Heterogeneous FDG-guided dose-escalation for locally advanced NSCLC (the NARLAL2 trial): Design and early dosimetric results of a randomized, multi-centre phase-III study

Møller, D.S.; Nielsen, Troels Halfeld; Brink, Carsten; Hoffmann, Lone; Lutz, Christina; Lund, M.D.; Hansen, Olfred; Schytte, Tine; Khalil, Azza Ahmed; Knap, M.M.; Nyhus, Christa Haugaard; Ottosson, W.; Sibolt, Patrik; Borissova, Svetlana; Josipović, Mirjana; Persson, Gitte Fredberg; Appelt, Ane L

doi:10.1016/j.radonc.2017.06.022

Cited by 25 publications

(19 citation statements)

References 31 publications

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“…Even though several attempts of dose escalations were not successful due to increased toxicity, there is a potential in equitoxic image-guided dose escalation [4,5]. FDG-PET dose escalation is currently being tested in a number of precision radiation oncology trials [22,26]. However, this approach will also require measures to identify the patients who are at greater risk of radiation-induced toxicity.…”

Section: Discussionmentioning

confidence: 99%

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Farr

West

Yeghiaian-Alvandi

et al. 2019

Physics and Imaging in Radiation Oncology

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Background and purpose: Functional avoidance radiation therapy (RT) aims at sparing functional lung regions. The purpose of this simulation study was to evaluate the feasibility of functional lung avoidance methodology in RT of lung cancer and to characterize the achievable dosimetry of single photon emission computed tomography (SPECT) guided treatment planning. Materials and methods: Fifteen consecutive lung cancer patients were included and planned for definitive RT of 60-66 Gy in 2-Gy fractions. Two plans were optimized: a standard CT-plan, and functional SPECT-plan. The objective was to reduce dose to the highly functional lung subvolumes without compromising tumour coverage, and respecting dose to other organs at risk. For each patient a 3D-conformal, intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy plans were created for standard and functional avoidance. Standard versus functional dose-volume parameters for functional lung (FL) subvolumes, organs at risk and tumour coverage were compared. Results: The largest dose reduction was achieved with IMRT plans. Functional plans resulted in dose reduction from 9.0 Gy to 6.7 Gy (mean reduction of 2.3 Gy or 26%) to the highest functional subvolume FL80% (95%CI 1.1; 3.5). Dose to FL40% was reduced from 13.3 Gy to 11.6 Gy with functional planning. Dose reduction to FL40% was 1.7 Gy (95%CI 0.9; 2.6). Functional volume of lung receiving over 20 Gy improved by 5% (standard 22%, functional 17%). Dose to organs at risk and tumour coverage were not significantly different between plans. Conclusions: SPECT/CT-guided planning resulted in improved dose-volumetric outcomes for functional lung. This methodology may lead to potential reduction in radiation-induced lung toxicity.

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Section: Discussionmentioning

confidence: 99%

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Farr

West

Yeghiaian-Alvandi

et al. 2019

Physics and Imaging in Radiation Oncology

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“…In Denmark, a national storage facility of DICOM data has been established [8]. It is currently used by a number of clinical trials [9][10][11][12][13] and contains radiotherapy information from more than 5000 patients. This study focuses on the largest clinical trial in the data bank; a clinical randomized trial on hypo-fractionation from the Danish Breast Cancer Group (DBCG) with 1883 patients, of which 1550 patients were Danish.…”

Section: Introductionmentioning

confidence: 99%

DBCG hypo trial validation of radiotherapy parameters from a national data bank versus manual reporting

et al. 2017

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“…11 [ 18 F] FDG-PET/CT has been shown to change the extent of disease identification and delineation in 15%-20% of cancer patients compared to CT alone in a retrospective analysis. 12 Consequently, [ 18 F]FDG-PET/CT-guided RT planning has seen increasing use in head and neck cancer, 13 lung cancer, [14][15][16] breast cancer, 17,18 esophageal cancer, 19 non-Hodgkin's lymphoma, 20 gynecologic cancer, 21 rectal cancer, 22 and anal cancer. 23 The advantages of combined anatomic and functional imaging have led to widespread adoption of PET/CT in RT clinics.…”

Section: Introductionmentioning

confidence: 99%

Task Group 174 Report: Utilization of [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography ([¹⁸F]FDG‐PET) in Radiation Therapy

et al. 2019

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The use of positron emission tomography (PET) in radiation therapy (RT) is rapidly increasing in the areas of staging, segmentation, treatment planning, and response assessment. The most common radiotracer is 18F‐fluorodeoxyglucose ([18F]FDG), a glucose analog with demonstrated efficacy in cancer diagnosis and staging. However, diagnosis and RT planning are different endeavors with unique requirements, and very little literature is available for guiding physicists and clinicians in the utilization of [18F]FDG‐PET in RT. The two goals of this report are to educate and provide recommendations. The report provides background and education on current PET imaging systems, PET tracers, intensity quantification, and current utilization in RT (staging, segmentation, image registration, treatment planning, and therapy response assessment). Recommendations are provided on acceptance testing, annual and monthly quality assurance, scanning protocols to ensure consistency between interpatient scans and intrapatient longitudinal scans, reporting of patient and scan parameters in literature, requirements for incorporation of [18F]FDG‐PET in treatment planning systems, and image registration. The recommendations provided here are minimum requirements and are not meant to cover all aspects of the use of [18F]FDG‐PET for RT.

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Heterogeneous FDG-guided dose-escalation for locally advanced NSCLC (the NARLAL2 trial): Design and early dosimetric results of a randomized, multi-centre phase-III study

Abstract: FDG-driven inhomogeneous dose-escalation achieves large increment in tumour and lymph node dose, while delivering similar doses to normal tissue as homogenous standard plans.

Cited by 25 publications

References 31 publications

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

DBCG hypo trial validation of radiotherapy parameters from a national data bank versus manual reporting

Task Group 174 Report: Utilization of [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography ([¹⁸F]FDG‐PET) in Radiation Therapy

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Heterogeneous FDG-guided dose-escalation for locally advanced NSCLC (the NARLAL2 trial): Design and early dosimetric results of a randomized, multi-centre phase-III study

Abstract: FDG-driven inhomogeneous dose-escalation achieves large increment in tumour and lymph node dose, while delivering similar doses to normal tissue as homogenous standard plans.

Cited by 25 publications

References 31 publications

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

Functional perfusion image guided radiation treatment planning for locally advanced lung cancer

DBCG hypo trial validation of radiotherapy parameters from a national data bank versus manual reporting

Task Group 174 Report: Utilization of [18F]Fluorodeoxyglucose Positron Emission Tomography ([18F]FDG‐PET) in Radiation Therapy

Contact Info

Product

Resources

About

Task Group 174 Report: Utilization of [¹⁸F]Fluorodeoxyglucose Positron Emission Tomography ([¹⁸F]FDG‐PET) in Radiation Therapy