Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy

Caitlin A. Schonewolf, Vivek Verma, Carl M. Post, Abigail T. Berman, Melissa A. Frick, Anil Vachani, Chi Lin, Charles B. Simone

Research output: Contribution to journalArticle

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Abstract

Background: The benefit of invasive mediastinal nodal staging (IMNS) in addition to positron emission tomography-computed tomography (PET/CT) is undefined for early stage non-small cell lung cancer (NSCLC). This multi-institutional investigation aimed to evaluate outcomes and patterns of failure in patients staged with PET/CT with or without additional IMNS. Methods: Two academic centers assessed all consecutive patients staged with PET/CT for early-stage, primary lung NSCLC (cT1-2aN0M0) treated with SBRT. Local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Results: Overall, 180 patients (199 lesions) were staged with PET/CT alone and 56 patients (58 lesions) underwent additional IMNS. Among patients receiving IMNS, 52 (93%) underwent EBUS and 4 (7%) underwent mediastinoscopy. At a median follow-up of 33.5 months (range, 1.9–80.9 months), there was no significant difference in LRFS (37 vs. 47 months, p = 0.309), NRFS (34 vs. 42 months p = 0.370), DMFS (36 vs. 47 months, p = 0.234) or OS (37 vs. 47 months, p = 0.236) between patients undergoing PET/CT-only versus PET/CT + IMNS staging, respectively. Receipt of IMNS did not correlate with any outcome on either univariate or multivariate analysis (p > 0.05). Patterns of failure in both groups were similar, including crude isolated nodal failure rates (8% PET/CT-only versus 14% PET + IMNS group, p = 0.202). Conclusions: Patients undergoing IMNS had similar survival and patterns of recurrence as those receiving PET/CT alone. Further study, ideally prospectively, is needed to determine which subgroups might benefit from IMNS.

Original languageEnglish (US)
Pages (from-to)53-59
Number of pages7
JournalLung Cancer
Volume117
DOIs
StatePublished - Mar 2018

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Non-Small Cell Lung Carcinoma
Positron-Emission Tomography
Radiotherapy
Survival
Recurrence
Neoplasm Metastasis
Mediastinoscopy
Positron Emission Tomography Computed Tomography
Multivariate Analysis
Lung

Keywords

  • Endobronchial ultrasound
  • Mediastinoscopy
  • Non-small cell lung cancer
  • Positron emission tomography
  • Stereotactic ablative radiotherapy
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy. / Schonewolf, Caitlin A.; Verma, Vivek; Post, Carl M.; Berman, Abigail T.; Frick, Melissa A.; Vachani, Anil; Lin, Chi; Simone, Charles B.

In: Lung Cancer, Vol. 117, 03.2018, p. 53-59.

Research output: Contribution to journalArticle

Schonewolf, Caitlin A. ; Verma, Vivek ; Post, Carl M. ; Berman, Abigail T. ; Frick, Melissa A. ; Vachani, Anil ; Lin, Chi ; Simone, Charles B. / Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy. In: Lung Cancer. 2018 ; Vol. 117. pp. 53-59.
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title = "Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy",
abstract = "Background: The benefit of invasive mediastinal nodal staging (IMNS) in addition to positron emission tomography-computed tomography (PET/CT) is undefined for early stage non-small cell lung cancer (NSCLC). This multi-institutional investigation aimed to evaluate outcomes and patterns of failure in patients staged with PET/CT with or without additional IMNS. Methods: Two academic centers assessed all consecutive patients staged with PET/CT for early-stage, primary lung NSCLC (cT1-2aN0M0) treated with SBRT. Local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Results: Overall, 180 patients (199 lesions) were staged with PET/CT alone and 56 patients (58 lesions) underwent additional IMNS. Among patients receiving IMNS, 52 (93{\%}) underwent EBUS and 4 (7{\%}) underwent mediastinoscopy. At a median follow-up of 33.5 months (range, 1.9–80.9 months), there was no significant difference in LRFS (37 vs. 47 months, p = 0.309), NRFS (34 vs. 42 months p = 0.370), DMFS (36 vs. 47 months, p = 0.234) or OS (37 vs. 47 months, p = 0.236) between patients undergoing PET/CT-only versus PET/CT + IMNS staging, respectively. Receipt of IMNS did not correlate with any outcome on either univariate or multivariate analysis (p > 0.05). Patterns of failure in both groups were similar, including crude isolated nodal failure rates (8{\%} PET/CT-only versus 14{\%} PET + IMNS group, p = 0.202). Conclusions: Patients undergoing IMNS had similar survival and patterns of recurrence as those receiving PET/CT alone. Further study, ideally prospectively, is needed to determine which subgroups might benefit from IMNS.",
keywords = "Endobronchial ultrasound, Mediastinoscopy, Non-small cell lung cancer, Positron emission tomography, Stereotactic ablative radiotherapy, Stereotactic body radiation therapy",
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T1 - Outcomes of invasive mediastinal nodal staging versus positron emission tomography staging alone for early-stage non-small cell lung cancer treated with stereotactic body radiation therapy

AU - Schonewolf, Caitlin A.

