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Strahlentherapie und Onkologie

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Open Access 01-02-2020 | Computed Tomography | Original Article

Tumor regression during radiotherapy for non-small cell lung cancer patients using cone-beam computed tomography images

Authors: J. E. van Timmeren, W. van Elmpt, D. de Ruysscher, B. Reymen, O. Hansen, C. Brink

Published in: Strahlentherapie und Onkologie | Issue 2/2020

Abstract

Purpose

Previous literature has reported contradicting results regarding the relationship between tumor volume changes during radiotherapy treatment for non-small cell lung cancer (NSCLC) patients and locoregional recurrence-free rate or overall survival. The aim of this study is to validate the results from a previous study by using a different volume extraction procedure and evaluating an external validation dataset.

Methods

For two datasets of 94 and 141 NSCLC patients, gross tumor volumes were determined manually to investigate the relationship between tumor volume regression and locoregional control using Kaplan–Meier curves. For both datasets, different subgroups of patients based on histology and chemotherapy regimens were also investigated. For the first dataset (n = 94), automatically determined tumor volumes were available from a previously published study to further compare their correlation with updated clinical data.

Results

A total of 70 out of 94 patients were classified into the same group as in the previous publication, splitting the dataset based on median tumor regression calculated by the two volume extraction methods. Non-adenocarcinoma patients receiving concurrent chemotherapy with large tumor regression show reduced locoregional recurrence-free rates in both datasets (p < 0.05 in dataset 2). For dataset 2, the opposite behavior is observed for patients not receiving chemotherapy, which was significant for overall survival (p = 0.01) but non-significant for locoregional recurrence-free rate (p = 0.13).

Conclusion

The tumor regression pattern observed during radiotherapy is not only influenced by irradiation but depends largely on the delivered chemotherapy schedule, so it follows that the relationship between patient outcome and the degree of tumor regression is also largely determined by the chemotherapy schedule. This analysis shows that the relationship between tumor regression and outcome is complex, and indicates factors that could explain previously reported contradicting findings. This, in turn, will help guide future studies to fully understand the relationship between tumor regression and outcome.

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Kasmann L, Niyazi M, Blanck O, Baues C, Baumann R, Dobiasch S, Eze C, Fleischmann D, Gauer T, Giordano FA, Goy Y, Hausmann J, Henkenberens C, Kaul D, Klook L, Krug D, Maurer M, Panje CM, Rosenbrock J, Sautter L, Schmitt D, Suss C, Thieme AH, Trommer-Nestler M, Ziegler S, Ebert N, Medenwald D, Ostheimer C (2018) Predictive and prognostic value of tumor volume and its changes during radical radiotherapy of stage III non-small cell lung cancer : A systematic review. Strahlenther Onkol 194(2):79–90. https://doi.org/10.1007/s00066-017-1221-y CrossRefPubMed

Oberije C, De Ruysscher D, Houben R, van de Heuvel M, Uyterlinde W, Deasy JO, Belderbos J, Dingemans AM, Rimner A, Din S, Lambin P (2015) A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients. Int J Radiat Oncol Biol Phys 92(4):935–944. https://doi.org/10.1016/j.ijrobp.2015.02.048 CrossRefPubMedPubMedCentral

Ball DL, Fisher RJ, Burmeister BH, Poulsen MG, Graham PH, Penniment MG, Vinod SK, Krawitz HE, Joseph DJ, Wheeler GC, McClure BE (2013) The complex relationship between lung tumor volume and survival in patients with non-small cell lung cancer treated by definitive radiotherapy: a prospective, observational prognostic factor study of the Trans-Tasman Radiation Oncology Group (TROG 99.05). Radiother Oncol 106 (3):305–311. https://doi.org/10.1016/j.radonc.2012.12.003 CrossRefPubMed

Roengvoraphoj O, Wijaya C, Eze C, Li M, Dantes M, Taugner J, Tufman A, Huber RM, Belka C, Manapov F (2018) Analysis of primary tumor metabolic volume during chemoradiotherapy in locally advanced non-small cell lung cancer. Strahlenther Onkol 194(2):107–115. https://doi.org/10.1007/s00066-017-1229-3 CrossRefPubMed

Elsayad K, Kriz J, Reinartz G, Scobioala S, Ernst I, Haverkamp U, Eich HT (2016) Cone-beam CT-guided radiotherapy in the management of lung cancer: Diagnostic and therapeutic value. Strahlenther Onkol 192(2):83–91. https://doi.org/10.1007/s00066-015-0927-y CrossRefPubMed

Jabbour SK, Kim S, Haider SA, Xu X, Wu A, Surakanti S, Aisner J, Langenfeld J, Yue NJ, Haffty BG, Zou W (2015) Reduction in Tumor Volume by Cone Beam Computed Tomography Predicts Overall Survival in Non-Small Cell Lung Cancer Treated With Chemoradiation Therapy. Int J Radiat Oncol Biol Phys 92(3):627–633. https://doi.org/10.1016/j.ijrobp.2015.02.017 CrossRefPubMedPubMedCentral

Wald P, Mo X, Barney C, Gunderson D, Haglund AK, Bazan J, Grecula J, Chakravarti A, Williams T, Carbone DP, Xu-Welliver M (2017) Prognostic Value of Primary Tumor Volume Changes on kV-CBCT during Definitive Chemoradiotherapy for Stage III Non-Small Cell Lung Cancer. J Thorac Oncol 12(12):1779–1787. https://doi.org/10.1016/j.jtho.2017.08.010 CrossRefPubMed

