Adaptive Dose Escalation using Serial Four-dimensional Positron Emission Tomography/Computed Tomography Scans during Radiotherapy for Locally Advanced Non-small Cell Lung Cancer

Yap, Mei Ling; Sun, Alexander; Higgins, J.; Clarke, K.; Marshall, Andrea; Becker, Nathan; Le, Lisa W.; Vines, Douglass; Bezjak, Andrea; Bissonnette, Jean Pierre

doi:10.1016/j.clon.2016.08.011

Cited by 14 publications

(10 citation statements)

References 21 publications

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“…Yap et al [20] performed a planning study based on serial respiratory-gated 18 F-fluorodeoxyglucose (FDG) PET/CT scans during RT to investigate the dosimetric benefits of a PET-based adaptive dose-escalation technique at weeks 0, 2, or 4 during RT concurrent with chemotherapy. The median doses received by 95% of the planning target volume (D 95 ) at weeks 0, 2, and 4 to the FDG-avid primary tumor and PET-nodal disease were 74.4, 75.3, and 74.1 Gy and 74.3, 71.0, and 69.5 Gy, respectively.…”

Section: Strategy Reducing the Radiation-related Toxicitiesmentioning

confidence: 99%

Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

Ahn

2017

Radiat Oncol J

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Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.

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Section: Strategy Reducing the Radiation-related Toxicitiesmentioning

confidence: 99%

Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

Ahn

2017

Radiat Oncol J

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“…Also, investigations on the ability to increase the therapeutic window, typically by increasing the tumor dose, e.g. through adaptive radiotherapy approaches [6–9], usually do not assess dose variations in normal tissue.…”

Section: Introductionmentioning

confidence: 99%

Lung and Heart Dose Variability During Radiation Therapy of Non-Small Cell Lung Cancer

Jan

Guy

Reshko

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose/Objectives The risk for lung and heart toxicity is typically assessed based on dose parameters during initial treatment planning. This study investigates volume and dose variability during radiotherapy. Material/Methods In this longitudinal investigation, variations in lung and heart volumes and standard dose parameters of mean lung dose (MLD), lung V20Gy, mean heart dose (MHD), and heart V40Gy were analyzed on weekly 4D CTs of 15 lung cancer patients during conventionally fractionated radiochemotherapy. Tumor, individual lung lobes and heart were delineated on the mid-ventilation phase of weekly 4D CTs. Lung lobes and heart were contoured also on individual breathing phases of pre-, mid- and post-treatment scans. Planning dose was transferred to consecutive scans via rigid registration. Volume and dose variations were assessed relative to the initial planning scan. Results Interfraction lung volume variability relative to week 0 was twice as large as tidal volume variability (8.0% ± 5.3% vs. 4.0% ± 3.3%, p=0.003). Interfraction lung volume variation ranged between 0.8% and 17.1% for individual patient means. Lower lung lobes had larger volume variability compared to upper lobes (13.5% ± 8.1% vs. 7.0% ± 5.0%, p<0.00001). Average MLD variation was 0.5 Gy (range 0.2 Gy to 1.0 Gy for individual patient means) and average lung V20Gy variation 0.9% (range 0.2% to 1.6%). Average heart volume variation was 7.2% (range 3.4% to 12.6%). Average MHD variation was 1.2 Gy (range 0.1 Gy to 3.0 Gy) and average heart V40Gy variation 1.4% (range 0% to 4.2%). Conclusions Anatomical and positional variations during radiotherapy induce changes in radiation doses to lung and heart. Repeated lung and heart dose assessment will provide a better estimate of the actually delivered dose and will improve prediction models for normal tissue toxicity, if assessed in larger cohorts.

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“…Additionally, the prescription guidance by PET is interesting for achieving a personalized hypofraction schedule. It was feasible in the initial reports of head and neck cancer, non-small-cell lung cancer, and esophageal cancer [14][15][16][17]. Fig.…”

Section: Discussionmentioning

confidence: 99%

Where is clinical research for radiotherapy going? Cross-sectional comparison of past and contemporary phase III clinical trials

2020

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Purpose: The features of past and contemporary phase III clinical trials for radiotherapy were reviewed to activate future clinical trials and to advise on actual clinical practice. Methods and materials: The phase III clinical trials for radiotherapy were searched in the database of 'ClinicalTrials. gov' by the U.S. National Institute of Health. Using the staring date, the studies during each period of 4 years were collected for the past (from Jan 2000 to Dec 2003) and contemporary (July 2014 to June 2018) years. For the investigated subjects, the patterns of studies were classified as: Category A, the comparisons of rival radiotherapy protocols; Category B, the comparisons of multidisciplinary approaches; Category C, the investigation of supplementary agents; and Category D, the investigation of optimal partners for concurrent radiotherapy. Results: The number of studies increased, from 96 past to 158 contemporary studies. The patterns of studies were similar with the mild increase of Category A in the contemporary years (22.9% vs. 29.1%). For the study locations and the funding sources, the Chinese studies (2.1% vs. 34.2%, P < 0.001) and the affiliated institutions of researchers (37.5% vs. 72.2%, P < 0.001) markedly increased in the contemporary years from the past Western studies and nonprofit organization, respectively. The robust radiation techniques were more usual in the contemporary years (11.5% vs. 44.9%, P < 0.001). The fractionation schedule and delivery technique were the common issues in both past and contemporary years of Category A. In Category B, the indications of stereotactic radiotherapy was the rising concern, with eight ongoing studies. Except for the studies of palliative or prophylactic goals and stereotactic radiotherapy, the escape from conventional fraction size was 37.9% (36/95) in the contemporary years with the median fraction size of 2.5 Gy (range 2.05-6.6 Gy) in the comparison with 19.0% (15/79) in the past years (P = 0.006). Conclusions: To activate the clinical trials for radiotherapy, the funding sources would be diversified, including industrial support. Hypofractionated schedules using robust techniques could be preemptively considered in actual clinical practice.

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Adaptive Dose Escalation using Serial Four-dimensional Positron Emission Tomography/Computed Tomography Scans during Radiotherapy for Locally Advanced Non-small Cell Lung Cancer

Cited by 14 publications

References 21 publications

Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

Lung and Heart Dose Variability During Radiation Therapy of Non-Small Cell Lung Cancer

Where is clinical research for radiotherapy going? Cross-sectional comparison of past and contemporary phase III clinical trials

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