181 CONVERT – the challenges of opening a multi-centre radiotherapy trial in the UK

Faivre-Finn, Corinne; Falk, S.; Ashcroft, Linda; Wilson, Elena; Groom, N.; Wilkinson, Diana; Appel, William F.; Bhatnagar, Ajay; Harden, Susan; Hatton, M.; McMenemin, R.; Mohammed, N.; O’Brien, Mary; Snee, M.

doi:10.1016/s0169-5002(13)70181-8

Cited by 1 publication

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Severe esophagitis is a dose-limiting toxic event that complicates intensification of treatments in locally advanced NSCLC and LS-SCLC. 2,4 We prospectively tested a simple method to avoid exposing the entire esophagus cross section to high doses. 9 We observed no grade 3 esophagitis and grade 2 events in 24% to 28% of participants despite all participants having gross tumor adjacent to the esophagus and 96% receiving the full 70 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…T he standard treatment of locally advanced non-small cell lung cancer (NSCLC) and limited-stage (LS) small cell lung cancer (SCLC) is concurrent chemoradiation therapy (CRT). 1,2 Because of the high rates of local tumor failure with standard radiation therapy, treatment intensification has been explored. In NSCLC, dose escalation to 74 Gy is associated with severe esophagitis (Common Terminology Criteria for Adverse Events [CTCAE] grade ≥3) in 17.4% of patients.…”

mentioning

confidence: 99%

“…3 In LS-SCLC, current regimens result in severe esophagitis rates of almost 20%. 2 Severe esophagitis is a serious dose-limiting toxic event requiring hospital admission, feeding tube, or total parenteral nutrition, which may lead to treatment interruptions and poor outcomes. 4 Intensity-modulated radiation therapy (IMRT), including volumetric-modulated arc therapy, increases dose conformality and provides greater sparing of normal tissues than traditional 3-dimensional conformal radiation.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Assessment of a Contralateral Esophagus–Sparing Technique in Locally Advanced Lung Cancer Treated With High-Dose Chemoradiation

et al. 2021

View full text Add to dashboard Cite

IMPORTANCESevere acute esophagitis occurs in up to 20% of patients with locally advanced lung cancer treated with chemoradiation therapy to at least 60 Gy once daily and represents a dose-limiting toxic event associated with poor outcomes. OBJECTIVE To assess whether formalized sparing of the contralateral esophagus (CE) is associated with reduced risk of severe acute esophagitis. DESIGN, SETTING, AND PARTICIPANTSThis single-center phase 1 nonrandomized clinical trial assessing an empirical CE-sparing technique enrolled patients from July 2015 to January 2019. In total, 27 patients with locally advanced non-small cell lung carcinoma (with or without solitary brain metastasis) or limited-stage small cell lung carcinoma with gross tumor within 1 cm of the esophagus were eligible.INTERVENTIONS Intensity-modulated radiation therapy to 70 Gy at 2 Gy/fraction concurrent with standard chemotherapy with or without adjuvant durvalumab. The esophageal wall contralateral to gross tumor was contoured as an avoidance structure to guide a steep dose falloff gradient. Target coverage was prioritized over CE sparing, and 99% of internal and planning target volumes had to be covered by 70 Gy and at least 63 Gy, respectively. MAIN OUTCOMES AND MEASURESThe primary end point was the rate of at least grade 3 acute esophagitis as assessed by Common Terminology Criteria for Adverse Events, version 4. RESULTSOf 27 patients enrolled, 25 completed chemoradiation therapy. Nineteen patients had non-small cell lung carcinoma, and 6 had small cell lung carcinoma. The median age at diagnosis was 67 years (range, 51-81 years), and 15 patients (60%) were men. Thirteen patients (52%) had stage IIIA cancer, 10 (40%) had stage IIIB cancer, and 2 (8%) had stage IV cancer. The median CE maximum dose was 66 Gy (range, 44-71 Gy); the median volume of CE receiving at least 55 Gy was 1.4 cm 3 (range, 0-5.3 cm 3 ), and the median volume of CE receiving at least 45 Gy was 2.7 cm 3 (range, 0-9.2 cm 3 ). The median combined percentage of lung receiving at least 20 Gy was 25% (range, 11%-37%). The median follow-up was 33.3 months (range, 11.1-52.2 months). Among the 20 patients who had treatment breaks of 0 to 3 days and were thus evaluable for the primary end point, the rate of at least grade 3 esophagitis was 0%. Other toxic events observed among all 25 patients included 7 (28%) with grade 2 esophagitis, 3 (12%) with at least grade 2 pneumonitis (including 1 with grade 5), and 2 (8%) with at least grade 3 cardiac toxic event (including 1 with grade 5). There was no isolated local tumor failure. The 2-year progression-free survival rate was 57% (95% CI, 33%-75%), and the 2-year overall survival rate was 67% (95% CI, 45%-82%). CONCLUSIONS AND RELEVANCEThis phase 1 nonrandomized clinical trial found that the CE-sparing technique was associated with reduced risk of esophagitis among patients treated uniformly with chemoradiation therapy (to 70 Gy), with no grade 3 or higher esophagitis despite tumor within 1 cm of the esophagus. This technique may be translated...

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation