A Randomized Study of Involved-Field Irradiation Versus Elective Nodal Irradiation in Combination With Concurrent Chemotherapy for Inoperable Stage III Nonsmall Cell Lung Cancer

Yuan, Shuanghu; Sun, Xia; Li, Minghuan; Yu, Jinming; Ren, Rong; Yu, Yang; Li, Jianbin; Xiu-qing, Liu; Wang, Renben; Li, Baosheng; Kong, Li; Yin, Yong

doi:10.1097/01.coc.0000256691.27796.24

Cited by 225 publications

(105 citation statements)

References 16 publications

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“…Yuan et al (29) reported a prospectively randomised dose escalation trial in patients with inoperable stage III NSCLC who were enrolled on 3DCRT of 1.8 to 2 Gy and 68 to 74 Gy for involved-field irradiation (IFI) covering the primary tumour and involved lymph nodes, or 60 to 64 Gy covering the primary tumour and involved lymph nodes, and elective nodal irradiation (ENI). Yuan et al (29) documented a better outcome and local control, as well as lower radiation pneumonitis rates, in the dose escalated (68-74 Gy) IFI arm than the 60 Gy ENI arm.…”

Section: Significance Of Dose Escalation In Locally Advanced Nsclcmentioning

confidence: 98%

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Selek¹,

Bölükbaşı²,

Welsh³

et al. 2015

Balkan Med J

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In the evolution of radiation oncology technology, improved planning and treatment delivery advanced from two-dimensional radiotherapy (2DRT) to three-dimensional conformal radiotherapy (3DCRT) two decades ago. In the last decade, intensity-modulated radiation therapy (IMRT) emerged in addition to daily image guidance and fourdimensional (4D) image-based motion management (1). Chemoradiotherapy, which was actually established mainly with a 2DRT trial-RTOG 9410, is the current standard of care in patients with inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC) when compared to sequential protocols (2-7). Currently, aggressive chemoradiotherapy is the standard, and is well accepted in highly selected septuagenarians with inoperable stage IIIB NSCLC (8). Conventional doses (60-63 Gy) of 3DCRT were well-thought-out not enough to succeed for desired local control to avoid dismal survival. There has been a significant challenge in safely escalating the radiation dose over 60 Gy, while preserving the critical organ at risk (OAR) structures (9-12). In the last decade, IMRT has been the leading improvement, and has been considered as the key solution for safe dose escalation and delivery. Other accompanying challenges are the fight with unpredictable movement of the tumor during the respiratory phases, the need to increase the accuracy of treatment delivery during each fraction, and the necessity to clarify the heterogeneity correction in treatment planning systems. The newest technology has been improved upon in recent years by 4D image-based motion capturing and the management of treatment planning, the evolution of calculation algorithms in treatment planning systems that are capable of better estimating the dose delivery to tumors and normal structures, and image-guided radiotherapy. All of these improvements increased the daily setup accuracy. There is a requirement for radiotherapy is evident in NSCLC, with than 60% of these patients requiring radiotherapy during treatment, and more than 40% of patients who receive radiotherapy receive it during the initial treatment (13,14). Therefore, due to the growing struggle with lung cancer, the current debate, based on inclusion of all modern technology, is whether IMRT has an advantage over 3DCRT in the outcomes of local control, surChemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC). Three-dimensional radiotherapy (3DCRT) has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT). IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan.This includes calc...

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Section: Significance Of Dose Escalation In Locally Advanced Nsclcmentioning

confidence: 98%

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Selek¹,

Bölükbaşı²,

Welsh³

et al. 2015

Balkan Med J

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“…[105][106][107] With tantalizing recent data suggesting that radiotherapy parameters, such as dose and fractionation, may be of significance in altering survival, either alone or in combination with chemotherapy, dose-escalation trials have been pursued, with promising clinical results. [108][109][110][111] However, conventional dose escalation has not provided clear evidence of benefit in the recently terminated Radiation Therapy Oncology Group (RTOG) trial that evaluated 74 versus 60 Gy dosages of therapy.…”

