Contact of a tumour with the pleura is not associated with regional recurrence following stereotactic ablative radiotherapy for early stage non-small cell lung cancer. (February 2019)

• Record Type: Journal Article
• Authors: Wink, Krista C.J.; Löck, Steffen; Rossi, Maddalena; van Baardwijk, Angela; Belderbos, José; de Ruysscher, Dirk; Troost, Esther G.C.
• Is Part Of: Radiotherapy and oncology. Volume 131(2019)
• Page Start: 120
• Page End: 126
• Publication Date: 2019-02
• Subjects: Early stage NSCLC -- Radiotherapy -- SABR -- Isolated regional recurrence -- Visceral pleural invasion; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2018.11.024
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: The 2-year cumulative incidence of isolated regional recurrence following stereotactic ablative radiotherapy (SABR) for early stage non-small cell lung cancer was 3%. The 2-year cumulative incidence of distant recurrence following SABR was 15%. The presence, type and length of pleural contact as surrogate for visceral pleural invasion were not associated with regional or distant recurrence and overall survival. Of the patients with an IRR, 33% received radical treatment with either radiotherapy alone or sequential or concurrent chemoradiotherapy and 43% received best supportive care. Abstract: Background and purpose: The aim was to investigate the incidence of isolated regional failure following stereotactic ablative radiotherapy (SABR) and risk factors for recurrence. Materials and methods: Early stage non-small cell lung cancer (NSCLC) patients treated with SABR were included in this retrospective cohort study, with isolated regional recurrence (IRR) as primary endpoint, distant recurrence (DR) and overall survival (OS) as secondary endpoints. Survival analyses were performed using the cumulative incidence function (IRR and DR) or the Kaplan–Meier method (OS) and Cox proportional hazards modelling for univariate and multivariate analyses. The prognostic effect of contact between the tumour and the pleura was investigated using the CT scans used for SABR planning. Results: A total of 554 patients were included, of whom 494 could be analysed for IRR. The median follow-up for surviving patients was 48.1 months. Twenty-one patients developed an IRR (4%). The cumulative incidence of IRR and DR after 1-, 2-, and 5 years was 2%, 3%, 7% and 8%, 15% and 21%, respectively. Two year OS was 71%. The presence and type of pleural contact was not associated with any of the studied outcomes. Conclusion: The presence, type and length of pleural contact as surrogate for visceral pleural invasion were not predictive for outcome. Further studies focussing on risk factors for occult nodal involvement, (I)RR, distant metastases and mortality in early stage NSCLC are warranted for the development of risk adapted diagnostic, treatment and follow-up strategies as more younger, operable and fitter patients receive SABR.