Systematic EndoscopIc Staging of Mediastinum to determine Impact on radiotherapy for locally advanced lung Cancer (SEISMIC): an international multi-centre cohort study

Research Opportunity
PhD students, Masters by Research
Department / Centre
Medicine
Location
Royal Melbourne Hospital
Primary Supervisor Email Number Webpage
Associate Professor Daniel Steinfort Daniel.Steinfort@mh.org.au
Co-supervisor Email Number Webpage
Associate Professor Shankar Siva Shankar.Siva@mh.org.au

Summary Lung Cancer remains the most common cause of cancer death in Australia & the western world. Non-small cell lung cancer (NSCLC) comprises 87% of all lung cancers, and of these over 25% are diagnosed with locally advanced disease – defined by involvement of mediastinal lymph nodes (LN). The SEISMIC study aims to identify the optimal method for mediastinal LN and planning of radiation therapy fields.

Project Details

Accurate and systematic mediastinal lymph node staging is strongly recommended for early stage NSCLC, and is associated with survival benefit.  Mediastinal LN involvement may be suspected on the basis of non-invasive imaging with Positron Emission Tomography (PET) or Computed Tomography (CT).  Tissue diagnosis, by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is recommended given the imperfect accuracy of PET for mediastinal staging of NSCLC.

Current practice for Radiation field planning is to identify treatment volume based on PET-identified disease extent alone. However our pilot data demonstrates EBUS-TBNA detects PET-occult LN metastases in over 10% of patients with locally advanced NSCLC.

This study will evaluate LN by EBUS-TBNA in patients with locally advanced NSCLC. Outcomes on a per lymph node basis will be compared between PET alone, and PET combined with EBUS-TBNA findings.  Clinical treatment plans will be composed and delivered incorporating both PET and EBUS findings. Study outcomes will be based on comparisons between staging as determined by PET alone, and by PET + EBUS for patients with discordant PET & EBUS findings regarding mediastinal disease extent. Radiation plans will be evaluated, examining tumour coverage, including to PET-occult sites of LN disease and radiation dose to organs at risk, in order to assess both Tumour control probability (TCP – likelihood of effective cure) and Normal Tissue Complication Probability (NTCP – likelihood of developing major complications of radiation treatment).

This novel project will address four main aims as it seeks to redefine the evidence base for radiation planning in locally advanced NSCLC

  1. To confirm the ability of systematic LN staging with EBUS-TBNA in LA-NSCLC to detect PET-occult LN metastases.
  2. To evaluate the impact of additional information acquired from systematic EBUS-TBNA staging on radiation planning as well as likely impact on radiation outcomes (efficacy & toxicity).
  3. To develop risk prediction models using routinely collected clinical and radiologic information for accurate identification of patients with PET-occult LN metastases.
  4. To assess the impact of presence of PET-occult disease on long term clinical outcomes in LA-NSCLC following curative intent radiotherapy.


Faculty Research Themes

Cancer

School Research Themes

Cancer in Medicine



Research Opportunities

PhD students, Masters by Research
Students who are interested in joining this project will need to consider their elegibility as well as other requirements before contacting the supervisor of this research

Graduate Research application

Honours application

Key Contact

For further information about this research, please contact a supervisor.

Department / Centre

Medicine

Research Node

Royal Melbourne Hospital

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