Results of a Phase I trial of concurrent chemotherapy and escalating doses of radiation for unresectable non–small-cell lung cancer

Schild, Steven E.; McGinnis, William L.; Graham, David L.; Hillman, Shauna; Fitch, Tom R.; Northfelt, Donald W.; Garces, Yolanda I.; Shahidi, Homayoon; Tschetter, Loren K.; Schaefer, Paul; Adjei, Alex A.; Jett, James R.

doi:10.1016/j.ijrobp.2006.02.046

Cited by 112 publications

(53 citation statements)

References 20 publications

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“…Although several prospective phase I/II cooperative group studies suggested encouraging OS results with 74-Gy TRT, outcomes may have been biased by the selection of a relatively favorable group of patients, given that these studies were among the first trials to routinely include FDG-PET imaging for staging evaluation [62][63][64]. In addition, some trials had quite restrictive dose constraints, particularly regarding the allowed exposure of the uninvolved lung volume of 20 Gy (e.g., V20), which could have led to enrolling patients with relatively limited tumor burdens.…”

Section: Trt Considerationsmentioning

confidence: 99%

Novel Approaches of Chemoradiotherapy in Unresectable Stage IIIA and Stage IIIB Non-Small Cell Lung Cancer

Stinchcombe

2012

The Oncologist

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After completing this course, the reader will be able to:1. Describe the current status of phase II trials with novel agents in order to distinguish the role of phase III trials in determining the role of novel agents.2. Describe target therapy in stage III non-small cell lung cancer and discuss the status of personalized medicine in stage III disease.3. State the current standard for thoracic radiation therapy and the current status of hypofractionated, adaptive radiotherapy and proton therapy and evaluate the recent radiation therapy oncology group (RTOG) 0617 trial.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACT

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Section: Trt Considerationsmentioning

confidence: 99%

Novel Approaches of Chemoradiotherapy in Unresectable Stage IIIA and Stage IIIB Non-Small Cell Lung Cancer

Stinchcombe

2012

The Oncologist

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“…The results of this study encouraged performance of further Phase II studies of concurrent chemoradiotherapy at a dose of 74 Gy. The results of these studies were also favorable with the median survival of 18-37 months and >grade 3 esophagitis and pulmonary toxicity in only 11-17% and 0-30% of the patients, respectively [38][39][40][41][42][43].…”

Section: Clinical Results Of Pbt For Advanced Nsclcmentioning

confidence: 93%

The use of proton-beam therapy in the treatment of non-small-cell lung cancer

Oshiro¹,

Sakurai

2013

Expert Review of Medical Devices

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“…In order to improve the local regional control rates, many centers initiated dose escalation trials in stage III NSCLC patients to observe the feasibility and safety constraints of concurrent chemoradiotherapy with higher doses. Most concluded that 74 Gy was a tolerable dose in the well-controlled setups of 3DCRT (24)(25)(26). From a study including 106 NSCLC patients at the University of Michigan, Kong et al (27) reasoned that each 1 Gy increment improved the five-year local control rate by 1.25% as decreasing the death risk by 3%.…”

Section: Significance Of Dose Escalation In Locally Advanced Nsclcmentioning

confidence: 99%

“…As an advancement over 2DRT, 3D-CRT has been reported to decrease toxicity in addition to allowing a dose escalation from 60 Gy to 74 Gy in concurrent chemoradiotherapy (24)(25)(26). IMRT is considered an innovation that can successfully reduce normal tissue toxicity in locally advanced NSCLC patients (32)(33)(34)(35)(36)(37)(38)(39)(40).…”

Section: Evolution In Imrtmentioning

confidence: 99%

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

Selek¹,

Bölükbaşı²,

Welsh³

et al. 2015

Balkan Med J

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In the evolution of radiation oncology technology, improved planning and treatment delivery advanced from two-dimensional radiotherapy (2DRT) to three-dimensional conformal radiotherapy (3DCRT) two decades ago. In the last decade, intensity-modulated radiation therapy (IMRT) emerged in addition to daily image guidance and fourdimensional (4D) image-based motion management (1). Chemoradiotherapy, which was actually established mainly with a 2DRT trial-RTOG 9410, is the current standard of care in patients with inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC) when compared to sequential protocols (2-7). Currently, aggressive chemoradiotherapy is the standard, and is well accepted in highly selected septuagenarians with inoperable stage IIIB NSCLC (8). Conventional doses (60-63 Gy) of 3DCRT were well-thought-out not enough to succeed for desired local control to avoid dismal survival. There has been a significant challenge in safely escalating the radiation dose over 60 Gy, while preserving the critical organ at risk (OAR) structures (9-12). In the last decade, IMRT has been the leading improvement, and has been considered as the key solution for safe dose escalation and delivery. Other accompanying challenges are the fight with unpredictable movement of the tumor during the respiratory phases, the need to increase the accuracy of treatment delivery during each fraction, and the necessity to clarify the heterogeneity correction in treatment planning systems. The newest technology has been improved upon in recent years by 4D image-based motion capturing and the management of treatment planning, the evolution of calculation algorithms in treatment planning systems that are capable of better estimating the dose delivery to tumors and normal structures, and image-guided radiotherapy. All of these improvements increased the daily setup accuracy. There is a requirement for radiotherapy is evident in NSCLC, with than 60% of these patients requiring radiotherapy during treatment, and more than 40% of patients who receive radiotherapy receive it during the initial treatment (13,14). Therefore, due to the growing struggle with lung cancer, the current debate, based on inclusion of all modern technology, is whether IMRT has an advantage over 3DCRT in the outcomes of local control, surChemoradiotherapy is the current standard of care in patients with advanced inoperable stage IIIA or IIIB non-small cell lung cancer (NSCLC). Three-dimensional radiotherapy (3DCRT) has been a trusted method for a long time and has well-known drawbacks, most of which could be improved by Intensity Modulated Radiotherapy (IMRT). IMRT is not currently the standard treatment of locally advanced NSCLC, but almost all patients could benefit to a degree in organ at risk sparing, dose coverage conformality, or dose escalation. The most critical step for a radiation oncology department is to strictly evaluate its own technical and physical capabilities to determine the ability of IMRT to deliver an optimal treatment plan.This includes calc...

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Results of a Phase I trial of concurrent chemotherapy and escalating doses of radiation for unresectable non–small-cell lung cancer

Cited by 112 publications

References 20 publications

Novel Approaches of Chemoradiotherapy in Unresectable Stage IIIA and Stage IIIB Non-Small Cell Lung Cancer

Novel Approaches of Chemoradiotherapy in Unresectable Stage IIIA and Stage IIIB Non-Small Cell Lung Cancer

The use of proton-beam therapy in the treatment of non-small-cell lung cancer

Intensity-Modulated Radiotherapy versus 3-Dimensional Conformal Radiotherapy Strategies for Locally Advanced Non-Small-Cell Lung Cancer

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