Radiotherapy With Curative Intent in Patients With Early-stage, Medically Inoperable, Non–Small-cell Lung Cancer: A Systematic Review

Falkson, Conrad; Vella, Emily T.; Yu, Edward; El-Mallah, Medhat; Ellis, Peter; Ung, Yee C.

doi:10.1016/j.cllc.2016.10.008

Cited by 28 publications

(21 citation statements)

References 81 publications

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“…However, not all early-stage NSCLC patients are suited for surgery because of advanced age, patient refusal, or other reasons (3,4). Stereotactic body radiotherapy (SBRT) has been widely used as an effective alternative treatment for primary lung tumors, and reports excellent 3-year progression-free survival (PFS) of up to 90%, which is considerably better than past data with conventional radiotherapy (5,6).…”

Section: Introductionmentioning

confidence: 99%

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

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Abstract. The present study sought to evaluate the impact of the flattening filter-free (FFF) technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy. Its clinical safety and availability were compared with the flattening filter (FF) method. The cases of 65 patients who underwent lung volumetric modulated arc therapy-stereotactic body radiotherapy (VMAT-SBRT) using FF or FFF techniques were reviewed. A total of 55 Gy/4 fractions (fr) was prescribed for peripheral lesions or 56 Gy/7 fr for central lesions. The total monitor units (MU), treatment time, dose to tumors, dose to organs at risk, tumor control (local control rate, overall survival, progression-free survival) and adverse events between cases treated with FF and cases treated with the FFF technique were compared. A total of 35 patients were treated with conventional FF techniques prior to November 2014 and 30 patients were treated with FFF techniques after this date. It was revealed that the beam-on time was significantly shortened by the FFF technique (P<0.01). Other factors were similar for FFF and FF plans in respect to conformity (P=0.95), homogeneity (P=0.20) and other dosimetric values, including total MU and planning target volume/internal target volume coverage. The median follow-up period was 18 months (range, 2-35). One-year local control rates were 97.1 and 90.0% in the FF group and FFF groups, respectively (P=0.33). Grade 3 pneumonitis was observed in 5.8% of FF patients and 3.4% of FFF patients (P=1.00). No other adverse events ≥grade 3 were observed. The results of the study suggest that VMAT-SBRT using the FFF technique shortens the treatment time for lung SBRT while maintaining a high local control rate with low toxicity.

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Section: Introductionmentioning

confidence: 99%

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

et al. 2018

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“…El metanalisis de Wang revisó 11 540 pacientes de nueve estudios aleatorizados y siete estudios de cohortes, comparando resección sublobar, radioterapia (estándar [RTE] o SBRT) sin encontrar diferencias en recurrencia local. 52 La revisión de Falkson que incluyó cuatro revisiones sistemáticas y 52 estudios observacionales retrospectivos analizó el efecto de diferentes técnicas de radioterapia: 53 SBRT, RTE hiperfraccionada, convencional o protones. La SBRT por su efectividad biológica mayor (BED> 100Gy) obtiene mejores resultados en términos de control local y sobrevida.…”

Section: Pregunta Clínica 7 ¿El Tratamiento Con Sbrt Es Seguro Y Efiunclassified

Guía de Práctica Clínica Nacional para el manejo del Cáncer de Pulmón de células no pequeñas en estadios tempranos, localmente avanzados y metastásicos

