Ostheimer, C., Maeurer, M., Ebert, N., Schmitt, D., Krug, D., Baumann, R., Henkenberens, C., Giordano, F. A., Sautter, L., Lopez, Guerra, Fleischmann, D. F., Niyazi, M., Kasmann, L., Kaul, D., Thieme, A. H., Billiet, C., Dobiasch, S., Arnold, C. R., Oertel, M., Haussmann, J., Gauer, T., Goy, Y., Suess, C., Ziegler, S., Panje, C. M., Baues, C., Trommer-Nestler, M., Skripcak, T. and Medenwald, D. (2021). Prognostic impact of gross tumor volume during radical radiochemotherapy of locally advanced non-small cell lung cancer-results from the NCT03055715 multicenter cohort study of the Young DEGRO Trial Group. Strahlenther. Onkol., 197 (5). S. 385 - 396. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1439-099X

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Abstract

Background In radical radiochemotherapy (RCT) of inoperable non-small-cell lung cancer (NSCLC) typical prognostic factors include T- and N-stage, while there are still conflicting data on the prognostic relevance of gross tumor volume (GTV) and particularly its changes during RCT. The NCT03055715 study of the Young DEGRO working group of the German Society of Radiation Oncology (DEGRO) evaluated the prognostic impact of GTV and its changes during RCT. Methods A total of 21 university centers for radiation oncology from five different European countries (Germany, Switzerland, Spain, Belgium, and Austria) participated in the study which evaluated n = 347 patients with confirmed (biopsy) inoperable NSCLC in UICC stage III A/B who received radical curative-intent RCT between 2010 and 2013. Patient and disease data were collected anonymously via electronic case report forms and entered into the multi-institutional RadPlanBio platform for central data analysis. GTV before RCT (initial planning CT, GTV1) and at 40-50 Gy (re-planning CT for radiation boost, GTV2) was delineated. Absolute GTV before/during RCT and relative GTV changes were correlated with overall survival as the primary endpoint. Hazard ratios (HR) of survival analysis were estimated by means of adjusted Cox regression models. Results GTV1 was found to have a mean of 154.4 ml (95%CI: 1.5-877) and GTV2 of 106.2 ml (95% CI: 0.5-589.5), resulting in an estimated reduction of 48.2 ml (p < 0.001). Median overall survival (OS) was 18.8 months with a median of 22.1, 20.9, and 12.6 months for patients with high, intermediate, and low GTV before RT. Considering all patients, in one survival model of overall mortality, GTV2 (2.75 (1.12-6.75, p = 0.03) was found to be a stronger survival predictor than GTV1 (1.34 (0.9-2, p > 0.05). In patients with available data on both GTV1 and GTV2, absolute GTV1 before RT was not significantly associated with survival (HR 0-69, 0.32-1.49, p > 0.05) but GTV2 significantly predicted OS in a model adjusted for age, T stage, and chemotherapy, with an HR of 3.7 (1.01-13.53, p = 0.04) per 300 ml. The absolute decrease from GTV1 to GTV2 was correlated to survival, where every decrease by 50 ml reduced the HR by 0.8 (CI 0.64-0.99, p = 0.04). There was no evidence for a survival effect of the relative change between GTV1 and GTV2. Conclusion Our results indicate that independently of T stage, the re-planning GTV during RCT is a significant and superior survival predictor compared to baseline GTV before RT. Patients with a high absolute (rather than relative) change in GTV during RT show a superior survival outcome after RCT.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Ostheimer, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maeurer, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ebert, N.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schmitt, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krug, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baumann, R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Henkenberens, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Giordano, F. A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sautter, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lopez, GuerraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fleischmann, D. F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Niyazi, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kasmann, L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kaul, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thieme, A. H.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Billiet, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dobiasch, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arnold, C. R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oertel, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haussmann, J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gauer, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Goy, Y.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Suess, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ziegler, S.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Panje, C. M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Baues, C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Trommer-Nestler, M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Skripcak, T.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Medenwald, D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-606544
DOI: 10.1007/s00066-020-01727-4
Journal or Publication Title: Strahlenther. Onkol.
Volume: 197
Number: 5
Page Range: S. 385 - 396
Date: 2021
Publisher: SPRINGER HEIDELBERG
Place of Publication: HEIDELBERG
ISSN: 1439-099X
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
RADIATION-THERAPY; SURVIVAL; RADIOTHERAPY; STAGE; CTMultiple languages
Oncology; Radiology, Nuclear Medicine & Medical ImagingMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60654

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