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Background Photon involved-field radiation therapy (IFRT), the standard for locally advanced non-small cell lung cancer (LA-NSCLC), results in favorable outcomes without increased isolated nodal failures, perhaps from scattered dose to elective nodal stations. Given the high conformality of intensity-modulated proton therapy (IMPT), proton IFRT could increase nodal failures. We investigated the feasibility of IMPT for elective nodal irradiation (ENI) in LA-NSCLC. Materials and Methods IMPT IFRT plans were generated to the same total dose of 66.6–72 Gy received by 20 LA-NSCLC patients treated with photon IFRT. IMPT ENI plans were generated to 46 CGE to elective nodal (EN) planning treatment volumes (PTV) plus 24 CGE to involved field (IF)-PTVs. Results Proton IFRT and ENI both improved D95 involved field (IF)-PTV coverage by 4% (p<0.01) compared to photon IFRT. All evaluated dosimetric parameters improved significantly with both proton plans. Lung V20 and mean lung dose decreased 18% (p<0.01) and 36% (p<0.01), respectively, with proton IFRT and 11% (p=0.03) and 26% (p<0.01) with ENI. Mean esophagus dose decreased 16% with IFRT and 12% with ENI; heart V25 decreased 63% with both (all p<0.01). Conclusions This study demonstrates the feasibility of IMPT for LA-NSCLC ENI. Potential decreased toxicity indicates IMPT could allow ENI while maintaining a favorable therapeutic ratio compared to photon IFRT.

In familial mood disorders, a ventromedial prefrontal cortical deficit in baseline metabolism is not due to altered structural volume, and the response to serotonergic challenge appears predictive of acute mood response. The potential to predict treatment response can be tested by a combined challenge and treatment study.

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L ocally advanced, inoperable lung cancer is a challenging disease. Despite aggressive treatment with chemoradiation, local cancer recurrence is observed in approximately 50% of patients (1), and the median survival rate is only 23 to 25 months (2). Imaging genomics, otherwise known as radiogenomics, is a promising technique which can potentially improve prognostication and help guide new treatment strategies. This emerging field aims to capture the molecular subtypes and genetic underpinnings of a disease based on associations between radiologic imaging and genomic sequencing.Radiomics is a high-throughput computational technique in which mathematical features are derived from medical images. The analysis of cell-free DNA (cfDNA) is a complementary technique whereby traces of cfDNA are detectable in the bloodstream when apoptotic cells shed fragmented DNA. Using nextgeneration sequencing, cancer-specific mutations for genes implicated in the pathogenesis of lung cancer can be identified from a subset of cfDNA known as circulating tumor DNA (ctDNA). Both cfDNA and ctDNA, which are mechanistically and technologically different from tissue-based mutational assessment, are promising liquid biopsy-based markers of radiation response (3-7).This brief report provides preliminary results demonstrating the feasibility of an integrated radiomic, cfDNA, and ctDNA analysis in patients with locally advanced lung cancer. Our method is based on a prospective pilot study of patients who underwent concurrent chemoradiation in which liquid biopsies were performed during treatment. We hypothesized that cell death due to chemoradiation therapy would lead to the release of measurable cfDNA into the bloodstream, which when combined with CT radiomics and next-generation sequencing, could provide patient-specific radiogenomic expression patterns associated with prognosis. Materials and Methods Study DesignOur study design is summarized in Figure 1. All research was conducted in keeping with best clinical practice and regulatory compliance. Prospective data (images, plasma, patient outcomes) were generated from Pro00017361 (NCT00921739) approved by the

LS-SCLC patients staged with PET exhibited improved disease control and survival when compared with non-PET-staged LS-SCLC patients. Improved staging accuracy and better identification of intrathoracic disease may explain these findings, underscoring the value of PET-CT in these patients.

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