Section: Unresectable Diseasementioning

confidence: 99%

Molecular Profiling in Non–Small Cell Lung Cancer: A Step Toward Personalized Medicine

Raparia

Villa

DeCamp

et al. 2013

Archives of Pathology &Amp; Laboratory Medicine

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Context.-Lung carcinoma is the result of sequential accumulation of genetic and epigenetic changes. Lung adenocarcinoma is a heterogeneous disease with diverse somatic mutations, and several of them include the socalled driver mutations, which may serve as ''druggable'' therapeutic targets. Thus, development of personalized approaches for the treatment of non-small cell lung carcinoma (NSCLC) mandates that pathologists make a precise histologic classification inclusive of routine molecular analysis of such tumors.Objective.-To address the molecular mechanisms underlying NSCLC and how this knowledge reflects the multidisciplinary approach in the diagnosis and management of these patients. We will also summarize the current available and investigational personalized therapies for patients with resectable early-stage, unresectable locally advanced, and metastatic NSCLC.Data Sources.-Peer-reviewed published literature and personal experience.Conclusions.-There are multiple mechanisms involved in the pathogenesis of lung cancer, which operate in parallel and involve pathways of activation and inhibition of various cellular events. Further research is essential to characterize the histologic and mutational profiles of lung carcinomas, which will ultimately translate into improved and more personalized therapeutic management of patients with lung cancer.(Arch Pathol Lab Med. 2013;137:481-491; doi: 10.5858/ arpa.2012-0287-RA) L ung cancer is the leading cause of cancer-related mortality in both men and women in the United States. It is projected that in 2012, lung cancer will account for 26% and 29% of cancer-related deaths in the female and male population, respectively.1 Historically, lung cancer has been divided into 2 major categories based on the histologic features and response to conventional therapies, and they include non-small cell lung carcinoma (NSCLC) and small cell lung carcinoma. NSCLC includes 3 cell types (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma), and these can be further divided into various subtypes or variants.2 NSCLC accounts for most (~80%) of the lung cancers, with lung adenocarcinoma being the most common subtype in the United States. Despite significant improvements in radiologic imaging, supportive care, availability of newer antineoplastic agents, and multimodality therapy, the 5-year relative survival rate for lung cancer in the United States remains dismal, that is, at only 16% in 2007 compared to 12% in 1975, thus indicating little improvement in survival rate over a period of 3 decades.

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“…In the only prospective study comparing ENI with IF-RT, Yuan et al evaluated the effects of IF-RT in their prospective randomized trial in which 193 patients were randomly assigned to IF-RT to 68 to 74Gy or ENI to 60 to 64Gy using 3D-CRT, and reported that ENF was found in only 4% of patients in the ENI arm versus 7% in the IF-RT arm within 5 years 19) . Although the irradiation dose to elective nodal regions was higher in the ENI arm than in IF-RT arm, ENF was not significant in either arm (p=0.351).…”

Section: The Evidence Of If-rt -Is Eni Needed?mentioning

confidence: 99%

Involved-Field Radiation Therapy (IF-RT) for Non-Small Cell Lung Cancer (NSCLC)

Kimura¹

2012

Modern Practices in Radiation Therapy

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A Randomized Study of Involved-Field Irradiation Versus Elective Nodal Irradiation in Combination With Concurrent Chemotherapy for Inoperable Stage III Nonsmall Cell Lung Cancer

Abstract: IFI arm achieved better overall response and local control than ENI arm, and it allowed a dose of 68 to 74 Gy to be safely administered to patients with inoperable stage III NSCLC. Outcome improvement can be expected by conformal IFI combined with chemotherapy for stage III NSCLC.

Cited by 225 publications

References 16 publications

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Molecular Profiling in Non–Small Cell Lung Cancer: A Step Toward Personalized Medicine

Involved-Field Radiation Therapy (IF-RT) for Non-Small Cell Lung Cancer (NSCLC)

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