Outcomes by tumor histology and kras mutation status after lung stereotactic body radiation therapy for early-stage non-small-cell lung cancer

Raymond H. Mak, Gretchen Hermann, John H. Lewis, Hugo J W L Aerts, Elizabeth H. Baldini, Aileen B. Chen, Yolonda L. Colson, Fred H. Hacker, David Kozono, Jon O. Wee, Yu Hui Chen, Paul J. Catalano, Kwok Kin Wong, David J. Sher

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Abstract

Background We analyzed outcomes after lung stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung-carcinoma (NSCLC) by histology and KRAS genotype. Patients and Methods We included 75 patients with 79 peripheral tumors treated with SBRT (18 Gy × 3 or 10 to 12 Gy × 5) at our institution from 2009 to 2012. Genotyping for KRAS mutations was performed in 10 patients. Outcomes were analyzed by the Kaplan-Meier method/Cox regression, or cumulative incidence method/Fine-Gray analysis. Results The median patient age was 74 (range, 46 to 93) years, and Eastern Cooperative Oncology Group performance status was 0 to 1 in 63%. Tumor histology included adenocarcinoma (44%), squamous cell carcinoma (25%), and NSCLC (18%). Most tumors were T1a (54%). Seven patients had KRAS-mutant tumors (9%). With a median follow-up of 18.8 months among survivors, the 1-year estimate of overall survival was 88%, cancer-specific survival (CSS) 92%, primary tumor control 94%, and freedom from recurrence (FFR) 67%. In patients with KRAS-mutant tumors, there was a significantly lower tumor control (67% vs. 96%; P =.04), FFR (48% vs. 69%; P =.03), and CSS (75% vs. 93%; P =.05). On multivariable analysis, histology was not associated with outcomes, but KRAS mutation (hazard ratio, 10.3; 95% confidence interval, 2.3-45.6; P =.0022) was associated with decreased CSS after adjusting for age. Conclusion In this SBRT series, histology was not associated with outcomes, but KRAS mutation was associated with lower FFR on univariable analysis and decreased CSS on multivariable analysis. Because of the small sample size, these hypothesis-generating results need to be studied in larger data sets.

Original languageEnglish (US)
Pages (from-to)24-32
Number of pages9
JournalClinical Lung Cancer
Volume16
Issue number1
DOIs
StatePublished - Jan 1 2015

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Non-Small Cell Lung Carcinoma
Histology
Radiotherapy
Lung
Mutation
Neoplasms
Radiosurgery
Survival
Recurrence
Sample Size
Survivors
Squamous Cell Carcinoma
Adenocarcinoma
Genotype
Confidence Intervals
Incidence

Keywords

  • Early stage
  • KRAS
  • Non-small-cell lung cancer
  • Stereotactic body radiotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

Outcomes by tumor histology and kras mutation status after lung stereotactic body radiation therapy for early-stage non-small-cell lung cancer. / Mak, Raymond H.; Hermann, Gretchen; Lewis, John H.; Aerts, Hugo J W L; Baldini, Elizabeth H.; Chen, Aileen B.; Colson, Yolonda L.; Hacker, Fred H.; Kozono, David; Wee, Jon O.; Chen, Yu Hui; Catalano, Paul J.; Wong, Kwok Kin; Sher, David J.

In: Clinical Lung Cancer, Vol. 16, No. 1, 01.01.2015, p. 24-32.

Research output: Contribution to journalArticle

Mak, RH, Hermann, G, Lewis, JH, Aerts, HJWL, Baldini, EH, Chen, AB, Colson, YL, Hacker, FH, Kozono, D, Wee, JO, Chen, YH, Catalano, PJ, Wong, KK & Sher, DJ 2015, 'Outcomes by tumor histology and kras mutation status after lung stereotactic body radiation therapy for early-stage non-small-cell lung cancer', Clinical Lung Cancer, vol. 16, no. 1, pp. 24-32. https://doi.org/10.1016/j.cllc.2014.09.005
Mak, Raymond H. ; Hermann, Gretchen ; Lewis, John H. ; Aerts, Hugo J W L ; Baldini, Elizabeth H. ; Chen, Aileen B. ; Colson, Yolonda L. ; Hacker, Fred H. ; Kozono, David ; Wee, Jon O. ; Chen, Yu Hui ; Catalano, Paul J. ; Wong, Kwok Kin ; Sher, David J. / Outcomes by tumor histology and kras mutation status after lung stereotactic body radiation therapy for early-stage non-small-cell lung cancer. In: Clinical Lung Cancer. 2015 ; Vol. 16, No. 1. pp. 24-32.
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abstract = "Background We analyzed outcomes after lung stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung-carcinoma (NSCLC) by histology and KRAS genotype. Patients and Methods We included 75 patients with 79 peripheral tumors treated with SBRT (18 Gy × 3 or 10 to 12 Gy × 5) at our institution from 2009 to 2012. Genotyping for KRAS mutations was performed in 10 patients. Outcomes were analyzed by the Kaplan-Meier method/Cox regression, or cumulative incidence method/Fine-Gray analysis. Results The median patient age was 74 (range, 46 to 93) years, and Eastern Cooperative Oncology Group performance status was 0 to 1 in 63{\%}. Tumor histology included adenocarcinoma (44{\%}), squamous cell carcinoma (25{\%}), and NSCLC (18{\%}). Most tumors were T1a (54{\%}). Seven patients had KRAS-mutant tumors (9{\%}). With a median follow-up of 18.8 months among survivors, the 1-year estimate of overall survival was 88{\%}, cancer-specific survival (CSS) 92{\%}, primary tumor control 94{\%}, and freedom from recurrence (FFR) 67{\%}. In patients with KRAS-mutant tumors, there was a significantly lower tumor control (67{\%} vs. 96{\%}; P =.04), FFR (48{\%} vs. 69{\%}; P =.03), and CSS (75{\%} vs. 93{\%}; P =.05). On multivariable analysis, histology was not associated with outcomes, but KRAS mutation (hazard ratio, 10.3; 95{\%} confidence interval, 2.3-45.6; P =.0022) was associated with decreased CSS after adjusting for age. Conclusion In this SBRT series, histology was not associated with outcomes, but KRAS mutation was associated with lower FFR on univariable analysis and decreased CSS on multivariable analysis. Because of the small sample size, these hypothesis-generating results need to be studied in larger data sets.",
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T1 - Outcomes by tumor histology and kras mutation status after lung stereotactic body radiation therapy for early-stage non-small-cell lung cancer

