de Vaart, P., Mast, M.E., Oomen - de Hoop, E. (Esther), Hoogeman, M.S. (Mischa), Nuyttens, J.J.M.E., Duijm, M, van Zyp, NCV, Granton, P.V., van de Vaart, P., Mast, M.E., Oomen - de Hoop, E. (Esther), Hoogeman, M.S. (Mischa), and Nuyttens, J.J.M.E.

Abstract

Background: Stereotactic body radiation therapy (SBRT) results in high local control (LC) rates in patients with non-small cell lung cancer (NSCLC). For central lung tumors, risk-adapted fractionation schedules are used and underdosage to the Planned Target Volume (PTV) is often accepted to respect the dose constraints of the organs at risk in order to avoid high rates of toxicity. The purpose of this study was to analyze the effect of PTV underdosage and other possible prognostic factors on localand disease control after SBRT in patients with central lung tumors. Material and Methods: Patients with centrally located NSCLC treated with SBRT were included. The doses were converted into biologically equivalent dose using a/b-value of 10 Gy (BED10). Underdosage to the PTV was defined as the (percentage of) PTV receiving less than 100 Gy BED10; (%)PTV < 100 BED10. Potential prognostic factors for LC and Disease Free Survival (DFS) were evaluated using Cox regression analysis. Results: Two hundred and twenty patients received 12 fractions of SBRT. LC-rates were 88% at 2 years and 81% at 3 years. Twenty-seven patients developed a local recurrence. Both the PTV < 100 BED10 and %PTV < 100 BED10 were not prognostic for LC. Tumor size and forced expiratory volume in 1 second (FEV1) were independently prognostic for LC. Disease progression was reported in 75 patients with DFS-rates of 66% at 2 years and 56% at 3 years. Diseas

Published
2020
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2. Development and external validation of a nomogram to predict overall survival following stereotactic body radiotherapy for early-stage lung cancer

Author

Baker, S, Bakunina, K., Duijm, M, Hoogeman, M.S. (Mischa), Cornelissen, R. (Robin), Antonisse, I., Praag, J., Heemsbergen, W.D., Nuyttens, J.J.M.E., Baker, S, Bakunina, K., Duijm, M, Hoogeman, M.S. (Mischa), Cornelissen, R. (Robin), Antonisse, I., Praag, J., Heemsbergen, W.D., and Nuyttens, J.J.M.E.

Abstract

Background: Prognostication tools for early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) are currently lacking. The purpose of this study was to develop and externally validate a nomogram to predict overall survival in individual patients with peripheral early-stage disease. Methods: A total of 587 NSCLC patients treated with biologically effective dose > 100 Gy10 were eligible. A Cox proportional hazards model was used to build a nomogram to predict 6-month, 1-year, 3-year and 5-year overall survival. Internal validation was performed using bootstrap sampling. External validation was performed in a separate cohort of 124 NSCLC patients with central tumors treated with SBRT. Discriminatory ability was measured by the concordance index (C-index) while predictive accuracy was assessed with calibration slope and plots. Results: The resulting nomogram was based on six prognostic factors: age, sex, Karnofsky Performance Status, operability, Charlson Comorbidity Index, and tumor diameter. The slope of the calibration curve for nomogrampredicted versus Kaplan-Meier-estimated overall survival was 0.77. The C-index of the nomogram (corrected for optimism) was moderate at 0.64. In the external validation cohort, the model yielded a C-index of 0.62. Conclusions: We established and validated a nomogram which can provide individual survival predictions for patients with early stage lung cancer treated with SBRT. The nomogram may assist patients and clinicians with treatment decision-making.

Published
2020
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3. Survival and Prognostic Factors of Ultra-Central Tumors Treated with Stereotactic Body Radiotherapy.