AU - Verma, Vivek

AU - Post, Carl M.

AU - Berman, Abigail T.

AU - Frick, Melissa A.

AU - Vachani, Anil

AU - Lin, Chi

AU - Simone, Charles B.

PY - 2018/3

Y1 - 2018/3

N2 - Background: The benefit of invasive mediastinal nodal staging (IMNS) in addition to positron emission tomography-computed tomography (PET/CT) is undefined for early stage non-small cell lung cancer (NSCLC). This multi-institutional investigation aimed to evaluate outcomes and patterns of failure in patients staged with PET/CT with or without additional IMNS. Methods: Two academic centers assessed all consecutive patients staged with PET/CT for early-stage, primary lung NSCLC (cT1-2aN0M0) treated with SBRT. Local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Results: Overall, 180 patients (199 lesions) were staged with PET/CT alone and 56 patients (58 lesions) underwent additional IMNS. Among patients receiving IMNS, 52 (93%) underwent EBUS and 4 (7%) underwent mediastinoscopy. At a median follow-up of 33.5 months (range, 1.9–80.9 months), there was no significant difference in LRFS (37 vs. 47 months, p = 0.309), NRFS (34 vs. 42 months p = 0.370), DMFS (36 vs. 47 months, p = 0.234) or OS (37 vs. 47 months, p = 0.236) between patients undergoing PET/CT-only versus PET/CT + IMNS staging, respectively. Receipt of IMNS did not correlate with any outcome on either univariate or multivariate analysis (p > 0.05). Patterns of failure in both groups were similar, including crude isolated nodal failure rates (8% PET/CT-only versus 14% PET + IMNS group, p = 0.202). Conclusions: Patients undergoing IMNS had similar survival and patterns of recurrence as those receiving PET/CT alone. Further study, ideally prospectively, is needed to determine which subgroups might benefit from IMNS.

AB - Background: The benefit of invasive mediastinal nodal staging (IMNS) in addition to positron emission tomography-computed tomography (PET/CT) is undefined for early stage non-small cell lung cancer (NSCLC). This multi-institutional investigation aimed to evaluate outcomes and patterns of failure in patients staged with PET/CT with or without additional IMNS. Methods: Two academic centers assessed all consecutive patients staged with PET/CT for early-stage, primary lung NSCLC (cT1-2aN0M0) treated with SBRT. Local recurrence-free survival (LRFS), nodal recurrence-free survival (NRFS), distant metastasis-free survival (DMFS), and overall survival (OS) were calculated using Kaplan-Meier methodology. Univariate and multivariate Cox proportional hazards modeling addressed factors associated with outcomes. Results: Overall, 180 patients (199 lesions) were staged with PET/CT alone and 56 patients (58 lesions) underwent additional IMNS. Among patients receiving IMNS, 52 (93%) underwent EBUS and 4 (7%) underwent mediastinoscopy. At a median follow-up of 33.5 months (range, 1.9–80.9 months), there was no significant difference in LRFS (37 vs. 47 months, p = 0.309), NRFS (34 vs. 42 months p = 0.370), DMFS (36 vs. 47 months, p = 0.234) or OS (37 vs. 47 months, p = 0.236) between patients undergoing PET/CT-only versus PET/CT + IMNS staging, respectively. Receipt of IMNS did not correlate with any outcome on either univariate or multivariate analysis (p > 0.05). Patterns of failure in both groups were similar, including crude isolated nodal failure rates (8% PET/CT-only versus 14% PET + IMNS group, p = 0.202). Conclusions: Patients undergoing IMNS had similar survival and patterns of recurrence as those receiving PET/CT alone. Further study, ideally prospectively, is needed to determine which subgroups might benefit from IMNS.

KW - Endobronchial ultrasound

KW - Mediastinoscopy

KW - Non-small cell lung cancer

KW - Positron emission tomography

KW - Stereotactic ablative radiotherapy

KW - Stereotactic body radiation therapy

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