Barrón-Barrón¹,

Alba²,

Alatorre-Alexander³

et al. 2019

Salud Publica Mex

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Resumen. El cáncer de pulmón es una de las principales causas de mortalidad alrededor del mundo. Su historia natural, con la manifestación de síntomas en etapas avanzadas y el retraso en su diagnóstico hacen que una gran proporción de pacientes se diagnostiquen en estadios tardíos de la enfermedad, lo que hace muy complicado el tratamiento exitoso de la misma. De esto deriva la importancia de dar origen a recomendaciones basadas en evidencia para soportar la toma de decisiones clínicas por parte de los grupos interdisicplinarios que se encargan del manejo de este padecimiento. Objetivos. Esta Guía de Práctica Clínica (GPC) contiene recomendaciones clínicas desarrolladas de forma sistematizada para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas públicas involucrados en el manejo de pacientes con cáncer de pulmón en estadios tempranos, localmente avanzados y metastásicos. Material y métodos. Este documento se desarrolló por parte de la Sociedad Mexicana de Oncología en colaboración con el Centro Nacional de Excelencia Tecnológica de México (Cenetec) a través de la dirección de integración de Guías de Práctica Clínica en cumplimiento a estándares internacionales como los descritos por el Instituto de Medicina de EUA (IOM, por sus siglas en inglés), el Instituto de Excelencia Clínica de Gran Bretaña (NICE, por sus siglas en inglés), la Red Colegiada para el Desarrollo de Guías de Escocia (SIGN, por sus siglas en inglés), la Red Internacional de Guías (G-I-N, por sus siglas en inglés); entre otros. Se integró en representación de la Sociedad Mexicana de Oncología un Grupo de Desarrollo de la Guía (GDG) de manera interdisciplinaria, considerando oncólogos médicos, cirujanos oncólogos, cirujanos de tórax, radio-oncólogos, y metodólogos con experiencia en revisiones sistemáticas de la literatura y guías de práctica clínica. Resultados. Se consensuaron 62 preguntas cllínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente la misma, antes de ser incorporada en el cuerpo de evidencia de la Guía. El GDG acordó mediante la técnica de consenso formal de expertos Panel Delphi la redacción final de las recomendaciones clínicas. Conclusión. Esta Guía de Práctica Clínica pretende proveer recomendaciones clínicas para el manejo de los distintos estadios de la enfermedad y que asistan en el proceso de toma de decisiones compartida. El GDG espera que esta guía contribuya a mejorar la calidad de la atención clínica en las pacientes con cáncer de pulmón de células no pequeñas.

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“…The present report integrates available evidence from observational studies found in the systematic review 7 medically inoperable or who refuse surgery. The intended users of the guideline are radiation planning and treatment providers, oncologists, thoracic surgeons, respirologists, diagnostic assessment groups, and other health care providers involved with lung cancer.…”

Section: Practice Guidelinementioning

confidence: 99%

“…Further details of the methods and findings of the systematic review that informed these recommendations have been published elsewhere 7 . Briefly, medline, embase, and the Cochrane Library were searched for studies comparing stereotactic radiation treatment with curative intent, observation, and other types of rt for early-stage medically inoperable nsclc.…”

Section: Methodsmentioning

confidence: 99%

Guideline for Radiotherapy with Curative Intent in Patients with Early-Stage Medically Inoperable Non-Small-Cell Lung Cancer

Falkson

Vella

et al. 2017

Current Oncology

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Objectives For this guideline, we investigated the effectiveness of radiotherapy with curative intent in medically inoperable patients with early-stage non-small-cell lung cancer (nsclc). MethodsThe guideline was developed by Cancer Care Ontario's Program in Evidence-Based Care and by the Lung Cancer Disease Site Group through a systematic review of mainly retrospective studies, expert consensus, and formal internal and external reviews. Recommendations■ Stereotactic body radiation therapy (sbrt) with curative intent is an option that should be considered for patients with early-stage, node-negative, medically inoperable nsclc. Qualifying Statements ■Because of the high dose per fraction, the planning process and treatment delivery for sbrt require the use of advanced technology to maintain an appropriate level of safety. Consistent patient positioning and 4-dimensional analysis of tumour and critical structure motion during simulation and treatment delivery are essential. ■Preliminary results for proton-beam therapy have been promising, but the technique requires further clinical study.■ Recommended fractionation schemes for sbrt should result in a biologically effective dose of 100 or greater by the linear quadric model, choosing an α/β value of 10 [bed 10(LQ) ≥ 100]. Qualifying Statements ■Because of the increased risk of treatment-related adverse events associated with centrally located tumours, consideration of tumour size and proximity to critical central structures is required when determining the dose and fractionation. ■Examples of dose-fractionation schemes used in the included studies have been provided. ■Based on the current evidence and the opinion of the authors, radiation doses at bed 10(LQ) greater than 146 might significantly increase toxicity and should be avoided. ■Determination of the radiation bed by the linear quadratic model has limitations for the extreme hypofractionated schemes used in sbrt.

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Radiotherapy With Curative Intent in Patients With Early-stage, Medically Inoperable, Non–Small-cell Lung Cancer: A Systematic Review

Cited by 28 publications

References 81 publications

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

Flattening filter-free technique in volumetric modulated arc therapy for lung stereotactic body radiotherapy: A clinical comparison with the flattening filter technique

Guía de Práctica Clínica Nacional para el manejo del Cáncer de Pulmón de células no pequeñas en estadios tempranos, localmente avanzados y metastásicos

Guideline for Radiotherapy with Curative Intent in Patients with Early-Stage Medically Inoperable Non-Small-Cell Lung Cancer

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