AU - Mak, Raymond H.

AU - Hermann, Gretchen

AU - Lewis, John H.

AU - Aerts, Hugo J W L

AU - Baldini, Elizabeth H.

AU - Chen, Aileen B.

AU - Colson, Yolonda L.

AU - Hacker, Fred H.

AU - Kozono, David

AU - Wee, Jon O.

AU - Chen, Yu Hui

AU - Catalano, Paul J.

AU - Wong, Kwok Kin

AU - Sher, David J.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background We analyzed outcomes after lung stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung-carcinoma (NSCLC) by histology and KRAS genotype. Patients and Methods We included 75 patients with 79 peripheral tumors treated with SBRT (18 Gy × 3 or 10 to 12 Gy × 5) at our institution from 2009 to 2012. Genotyping for KRAS mutations was performed in 10 patients. Outcomes were analyzed by the Kaplan-Meier method/Cox regression, or cumulative incidence method/Fine-Gray analysis. Results The median patient age was 74 (range, 46 to 93) years, and Eastern Cooperative Oncology Group performance status was 0 to 1 in 63%. Tumor histology included adenocarcinoma (44%), squamous cell carcinoma (25%), and NSCLC (18%). Most tumors were T1a (54%). Seven patients had KRAS-mutant tumors (9%). With a median follow-up of 18.8 months among survivors, the 1-year estimate of overall survival was 88%, cancer-specific survival (CSS) 92%, primary tumor control 94%, and freedom from recurrence (FFR) 67%. In patients with KRAS-mutant tumors, there was a significantly lower tumor control (67% vs. 96%; P =.04), FFR (48% vs. 69%; P =.03), and CSS (75% vs. 93%; P =.05). On multivariable analysis, histology was not associated with outcomes, but KRAS mutation (hazard ratio, 10.3; 95% confidence interval, 2.3-45.6; P =.0022) was associated with decreased CSS after adjusting for age. Conclusion In this SBRT series, histology was not associated with outcomes, but KRAS mutation was associated with lower FFR on univariable analysis and decreased CSS on multivariable analysis. Because of the small sample size, these hypothesis-generating results need to be studied in larger data sets.

AB - Background We analyzed outcomes after lung stereotactic body radiotherapy (SBRT) for early-stage non-small cell lung-carcinoma (NSCLC) by histology and KRAS genotype. Patients and Methods We included 75 patients with 79 peripheral tumors treated with SBRT (18 Gy × 3 or 10 to 12 Gy × 5) at our institution from 2009 to 2012. Genotyping for KRAS mutations was performed in 10 patients. Outcomes were analyzed by the Kaplan-Meier method/Cox regression, or cumulative incidence method/Fine-Gray analysis. Results The median patient age was 74 (range, 46 to 93) years, and Eastern Cooperative Oncology Group performance status was 0 to 1 in 63%. Tumor histology included adenocarcinoma (44%), squamous cell carcinoma (25%), and NSCLC (18%). Most tumors were T1a (54%). Seven patients had KRAS-mutant tumors (9%). With a median follow-up of 18.8 months among survivors, the 1-year estimate of overall survival was 88%, cancer-specific survival (CSS) 92%, primary tumor control 94%, and freedom from recurrence (FFR) 67%. In patients with KRAS-mutant tumors, there was a significantly lower tumor control (67% vs. 96%; P =.04), FFR (48% vs. 69%; P =.03), and CSS (75% vs. 93%; P =.05). On multivariable analysis, histology was not associated with outcomes, but KRAS mutation (hazard ratio, 10.3; 95% confidence interval, 2.3-45.6; P =.0022) was associated with decreased CSS after adjusting for age. Conclusion In this SBRT series, histology was not associated with outcomes, but KRAS mutation was associated with lower FFR on univariable analysis and decreased CSS on multivariable analysis. Because of the small sample size, these hypothesis-generating results need to be studied in larger data sets.

KW - Early stage

KW - KRAS

KW - Non-small-cell lung cancer

KW - Stereotactic body radiotherapy

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