Local Radiotherapy Intensification for Locally Advanced Non–small-cell Lung Cancer – A Call to Arms

Kalman, Noah S.; Weiss, Elisabeth; Walker, Paul R.; Rosenman, Julian G.

doi:10.1016/j.cllc.2017.05.024

Cited by 15 publications

(10 citation statements)

References 75 publications

(109 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Escalating local therapy from conventional radiation using fusion with imaging, including PET-CT to select high-risk patients and using modern techniques (SBRT/lattice), allow for the intensification of treatment. We feel, as do Kalman et al, that a clinical trial incorporating this concept is highly indicated [22].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Lattice Radiotherapy in Voluminous Non-small Cell Lung Cancer

Amendola¹,

Pérez²,

Wu³

et al. 2019

Cureus

View full text Add to dashboard Cite

Objective Lattice radiotherapy (LRT) is a novel technique of delivering heterogeneous doses of radiation to voluminous tumors not amenable to surgery. Built from the conventional two-dimensional grid, LRT utilizes the power of new technology, three-dimensional radiation allowing the delivery of higher doses of radiation to small spheres, also called vertices, inside bulky tumors while limiting exposure to surrounding healthy tissue. The main goals of the study were the evaluation of tumor response and the overall safety of LRT in this cohort of patients with bulky non-small cell lung cancer. Materials and methods During a seven-year period, 10 patients with non-small cell lung cancer (NSCLC), who presented with bulky, unresectable tumors, were treated using a single fraction of LRT followed by conventionally fractionated radiation. Patients received one initial LRT fraction of 18 Gy in the vertices and 3 Gy in the periphery. After the LRT, all patients continued with conventional radiation: 25 to 29 daily fractions of 1.8 Gy to 2 Gy. Results With a median follow-up of six months (range: one to 71 months), the mean decrease in tumor volume was 42%. The overall survival of the entire group ranged from four to 86 months (mean 22, median 16). There was no mortality related to LRT. No significant acute or chronic toxicity was noted. Conclusion In this small cohort, LRT appears to be a safe and effective modality to treat bulky NSCLC. Further research is needed to establish its efficacy in the management of voluminous NSCLC.

show abstract

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Lattice Radiotherapy in Voluminous Non-small Cell Lung Cancer

Amendola¹,

Pérez²,

Wu³

et al. 2019

Cureus

View full text Add to dashboard Cite

show abstract

“…The experience acquired in stage I NSCLC -with excellent results-has aroused the interest of using this treatment in other stages of this illness 32 . In fact, SBRT for NSCLC is a very dynamic field and a call upon the thoracic oncology community is being made encouraging the design and development of new studies 33 .…”

Section: Stereotactic Body Radiation Therapymentioning

confidence: 99%

How to integrate stereotactic body radiation therapy and hypofractionation in the management of stage III lung cancer in the age of immunotherapy

Rico

Andueza

Martínez

et al. 2020

An Sist Sanit Navar

View full text Add to dashboard Cite

show abstract

“…A multi-institutional trial has been proposed that would use a SBRT boost to metabolically active residual disease seen on PET-CT 2-4 weeks after chemoradiation treatment completion (47). Patients with a complete response would be observed.…”

Section: Adapted Therapymentioning

confidence: 99%

Optimizing radiation dose and fractionation for the definitive treatment of locally advanced non-small cell lung cancer

Roach¹,

Bradley²,

Robinson³

2018

J. Thorac. Dis.

View full text Add to dashboard Cite

Radiation therapy is the foundation for treatment of locally advanced non-small cell lung cancer (NSCLC), a disease that is often inoperable and has limited long term survival. Local control of disease is strongly linked to patient survival and continues to be problematic despite continued attempts at changing the dose and fractionation of radiation delivered. Technological advancements such as 4-dimensional computed tomography (CT) based planning, positron emission tomography (PET) based target delineation, and daily image guidance have allowed for ever more accurate and conformal treatments. A limit to dose escalation with conventional fractions of 2 Gy once per day appears to have been reached at 60 Gy in the randomized trial Radiation Therapy Oncology Group (RTOG) 0617. Higher doses were surprisingly associated with worse overall survival. Approaches other than conventional dose escalation have been explored to better control disease including accelerating treatment to limit tumor repopulation both with hyperfractionation and its multiple small (<2 Gy) fractions each day and with hypofractionation and its single larger (>2 Gy) fraction each day. These accelerated regimens are increasingly being used with concurrent chemotherapy, and multiple institutions have reported it as tolerable. Tailoring treatment to individual patient disease and normal anatomic characteristics has been explored with isotoxic dose escalation up to the tolerance of organs at risk, with both hyperfractionation and hypofractionation. Metabolic imaging during and after treatment is increasingly being used to boost doses to residual disease. Boost doses have included moderate hypofractionation of 2-4 Gy, and more recently extreme hypofractionation with stereotactic body radiation therapy (SBRT). In spite of all these changes in dose and fractionation, lung and cardiovascular toxicity remain obstacles that limit disease control and patient survival.

show abstract

Local Radiotherapy Intensification for Locally Advanced Non–small-cell Lung Cancer – A Call to Arms

Cited by 15 publications

References 75 publications

Safety and Efficacy of Lattice Radiotherapy in Voluminous Non-small Cell Lung Cancer

Safety and Efficacy of Lattice Radiotherapy in Voluminous Non-small Cell Lung Cancer

How to integrate stereotactic body radiation therapy and hypofractionation in the management of stage III lung cancer in the age of immunotherapy

Optimizing radiation dose and fractionation for the definitive treatment of locally advanced non-small cell lung cancer

Contact Info

Product

Resources

About