Elsayad K, Samhouri L, Scobioala S, Haverkamp U, Eich HT (2018) Is tumor volume reduction during radiotherapy prognostic relevant in patients with stage III non-small cell lung cancer? J Cancer Res Clin Oncol. https://doi.org/10.1007/s00432-018-2640-6 CrossRefPubMed

Brink C, Bernchou U, Bertelsen A, Hansen O, Schytte T, Bentzen SM (2014) Locoregional control of non-small cell lung cancer in relation to automated early assessment of tumor regression on cone beam computed tomography. Int J Radiat Oncol Biol Phys 89(4):916–923. https://doi.org/10.1016/j.ijrobp.2014.03.038 CrossRefPubMed

10.

van Timmeren JE, Leijenaar RTH, van Elmpt W, Reymen B, Oberije C, Monshouwer R, Bussink J, Brink C, Hansen O, Lambin P (2017) Survival prediction of non-small cell lung cancer patients using radiomics analyses of cone-beam CT images. Radiother Oncol 123(3):363–369. https://doi.org/10.1016/j.radonc.2017.04.016 CrossRefPubMed

11.

Bland JM, Altman DG (1986) Statistical Methods for Assessing agreement between two methods of clinical measurement. Lancet 1:307–310CrossRefPubMed

12.

El Sharouni SY, Kal HB, Battermann JJ (2003) Accelerated regrowth of non-small-cell lung tumours after induction chemotherapy. Br J Cancer 89:2184. https://doi.org/10.1038/sj.bjc.6601418 CrossRefPubMedPubMedCentral

13.

R Core Team (2013). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. http://www.R-project.org/

14.

Steenbakkers RJ, Duppen JC, Fitton I, Deurloo KE, Zijp L, Uitterhoeve AL, Rodrigus PT, Kramer GW, Bussink J, De Jaeger K, Belderbos JS, Hart AA, Nowak PJ, van Herk M, Rasch CR (2005) Observer variation in target volume delineation of lung cancer related to radiation oncologist-computer interaction: a “Big Brother” evaluation. Radiother Oncol 77(2):182–190. https://doi.org/10.1016/j.radonc.2005.09.017 CrossRefPubMed

15.

van Baardwijk A, Bosmans G, Boersma L, Buijsen J, Wanders S, Hochstenbag M, van Suylen RJ, Dekker A, Dehing-Oberije C, Houben R, Bentzen SM, van Kroonenburgh M, Lambin P, De Ruysscher D (2007) PET-CT-based auto-contouring in non-small-cell lung cancer correlates with pathology and reduces interobserver variability in the delineation of the primary tumor and involved nodal volumes. Int J Radiat Oncol Biol Phys 68(3):771–778. https://doi.org/10.1016/j.ijrobp.2006.12.067 CrossRefPubMed

16.

Hansen O, Knap MM, Khalil A, Nyhus CH, McCulloch T, Holm B, Brink C, Hoffmann L, Schytte T (2017) A randomized phase II trial of concurrent chemoradiation with two doses of radiotherapy, 60 Gy and 66 Gy, concomitant with a fixed dose of oral vinorelbine in locally advanced NSCLC. Radiother Oncol 123(2):276–281. https://doi.org/10.1016/j.radonc.2017.03.017 CrossRefPubMed

17.

Franceschini D, De Rose F, Cozzi L, Navarria P, Clerici E, Franzese C, Comito T, Tozzi A, Iftode C, D’Agostino G, Sorsetti M (2017) Radical hypo-fractionated radiotherapy with volumetric modulated arc therapy in lung cancer : A retrospective study of elderly patients with stage III disease. Strahlenther Onkol 193(5):385–391. https://doi.org/10.1007/s00066-017-1103-3 CrossRefPubMed

18.

Kanzaki H, Kataoka M, Nishikawa A, Uwatsu K, Nagasaki K, Nishijima N, Ochi T, Mochizuki T (2016) Impact of early tumor reduction on outcome differs by histological subtype in stage III non-small-cell lung cancer treated with definitive radiotherapy. Int J Clin Oncol 21(5):853–861. https://doi.org/10.1007/s10147-016-0982-0 CrossRefPubMed

19.

Ostheimer C, Evers C, Bache M, Reese T, Vordermark D (2018) Prognostic implications of the co-detection of the urokinase plasminogen activator system and osteopontin in patients with non-small-cell lung cancer undergoing radiotherapy and correlation with gross tumor volume. Strahlenther Onkol 194(6):539–551. https://doi.org/10.1007/s00066-017-1255-1 CrossRefPubMed

Title: Tumor regression during radiotherapy for non-small cell lung cancer patients using cone-beam computed tomography images
Authors: J. E. van Timmeren
W. van Elmpt
D. de Ruysscher
B. Reymen
O. Hansen
C. Brink
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
NSCLC
Computed Tomography
NSCLC
Radiotherapy
Cytostatic Therapy
Published in: Strahlentherapie und Onkologie / Issue 2/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01522-w

At a glance: The STEP trials

Springer Medicine

Tumor regression during radiotherapy for non-small cell lung cancer patients using cone-beam computed tomography images

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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