Author

Salvestrini V, Duijm M, Loi M, and Nuyttens JJ

Abstract

Introduction: Stereotactic body radiotherapy (SBRT) reported excellent outcomes and a good tolerability profile in case of central lung tumors, as long as risk-adapted schedules were adopted. High grade toxicity was more frequently observed for tumors directly touching or overlapping the trachea, proximal bronchial tree (PBT), and esophagus. We aim to identify prognostic factors associated with survival for Ultra-Central (UC) tumors. Methods: We retrospectively evaluated patients treated with SBRT for primary or metastatic UC lung tumors. SBRT schedules ranged from 45 to 60 Gy. Results: A total number of 126 ultra-central lung tumors were reviewed. The Median follow-up time was 23 months. Median Overall Survival (OS) and Progression Free Survival (PFS) was 29.3 months and 16 months, respectively. Local Control (LC) rates at 1 and 2 were 86% and 78%, respectively. Female gender, age < 70 years, and tumor size < 5 cm were significantly associated with better OS. The group of patients with tumors close to the trachea but further away from the PBT also correlated with better OS. The acute G2 dysphagia, cough, and dyspnea were 11%, 5%, and 3%, respectively. Acute G3 dyspnea was experienced by one patient. Late G3 toxicity was reported in 4% of patients. Conclusion: risk-adaptive SBRT for ultra-central tumors is safe and effective, even if it remains a high-risk clinical scenario.

Published
2022
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4. Development and external validation of a nomogram to predict overall survival following stereotactic body radiotherapy for early-stage lung cancer.

Author

Baker S, Bakunina K, Duijm M, Hoogeman MS, Cornelissen R, Antonisse I, Praag J, Heemsbergen WD, and Nuyttens JJ

Subjects
Adult, Aged, Aged, 80 and over, Carcinoma, Non-Small-Cell Lung mortality, Carcinoma, Non-Small-Cell Lung pathology, Female, Humans, Lung Neoplasms mortality, Lung Neoplasms pathology, Male, Middle Aged, Prognosis, Proportional Hazards Models, Reproducibility of Results, Carcinoma, Non-Small-Cell Lung radiotherapy, Lung Neoplasms radiotherapy, Nomograms, Radiosurgery mortality
Abstract

Background: Prognostication tools for early-stage non-small cell lung cancer (NSCLC) patients treated with stereotactic body radiotherapy (SBRT) are currently lacking. The purpose of this study was to develop and externally validate a nomogram to predict overall survival in individual patients with peripheral early-stage disease., Methods: A total of 587 NSCLC patients treated with biologically effective dose > 100 Gy 10 were eligible. A Cox proportional hazards model was used to build a nomogram to predict 6-month, 1-year, 3-year and 5-year overall survival. Internal validation was performed using bootstrap sampling. External validation was performed in a separate cohort of 124 NSCLC patients with central tumors treated with SBRT. Discriminatory ability was measured by the concordance index (C-index) while predictive accuracy was assessed with calibration slope and plots., Results: The resulting nomogram was based on six prognostic factors: age, sex, Karnofsky Performance Status, operability, Charlson Comorbidity Index, and tumor diameter. The slope of the calibration curve for nomogram-predicted versus Kaplan-Meier-estimated overall survival was 0.77. The C-index of the nomogram (corrected for optimism) was moderate at 0.64. In the external validation cohort, the model yielded a C-index of 0.62., Conclusions: We established and validated a nomogram which can provide individual survival predictions for patients with early stage lung cancer treated with SBRT. The nomogram may assist patients and clinicians with treatment decision-making.

Published
2020
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5. Local Reirradiation of Recurrent Non-small Cell Lung Carcinoma Resulting in Long Disease-free Survival, Although in the Presence of Osteonecrosis.

Author

Duijm M, Schipaanboord B, Granton PV, and Nuyttens J

Abstract

High-dose reirradiation of the thorax can be offered to patients with only local disease progression of non-small-cell lung cancer (NSCLC) resulting in promising disease-free-survival. However, much is still unknown about related side-effects and occasionally an uncommon presentation can be caused by reirradiation. In this case report, we present a patient with a 3.5-year progression-free survival, although in the presence of a late, unexpected toxicity. A dosimetric analysis was performed to investigate the possibility of radiation-induced toxicity., Competing Interests: The authors have declared that no competing interests exist.

Published
2018
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