Context Patients with early stage but medically inoperable lung cancer patients have a poor rate of primary tumor control (30-40%) and a high rate of mortality (3-year survival 20-35%) with current management. Objective To evaluate the toxicity and efficacy of stereotactic body radiation therapy in a high risk population of patients with early stage but medically inoperable lung cancer. Design, Setting, and Patients Phase 2 North American multicenter study of patients with biopsy-proven peripheral T1-T2, N0, M0 non-small cell tumors less than 5 cm in diameter and medical conditions precluding surgical treatment. The prescription dose was 18 Gy per fraction times 3 fractions (54 Gy total) delivered in 1½-2 weeks. The study opened May 26, 2004, and closed October 13, 2006; data were analyzed through August 31, 2009. Main Outcome Measures The primary endpoint was primary tumor control with overall survival, disease free survival, adverse events, involved lobe, regional, and disseminated recurrence as secondary endpoints. Results A total of 59 patients accrued, of which 55 were evaluable (44 T1 and 11 T2 tumors) with a median follow-up of 34.4 months (range, 4.8 to 49.9 months). Only 1 patient had a primary tumor failure; the estimated 3-year primary tumor control rate was 97.6% (95% confidence interval [CI], 84.3%, 99.7%). Three patients had recurrence within the involved lobe; the 3-year primary tumor and involved lobe (local) control rate was 90.6% (95% CI, 76.0%, 96.5%). Two patients experienced regional failure; the local-regional control rate was 87.2% (95%CI, 71.0%, 94.7%). Eleven patients experienced disseminated recurrence; the 3-year rate of disseminated failure was 22.1% (95% CI, 12.3%, 37.8%). The rates of disease-free and overall survival at 3 years were 48.3% (95% CI, 34.4%, 60.8%) and 55.8% (95% CI, 41.6%, 67.9%), respectively. The median overall survival was 48.1 months (95% CI, 29.6% to not reached). Protocol specified treatment-related grade 3 adverse events were reported in 7 patients (12.7%; 95% CI, 9.6%, 15.8%); grade 4 events were reported in 2 patients (3.6%; 95%CI, 2.7%, 4.5%). No grade 5 adverse events were reported. Conclusion Patients with inoperable non-small cell lung cancer who received stereotactic body radiation therapy had a survival rate of 55.8% at 3 years, high rates of local tumor control, and moderate treatment-related morbidity.

Purpose-Radiation therapy to the pelvic lymph nodes in high risk prostate cancer is required on several RTOG clinical trials. Based on a prior lymph node contouring project we have shown significant disagreement in the definition of pelvic lymph node volumes amongst GU radiation oncology specialists involved in developing and executing current RTOG trials.Methods-A consensus meeting was held on October 3, 2007, to reach agreement on pelvic lymph node volumes. Data was presented to address the lymph node drainage of the prostate. Extensive discussion ensued to develop CTV pelvic lymph node consensus. Colleen A. Lawton, MD, Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee WI 53226, clawton@mcw.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Lymph node CTVs include the vessels (artery and vein) and a 7mm radial margin being careful to "carve out" bowel, bladder, bone, and muscle. Volumes begin at the L5/S1 interspace and end at the superior aspect of the pubic bone. Consensus on DVH constraints for OARs were also attained. Results-ConsensusConclusions-Consensus on pelvic lymph node CTVs for radiation therapy to address high-risk prostate cancer was attained and is available as web-based CT images as well as a descriptive format through the RTOG. This will allow for uniformity in evaluating the benefit and risk of such treatment. The challenge is that there are significant differences of opinion regarding appropriate pelvic LN volumes to be treated in this cohort of patients. A 2007 survey of RTOG genitourinary cancer experts indicated that significant variability existed amongst a group of radiation oncologists experienced in the treatment of prostate cancer and design of prostate cancer clinical trials.(8) Given the widely adopted use of intensity modulated radiation therapy (IMRT) to treat the pelvic lymph nodes and spare organs at risk (OAR) it is imperative that a consensus be obtained to establish the appropriate nodal volumes for these patients so that the relative safety and merit of such treatment can be established. The purpose of this study was to establish such a consensus. Keywords METHODSGiven the established variability in LN treatment volumes by the RTOG GU Radiation Oncologists a consensus meeting was held on October 3, 2007 sponsored by the RTOG. All physicians/institutions involved in the original contouring project were invited to attend. (8) Data was presented (CL) to address the lymph node drainage of the prostate using prostatic lymphography, extended lymph node dissection, the sentinel lymph node conce...

No abstract

No abstract

No abstract