Prognostic Value of Primary Tumor Volume Changes on kV-CBCT during Definitive Chemoradiotherapy for Stage III Non–Small Cell Lung Cancer
| Autor: | John C. Grecula, Terence M. Williams, Xiaokui Mo, Patrick Wald, C. Barney, David P. Carbone, A. Karl Haglund, Meng Xu-Welliver, Daniel Gunderson, Jose G. Bazan, Arnab Chakravarti |
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| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Multivariate analysis business.industry medicine.medical_treatment Hazard ratio Urology Definitive chemoradiotherapy medicine.disease Primary tumor Confidence interval 030218 nuclear medicine & medical imaging Stage III Non-Small Cell Lung Cancer Radiation therapy 03 medical and health sciences 0302 clinical medicine Oncology Volume (thermodynamics) 030220 oncology & carcinogenesis medicine Nuclear medicine business |
| Zdroj: | Journal of Thoracic Oncology. 12:1779-1787 |
| ISSN: | 1556-0864 |
| Popis: | Introduction Kilovoltge cone beam computed tomography (kV-CBCT) allows for tumor localization and response assessment during definitive chemoradiotherapy for locally advanced NSCLC. We hypothesize that significant tumor volume loss occurs early during radiotherapy and that the extent of volume loss correlates with clinical outcomes. Methods A total of 52 patients with locally advanced NSCLC treated with definitive chemoradiotherapy were reviewed. kV-CBCT images were used to contour primary gross tumor volumes at four time points during treatment. Patients were dichotomized according to absolute and relative volume changes at each time point. Statistical analyses were performed to evaluate correlations between volume changes and clinical outcomes. Results The median gross tumor volumes were 77.1, 48.3, 42.5, and 29.9 cm3 for fractions 1, 11, 21, and final, respectively. Greater relative volume loss between fractions 1 and 21 correlated with improved distant control (hazard ratio [HR] = 0.35, 95% confidence interval [CI]: 0.13–0.94, p = 0.038) and overall survival (HR = 0.40, 95% CI: 0.16–0.98, p = 0.046). Greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.17–0.88, p = 0.02) and trended toward improved overall survival (HR = 0.43, 95% CI: 0.17–1.06, p = 0.07). On multivariate analysis, greater relative volume loss between fractions 11 and 21 correlated with improved progression-free survival (HR = 0.39, 95% CI: 0.16–0.97, p = 0.041) and overall survival (HR = 0.31, 95% CI: 0.11–0.88, p = 0.027). Conclusions Significant primary tumor volume loss occurs early during radiotherapy for locally advanced NSCLC. Greater relative tumor volume loss during treatment correlates with improved disease control and overall survival. Thus, kV-CBCT has potential to be used as a practical prognostic imaging marker. |
| Databáze: | OpenAIRE |
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