Target splitting in radiation therapy for lung cancer: further developments and exemplary treatment plans

Wurstbauer, Karl; Deutschmann, H.; Kopp, Peter; Merz, Florian; Schöller, Helmut; Sedlmayer, Felix

doi:10.1186/1748-717x-4-30

Cited by 8 publications

(16 citation statements)

References 20 publications

(31 reference statements)

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“…Developing conformal, normal-tissue-sparing techniques in the treatment of lung cancer, doses > 80 Gy were applied, first conventionally fractionated and subsequently with accelerated, twice daily fractionation [8,[23][24][25][26][27]. The dose to the esophagus is mostly determined by the dose to mediastinal lymph node regions.…”

Section: Introductionmentioning

confidence: 99%

Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

Wurstbauer¹,

Merz²,

Sedlmayer

2009

Strahlenther Onkol

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Section: Introductionmentioning

confidence: 99%

Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

Wurstbauer¹,

Merz²,

Sedlmayer

2009

Strahlenther Onkol

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“…In the majority of the patients, the target-splitting technique was used [1,24,26,29,32], as described in detail previousgionäre 2-Jahres-Tumorkontrollrate liegt bei 49%. Ein Patient verstarb infolge einer Pneumonitis, ansonsten war die Toxizität gemessen an den EORTC/RTOG-Scoring-Kriterien moderat: Pneumonitis Grad 2 (n = 7), Grad 3 (n = 3); Ösophagus Grad 1 (n = 11); Herz Grad 3 (n = 1, Perikarditis; Tabelle 3).…”

Section: Radiotherapyunclassified

“…Schlüsselwörter: Nichtkleinzelliges Bronchialkarzinom · Strahlentherapie · Konformale Radiotherapie · "Target splitting" · Dosiseskalation ly [9,29,32]. Briefly, in an individually chosen transverse plane, the target is split into a cranial and a caudal volume, enabling the design of completely independent beam arrangements for either part.…”

Section: Radiotherapymentioning

confidence: 99%

“…In our opinion, the feasibility of higher doses for all tumor stages with acceptable morbidity is mainly derived from two facts: first, different dose gradients for primary lesions, involved and elective nodes, and second, the technical developments in treatment planning and dose delivery, as reflected by the use of slow planning CTs and the target-splitting technique. Both items have a high potential to spare normal tissues, discussed in detail in previous reports [20,29,31,32].…”

Section: Radiation Dose Escalationmentioning

confidence: 99%

“…Safe application of high-dose treatments demands sophisticated technical solutions. The conformal target-splitting technique was implemented in 1995, thus enabling dose escalations for nonresected NSCLC patients, considering dose constraints as described below [29,32]. The vast majority was treated with doses > 80 Gy.…”

Section: Introductionmentioning

confidence: 99%

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Non-Small Cell Lung Cancer in Stages I–IIIB

et al. 2010

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Sequential, conventionally fractionated high-dose radiotherapy by conformal target splitting is well tolerated. The results for survival and locoregional tumor control seem to at least equalize the outcome of simultaneous chemoradiation approaches, which, at present, are considered "state of the art" for patients with nonresected NSCLC. A higher potential of radiation therapy might be reached by accelerated fractionation regimens.

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DART-bid for loco-regionally advanced NSCLC

et al. 2017

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BackgroundTo report acute and late toxicity with long-term follow-up, and to describe our experiences with pulmonary dose constraints.MethodsBetween 2002 and 2009, 150 patients with 155 histologically/cytologically proven non-small cell lung cancer (NSCLC; tumor stages II, IIIA, IIIB in 6, 55 and 39%, respectively) received the following median doses: primary tumors 79.2 Gy (range 72.0–90.0 Gy), lymph node metastases 59.4 Gy (54.0–73.8 Gy), nodes electively 45 Gy; with fractional doses of 1.8 Gy twice daily (bid). In all, 86% of patients received 2 cycles of chemotherapy previously.ResultsFive treatment-related deaths occurred: pneumonitis, n = 1; progressive pulmonary fibrosis in patients with pre-existing pulmonary fibrosis, n = 2; haemorrhage, n = 2. In all, 8% of patients experienced grade 3 and 1.3% grade 4 pneumonitis; 11% showed late fibrotic alterations grade 2 in lung parenchyma. Clinically relevant acute esophagitis (grade 2 and 3) was seen in 33.3% of patients, 2 patients developed late esophageal stenosis (G3). Patients with upper lobe, middle lobe and central lower lobe tumours (n = 130) were treated with V20 (total lung) up to 50% and patients with peripheral lower lobe tumours (n = 14, basal lateral tumours excluded) up to 42%, without observing acute or late pulmonary toxicity >grade 3. Only patients with basal lateral lower lobe tumours (n = 5) experienced grade 4/5 pulmonary toxicity; V20 for this latter group ranged between 30 and 53%. The mean lung dose was below the QUANTEC recommendation of 20–23 Gy in all patients. The median follow-up time of all patients is 26.3 months (range 2.9–149.4) and of patients alive 80.2 months (range 63.9–149.4.). The median overall survival time of all patients is 26.3 months; the 2-, 5- and 8‑year survival rates of 54, 21 and 15%, respectively. The local tumour control rate at 2 and 5 years is 70 and 64%, the regional control rate 90 and 88%, respectively.Discussion and conclusionGrade 4 or 5 toxicity occurred in 7/150 patients (4.7%), which can be partially avoided in the future (e.g. by excluding patients with pre-existing pulmonary fibrosis). Tolerance and oncologic outcome compare favourably to concomitant chemoradiation also in long-term follow-up.

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Target splitting in radiation therapy for lung cancer: further developments and exemplary treatment plans

Abstract: Background: Reporting further developments evolved since the first report about this conformal technique.

Cited by 8 publications

References 20 publications

Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

Amphotericin B Lozengers: Prophylaxis for Esophagitis in Thoracic Radiotherapy

Non-Small Cell Lung Cancer in Stages I–IIIB

DART-bid for loco-regionally advanced NSCLC

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