Dose and fractionation schedules in radiotherapy for non-small cell lung cancer

Abstract

In the field of radiotherapy (RT), the issues of total dose, fractionation, and overall treatment time for non-small cell lung cancer (NSCLC) have been extensively investigated. There is some evidence to suggest that higher treatment intensity of RT, when given alone or sequentially with chemotherapy (CHT), is associated with improved survival. However, there is no evidence that the outcome is improved by RT at a higher dose and/or higher intensity when it is used concurrently with CHT. Moreover, some reports on the combination of full dose CHT with a higher biological dose of RT warn of the significant risk posed by such intensification. Stereotactic body radiotherapy (SBRT) provides a high rate of local control in the management of early-stage NSCLC through the use of high ablative doses. However, in centrally located tumors the use of SBRT may carry a risk of serious damage to the great vessels, bronchi, and esophagus, owing to the high ablative doses needed for optimal tumor control. There is a similar problem with moderate hypofractionation in radical RT for locally advanced NSCLC, and more evidence needs to be gathered regarding the safety of such schedules, especially when used in combination with CHT. In this article, we review the current evidence and questions related to RT dose/fractionation in NSCLC.

Low versus high dose of postoperative radiotherapy for locally advanced esophageal squamous cell carcinoma: a propensity score‐matched analysis

“…The radiotherapy dose is usually a critical factor for the prognosis of patients treated with radiotherapy. Stereotactic body radiotherapy with a high biologically equivalent dose can achieve efficacy comparable with surgery, particularly in patients with early‐stage non‐small cell lung cancer 14,15 . However, few studies have investigated the impact of the postoperative radiotherapy dose on ESCC prognosis.…”

Biological Response of Human Cancer Cells to Ionizing Radiation in Combination with Gold Nanoparticles

“…Even though cell lines are a unique tool to study the mechanisms behind the occurring radiosensitization due to AuNPs, it is crucial to discuss briefly how they might be utilized in either animal or human tumors. Depending on the type and stage of cancer, radiotherapy is usually applied in fractions giving in total 20–80 Gy [ 110 , 111 ]. One of the main side effects of cancer radiotherapy is that it cannot usually spare completely the nearby normal tissue.…”

Management of chemotherapy dose intensity for metastatic colorectal cancer (Review)

“…The chemotherapy dose requires adjustment according to each patient and must not always follow the dosage recommended by the guidelines. The dose and frequency are adjusted mostly in radiotherapy research or in the treatment of certain rare malignant diseases (64). The pharmacokinetic study of drugs should not only be applied under specific experimental conditions since there are various complex parameters to be taken into consideration (65).…”