• Clinical lung cancer · May 2019

    Predictors of Nodal and Metastatic Failure in Early Stage Non-small-cell Lung Cancer After Stereotactic Body Radiation Therapy.

    • Alberto Cerra-Franco, Sheng Liu, Michella Azar, Kevin Shiue, Samantha Freije, Jason Hinton, Christopher R Deig, Donna Edwards, Neil C Estabrook, Susannah G Ellsworth, Ke Huang, Khalil Diab, Mark P Langer, Richard Zellars, Feng-Ming Kong, Jun Wan, and Tim Lautenschlaeger.
    • Department of Radiation Oncology, Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN.
    • Clin Lung Cancer. 2019 May 1; 20 (3): 186-193.e3.

    Introduction/BackgroundMany patients with early stage non-small-cell lung cancer (ES-NSCLC) undergoing stereotactic body radiation therapy (SBRT) develop metastases, which is associated with poor outcomes. We sought to identify factors predictive of metastases after lung SBRT and created a risk stratification tool.Materials And MethodsWe included 363 patients with ES-NSCLC who received SBRT; the median follow-up was 5.8 years. The following patient and tumor factors were retrospectively analyzed for their association with metastases (defined as nodal and/or distant failure): gender; age; lobe involved; centrality; previous NSCLC; smoking status; gross tumor volume (GTV); T-stage; histology; dose; minimum, maximum, and mean GTV dose; and parenchymal lung failure. A metastasis risk-score linear-model using beta coefficients from a multivariate Cox model was built.ResultsA total of 111 (27.3%) of 406 lesions metastasized. GTV and dose were significantly associated with metastases on univariate and multivariate Cox proportional hazards modeling (P < .001 and hazard ratio [HR], 1.02 per mL; P < .05 and HR, 0.99 per Gy, respectively). Histology, T-stage, centrality, lung parenchymal failures, and previous NSCLC were not associated with development of metastasis. A metastasis risk-score model using GTV and prescription dose was built: risk score = (0.01611 × GTV) - (0.00525 × dose [BED10]). Two risk-score cutoffs separating the cohort into low-, medium-, and high-risk subgroups were examined. The risk score identified significant differences in time to metastases between low-, medium-, and high-risk patients (P < .001), with 3-year estimates of 81.1%, 63.8%, and 38%, respectively.ConclusionGTV and radiation dose are associated with time to metastasis and may be used to identify patients at higher risk of metastasis after lung SBRT.Copyright © 2018 Elsevier Inc. All rights reserved.

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