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Title: Lung Volume Reduction After Stereotactic Ablative Radiation Therapy of Lung Tumors: Potential Application to Emphysema

Abstract

Purpose: Lung volume reduction surgery (LVRS) improves dyspnea and other outcomes in selected patients with severe emphysema, but many have excessive surgical risk for LVRS. We analyzed the dose-volume relationship for lobar volume reduction after stereotactic ablative radiation therapy (SABR) of lung tumors, hypothesizing that SABR could achieve therapeutic volume reduction if applied in emphysema. Methods and Materials: We retrospectively identified patients treated from 2007 to 2011 who had SABR for 1 lung tumor, pre-SABR pulmonary function testing, and ≥6 months computed tomographic (CT) imaging follow-up. We contoured the treated lobe and untreated adjacent lobe(s) on CT before and after SABR and calculated their volume changes relative to the contoured total (bilateral) lung volume (TLV). We correlated lobar volume reduction with the volume receiving high biologically effective doses (BED, α/β = 3). Results: 27 patients met the inclusion criteria, with a median CT follow-up time of 14 months. There was no grade ≥3 toxicity. The median volume reduction of the treated lobe was 4.4% of TLV (range, −0.4%-10.8%); the median expansion of the untreated adjacent lobe was 2.6% of TLV (range, −3.9%-11.6%). The volume reduction of the treated lobe was positively correlated with the volume receiving BED ≥60 Gy (r{sup 2}=0.45, P=.0001). This persisted inmore » subgroups determined by high versus low pre-SABR forced expiratory volume in 1 second, treated lobe CT emphysema score, number of fractions, follow-up CT time, central versus peripheral location, and upper versus lower lobe location, with no significant differences in effect size between subgroups. Volume expansion of the untreated adjacent lobe(s) was positively correlated with volume reduction of the treated lobe (r{sup 2}=0.47, P<.0001). Conclusions: We identified a dose-volume response for treated lobe volume reduction and adjacent lobe compensatory expansion after lung tumor SABR, consistent across multiple clinical parameters. These data serve to inform our ongoing prospective trial of stereotactic ablative volume reduction (SAVR) for severe emphysema in poor candidates for LVRS.« less

Authors:
 [1];  [2];  [3];  [4];  [5];  [1];  [3]; ;  [1];  [1];  [3];  [1];  [3];  [3];  [1];  [3]
  1. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)
  2. Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, California (United States)
  3. (United States)
  4. Department of Radiology, Stanford University School of Medicine, Stanford, California (United States)
  5. Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California (United States)
Publication Date:
OSTI Identifier:
22420429
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 90; Journal Issue: 1; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; COMPUTERIZED TOMOGRAPHY; EMPHYSEMA; HAZARDS; LUNGS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; SURGERY; TOXICITY

Citation Formats

Binkley, Michael S., Shrager, Joseph B., Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Leung, Ann N., Popat, Rita, Trakul, Nicholas, Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, Atwood, Todd F., Chaudhuri, Aadel, Maxim, Peter G., Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Diehn, Maximilian, E-mail: Diehn@Stanford.edu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, Loo, Billy W., E-mail: BWLoo@Stanford.edu, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. Lung Volume Reduction After Stereotactic Ablative Radiation Therapy of Lung Tumors: Potential Application to Emphysema. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.05.025.
Binkley, Michael S., Shrager, Joseph B., Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Leung, Ann N., Popat, Rita, Trakul, Nicholas, Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, Atwood, Todd F., Chaudhuri, Aadel, Maxim, Peter G., Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Diehn, Maximilian, E-mail: Diehn@Stanford.edu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, Loo, Billy W., E-mail: BWLoo@Stanford.edu, & Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. Lung Volume Reduction After Stereotactic Ablative Radiation Therapy of Lung Tumors: Potential Application to Emphysema. United States. doi:10.1016/J.IJROBP.2014.05.025.
Binkley, Michael S., Shrager, Joseph B., Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Leung, Ann N., Popat, Rita, Trakul, Nicholas, Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California, Atwood, Todd F., Chaudhuri, Aadel, Maxim, Peter G., Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Diehn, Maximilian, E-mail: Diehn@Stanford.edu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, Loo, Billy W., E-mail: BWLoo@Stanford.edu, and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California. Mon . "Lung Volume Reduction After Stereotactic Ablative Radiation Therapy of Lung Tumors: Potential Application to Emphysema". United States. doi:10.1016/J.IJROBP.2014.05.025.
@article{osti_22420429,
title = {Lung Volume Reduction After Stereotactic Ablative Radiation Therapy of Lung Tumors: Potential Application to Emphysema},
author = {Binkley, Michael S. and Shrager, Joseph B. and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California and Leung, Ann N. and Popat, Rita and Trakul, Nicholas and Department of Radiation Oncology, University of Southern California Keck School of Medicine, Los Angeles, California and Atwood, Todd F. and Chaudhuri, Aadel and Maxim, Peter G. and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California and Diehn, Maximilian, E-mail: Diehn@Stanford.edu and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California and Loo, Billy W., E-mail: BWLoo@Stanford.edu and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California},
abstractNote = {Purpose: Lung volume reduction surgery (LVRS) improves dyspnea and other outcomes in selected patients with severe emphysema, but many have excessive surgical risk for LVRS. We analyzed the dose-volume relationship for lobar volume reduction after stereotactic ablative radiation therapy (SABR) of lung tumors, hypothesizing that SABR could achieve therapeutic volume reduction if applied in emphysema. Methods and Materials: We retrospectively identified patients treated from 2007 to 2011 who had SABR for 1 lung tumor, pre-SABR pulmonary function testing, and ≥6 months computed tomographic (CT) imaging follow-up. We contoured the treated lobe and untreated adjacent lobe(s) on CT before and after SABR and calculated their volume changes relative to the contoured total (bilateral) lung volume (TLV). We correlated lobar volume reduction with the volume receiving high biologically effective doses (BED, α/β = 3). Results: 27 patients met the inclusion criteria, with a median CT follow-up time of 14 months. There was no grade ≥3 toxicity. The median volume reduction of the treated lobe was 4.4% of TLV (range, −0.4%-10.8%); the median expansion of the untreated adjacent lobe was 2.6% of TLV (range, −3.9%-11.6%). The volume reduction of the treated lobe was positively correlated with the volume receiving BED ≥60 Gy (r{sup 2}=0.45, P=.0001). This persisted in subgroups determined by high versus low pre-SABR forced expiratory volume in 1 second, treated lobe CT emphysema score, number of fractions, follow-up CT time, central versus peripheral location, and upper versus lower lobe location, with no significant differences in effect size between subgroups. Volume expansion of the untreated adjacent lobe(s) was positively correlated with volume reduction of the treated lobe (r{sup 2}=0.47, P<.0001). Conclusions: We identified a dose-volume response for treated lobe volume reduction and adjacent lobe compensatory expansion after lung tumor SABR, consistent across multiple clinical parameters. These data serve to inform our ongoing prospective trial of stereotactic ablative volume reduction (SAVR) for severe emphysema in poor candidates for LVRS.},
doi = {10.1016/J.IJROBP.2014.05.025},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 1,
volume = 90,
place = {United States},
year = {Mon Sep 01 00:00:00 EDT 2014},
month = {Mon Sep 01 00:00:00 EDT 2014}
}