Can elective nodal irradiation be omitted in stage III non-small-cell lung cancer? analysis of recurrences in a phase II study of induction chemotherapy and involved-field radiotherapy

Senan, Suresh; Burgers, Sjaak A.; Samson, Michael; Klaveren, Rob J. van; Oei, S.S.; Koste, John van Soernsen de; Voet, P.; Lagerwaard, Frank J.; Haarst, Jan Maarten van; Aerts, Joachim; Meerbeeck, Jan P. van

doi:10.1016/s0360-3016(02)03028-6

Cited by 98 publications

(44 citation statements)

References 33 publications

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“…The utility of elective nodal irradiation remains controversial because of a low rate (around 6%) of isolated nodal failures beyond the RT field. 12 Therefore, an irradiation limited to the involved lymph node stations is usually recommended. 13 However, the clinical experience validating this approach were obtained with older techniques delivering a considerable "incidental dose" to the uninvolved mediastinal lymph nodes.…”

Section: Discussionmentioning

confidence: 99%

Simultaneously modulated accelerated radiation therapy reduces severe oesophageal toxicity in concomitant chemoradiotherapy of locally advanced non-small-cell lung cancer

Chajon¹,

Bellec²,

Castelli³

et al. 2015

BJR

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Objective: The aim of this study was to evaluate the potential of simultaneously modulated accelerated radiation therapy (SMART) to reduce the incidence of severe acute oesophagitis in the treatment of unresectable locally advanced non-small-cell lung cancer (LANSCLC). Methods: 21 patients were treated with SMART and concomitant platinum-based chemotherapy. The prescribed doses were limited to 54 Gy at 1.8 Gy per day to the zones of presumed microscopic extent while simultaneously maintaining doses of 66 Gy at 2.2 Gy per day to the macroscopic disease. The whole treatment was delivered over 30 fractions and 6 weeks. . With a median follow-up of 18 months (6-33 months), the 1-year local control rate was 70% and the disease-free survival rate was 47%. Conclusion: SMART reduces the incidence of severe oesophagitis and improves the whole dosimetric predictors of toxicity for the lung, heart and spine. Advances in knowledge: Our study shows that SMART optimizes the therapeutic ratio in the treatment of LANSCLC, opening a window for dose intensification. INTRODUCTIONConcurrent chemoradiotherapy is the standard of care for the treatment of unresectable locally advanced non-smallcell lung cancer (LANSCLC). 1 Acute oesophageal toxicity (AET) is the main acute limiting toxicity related to this approach, and is responsible for weight loss, insertion of tube feeding, hospital admissions and treatment discontinuation. A recent meta-analysis showed that hyperfractionated or accelerated radiotherapy (RT) schedules improve survival rates;3 however, when chemotherapy is associated concomitantly with these schedules, the incidence of severe oesophagitis of around 22% remains a subject of concern. 4 In the RT planning process, the delineation of target volumes to be treated is an obligatory step. The gross demonstrable disease is named gross tumour volume (GTV) and encompasses the primary tumour and the metastatic lymph nodes identified by the endoscopic and radiologic examinations. The microscopic tumour spread, outside of what can be visualized in a particular imaging modality, is named clinical target volume (CTV) and corresponds to a volume of tissue surrounding the primary tumour and the lymph node stations considered at risk of failure. 5 In the standard technique of RT, a homogeneous dose of 66 Gy at 2 or 1.8 Gy per fraction and per day is delivered to the GTV and CTV. In contrast to this standard technique, simultaneously modulated accelerated radiation therapy (SMART) is a technique delivering 66 Gy by using high fraction doses (2.2 Gy per fraction) to the GTV simultaneously with standard fraction doses (1.8 Gy per fraction) to regions of presumed microscopic extent (CTV), devised in such a manner that the biologically effective GTV dose is equivalent to 70 Gy delivered by conventional (2 Gy per fraction) fractionated RT. This regimen is delivered over 6 weeks, representing a moderate acceleration over a standard course. As proved in head and neck cancer, this technique lead to a moderate GTV dose acceleration without inc...

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Section: Discussionmentioning

confidence: 99%

Simultaneously modulated accelerated radiation therapy reduces severe oesophageal toxicity in concomitant chemoradiotherapy of locally advanced non-small-cell lung cancer

Chajon¹,

Bellec²,

Castelli³

et al. 2015

BJR

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“…The argument against the use of ENI may be summarized as follows 6,7) . 1) Failure is uncommon in nodal regions that are neither clinically involved nor specially targeted from many reports [8][9][10][11][12] .…”

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

confidence: 99%

“…In a phase I-II dose escalation study using IF-RT (RTOG 9311), the elective nodal failure rate was < 10% at last follow-up of 177 eligible patients 9) . Senan et al reported 50 patients with unresectable stage IIIA or IIIB NSCLC were treated with sequential chemotherapy and IF-RT, and omitting elective mediastinal irradiation did not result in isolated nodal failure 11) . Yu et al treated 80 patients 70 years or more with early stage (I / II) with IF-RT using intensity modulated radiation therapy (IMRT).…”

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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“…Current research with three-dimensional radiotherapy techniques explores dose escalation beyond 100 Gy with smaller target volumes. Previous dogma ordered that uninvolved lymph node stations be part of all target volumes, but some current research directs radiation only to clearly involved tumor and nodal stations [23]. These research efforts attempt to control visible disease with higher doses and minimize normal tissue toxicities by excluding them from high-dose target volumes.…”

Section: Radiotherapy Schedulesmentioning

confidence: 99%

Docetaxel-Based Combined-Modality Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer

Scagliotti

Turrisi

2003

The Oncologist

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The cytotoxic agent docetaxel not only has proven activity in non-small cell lung cancer-when used alone or in combination-but is also a potent radiosensitizer, and improved treatments are needed in all stages of this disease. In patients with locoregionally advanced (stage III) disease, docetaxel has shown efficacy with manageable toxicities when used alone or in combination with a platinum compound in a sequential manner before localized radical radiotherapy/surgery. Presently, therapeutic gains appear to be maximized by the use of concurrent chemotherapy and irradiation. This review focuses on research with combinations of docetaxel with either cisplatin or carboplatin and radiotherapy. Overall response and survival rates to date provide data worth pursuing.

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Can elective nodal irradiation be omitted in stage III non-small-cell lung cancer? analysis of recurrences in a phase II study of induction chemotherapy and involved-field radiotherapy

Cited by 98 publications

References 33 publications

Simultaneously modulated accelerated radiation therapy reduces severe oesophageal toxicity in concomitant chemoradiotherapy of locally advanced non-small-cell lung cancer

Simultaneously modulated accelerated radiation therapy reduces severe oesophageal toxicity in concomitant chemoradiotherapy of locally advanced non-small-cell lung cancer

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

Docetaxel-Based Combined-Modality Chemoradiotherapy for Locally Advanced Non-Small Cell Lung Cancer

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