ABSTRACT
PURPOSE/OBJECTIVE(S): Stereotactic body radiotherapy (SBRT) has become the standard of care for patients with medically inoperable early-stage non-small cell lung cancer (NSCLC) and for patients who refuse surgery. The aim of this study was to evaluate the effectiveness and safety of primary SBRT in patients with early-stage NSCLC. MATERIALS/METHODS: Retrospective multicenter study of 397 patients (416 primary lung tumours) treated with SBRT at 18 centres in Spain. 83.2% were men. The median age was 74.4 years. In 94.4% of cases, the tumour was inoperable. The pathological report was available in 54.6% of cases. SPSS vs 22.0. was used to perform all statistical analyses. RESULTS: Complete response was obtained in 53.6% of cases. Significant prognostic factors were standard CT planning (p = 0.014) and 4D cone beam CT (p = 0.000). Acute and chronic toxicity ≥ grade 3 was observed in 1.2% of cases. At a median follow-up of 30 months, local relapse was 9.6%, lymph node relapse 12.8%, distant metastasis 16.6%, and another lung tumour 11.5%. Complete response was the only significant prognostic factor for local relapse (p = 0.012) and distant metastasis (p = 0.001). The local relapse-free survival was 88.7%. The overall survival was 75.7%. The cancer-specific survival was 92.7%. The disease-free survival was 78.7%. CONCLUSION: SBRT is an effective and well-tolerated treatment option for patients with early-stage lung cancer who are not suitable for surgery. The most important prognostic factor for local and distant recurrence was complete response, which in our sample depended on the type of CT planning and the IGRT technique.
Subject(s)
Carcinoma, Non-Small-Cell Lung/radiotherapy , Lung Neoplasms/radiotherapy , Radiosurgery , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/pathology , Female , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Neoplasm Staging , Radiosurgery/adverse effects , Retrospective Studies , Treatment OutcomeABSTRACT
La radioterapia es una terapéutica curativa en cáncer de próstata localizado en sus modalidades de braquiterapia (BT) y radioterapia externa (EBRT). Una elevación temporal del antígeno prostático específico (PSA) después de un tratamiento radioterápico, con un descenso sin intervención terapéutica, puede ocurrir en el 30% de los pacientes. Este fenómeno es conocido como rebote de PSA y carece de efecto pronóstico en relación con el control del tumor. Genera ansiedad en el paciente por el miedo al fracaso y en el médico por la incertidumbre sobre el estado del tumor. Su etiología y patogénesis son aún desconocidas. Varios factores relacionados con el tumor y el tratamiento se han evaluado en los estudios que analizan este fenómeno: la edad es el único factor observado con mayor consistencia como predictor de rebote. La definición de fracaso biológico (BF), según criterios Phoenix, después de EBRT o BT con o sin de privación androgénica (ADT), como una elevación de, al menos, 2 ng/ml sobre el nadir de PSA, permite tener en cuenta mejor el fenómeno de rebote aunque no está libre de falsos BF que pueden afectar a la supervivencia libre de fracaso en pacientes con seguimientos inferiores a 3 años(AU)
Radiotherapy is a curative treatment for localized prostate cancer in its modalities of brachytherapy (BT) and external beam radiotherapy (EBRT). A temporary increase in prostate- specific antigen (PSA) values following a radiotherapy treatment coupled with a decrease without therapeutic intervention may happen in 30% of the patients. This phenomenon is known as PSA bounce and lacks prognostic effect in relation to tumor control. Additionally, it produces anxiety in the patient because of the fear of failure, and in the physicists due to the uncertainty about the state of the tumor. The etiology and pathogenesis are still unknown. Several factors associated with the tumor and the treatments have been evaluated in the studies which analyze this phenomenon, the age is the only observed factor with the highest consistency as a bounce predictor. The definition of biologic failure (BF) after EBRT or BT with or without androgenic deprivation (ADT) according to Phoenix criteria, which considers an increase of at least 2 ng/ml over PSA nadir, enables better taking the bounce phenomenon into account, although is not free from false BF that may affect to the relapse-free survival in patients with follow-up shorter than 3 years(AU)
