The acute and late toxicity results of a randomized phase II dose-escalation trial in non-small cell lung cancer (PET-boost trial)

Diessen, Judi van; Ruysscher, Dirk De; Sonke, Jan‐Jakob; Damen, E.; Sikorska, Karolina; Reymen, Bart; Elmpt, Wouter van; Westman, Gunnar; Persson, Gitte Fredberg; Dieleman, Edith; Björkestrand, Hedvig; Faivre-Finn, Corinne; Belderbos, J.

doi:10.1016/j.radonc.2018.09.019

Cited by 60 publications

(28 citation statements)

References 37 publications

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“…FDG-PET imaging is primarily used for staging purposes, as a supplement to anatomical images, but advances in the availability of PET imaging led to an increased interest in the feasibility of PET guided radiotherapy planning [8]. Several studies investigated the prognostic value of FDG-PET, and dose escalation to PET-positive areas within the tumor is one of the potential strategies for increasing effect of radiotherapy [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG–PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis

et al. 2020

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Positron emission tomography (PET) imaging with 2-deoxy-2-[18F]-fluorodeoxyglucose (FDG) was proposed as prognostic marker in radiotherapy. Various uptake metrics and cut points were used, potentially leading to inflated effect estimates. Here, we performed a meta-analysis and systematic review of the prognostic value of pretreatment FDG–PET in head and neck squamous cell carcinoma (HNSCC) and non-small cell lung cancer (NSCLC), with tests for publication bias. Hazard ratio (HR) for overall survival (OS), disease free survival (DFS), and local control was extracted or derived from the 57 studies included. Test for publication bias was performed, and the number of statistical tests and cut-point optimizations were registered. Eggers regression related to correlation of SUVmax with OS/DFS yielded p = 0.08/p = 0.02 for HNSCC and p < 0.001/p = 0.014 for NSCLC. No outcomes showed significant correlation with SUVmax, when adjusting for publication bias effect, whereas all four showed a correlation in the conventional meta-analysis. The number of statistical tests and cut points were high with no indication of improvement over time. Our analysis showed significant evidence of publication bias leading to inflated estimates of the prognostic value of SUVmax. We suggest that improved management of these complexities, including predefined statistical analysis plans, are critical for a reliable assessment of FDG–PET.

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Section: Introductionmentioning

confidence: 99%

Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG–PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis

et al. 2020

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“…Li et al reported on 20 patients treated with IMRT for inoperable stage II-III NSCLC with metastatic lymph nodes [21]. They treated their patients with a total dose of 78 Gy and 60-65 Gy for the primary and the metastatic lymph nodes, respectively, prescribed simulta- By contrast, fiercely escalated hypofractionation to the primary tumor or subregions of high FDG-uptake in concurrent or sequential CRT has been shown to be feasible, but associated with higher acute and late toxicities compared to conventional CRT [22]. In our study, addition of full-dose concurrent chemotherapy did not result in excessive toxicity as only moderate dose-escalation/hypofractionation in combination with SIB-IMRT and IGRT was used.…”

Section: Discussionmentioning

confidence: 99%

Chemoradiotherapy by intensity-modulated radiation therapy with simultaneous integrated boost in locally advanced or oligometastatic non-small-cell lung cancer—a two center experience

Mantel

Müller²,

Kleine

et al. 2021

Strahlenther Onkol

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Purpose Integrating moderate hypofractionation to the macroscopic tumor with elective nodal irradiation while sparing the organs at risk (OAR) in chemoradiotherapy of locally advanced non-small-cell lung cancer. Methods From 2010–2018, treatment, patient and tumor characteristics of 138 patients from two radiation therapy centers were assessed. Chemoradiotherapy by intensity-modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) to the primary tumor and macroscopic lymph node metastases was used. Results A total of 124 (90%) patients received concurrent chemotherapy. 106 (76%) patients had UICC (Union for International Cancer Control) stage ≥IIIB and 21 (15%) patients had an oligometastatic disease (UICC stage IV). Median SIB and elective total dose was 61.6 and 50.4 Gy in 28 fractions, respectively. Furthermore, 64 patients (46%) had an additional sequential boost to the primary tumor after the SIB-IMRT main series: median 6.6 Gy in median 3 fractions. The median cumulative mean lung dose was 15.6 Gy (range 6.2–29.5 Gy). Median follow-up and radiological follow-up for all patients was 18.0 months (range 0.6–86.9) and 16.0 months (range 0.2–86.9), respectively. Actuarial local control rates at 1, 2 and 3 years were 80.4, 68.4 and 57.8%. Median overall survival and progression-free survival was 30.0 months (95% confidence interval [CI] 23.5–36.4) and 12.1 months (95% CI 8.2–16.0), respectively. Treatment-related toxicity was moderate. Radiation-induced pneumonitis grade 2 and grade 3 occurred in 13 (9.8%) and 3 (2.3%) patients. Conclusions Chemoradiotherapy using SIB-IMRT showed promising local tumor control rates and acceptable toxicity in patients with locally advanced and in part oligometastatic lung cancer. The SIB concept, resulting in a relatively low mean lung dose, was associated with low numbers of clinically relevant pneumonitis. The overall survival appears promising in the presence of a majority of patients with UICC stage ≥IIIB disease.

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“…While improved imaging and radiotherapy technology have allowed ablative doses to be delivered to most early-stage cancers, the standard radiation dose schedule for many locally advanced tumors, such as for non-small cell lung cancer (NSCLC), has been almost unchanged since the 1980s, when radiotherapy was delivered using a 2D technique (Perez et al, 1980). Indeed, most dose-escalation attempts in inoperable NSCLC patients result in higher levels of acute and late toxicity, compared to the use of conventional chemoradiotherapy, even when using modern techniques (van Diessen et al, 2019). Whenever it is technically feasible, increasing the space between the tumor and the organs at risk is the most obvious solution and may lead to positive results.…”

Section: Technology For Radiation Treatment Planning and Deliverymentioning

confidence: 99%

Role of radiation oncology in modern multidisciplinary cancer treatment

et al. 2020

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Cancer care is moving from a disease-focused management toward a patient-centered tailored approach. Multidisciplinary management that aims to define individual, optimal treatment strategies through shared decision making between healthcare professionals and patient is a fundamental aspect of high-quality cancer care and often includes radiation oncology. Advances in technology and radiobiological research allow to deliver ever more tailored radiation treatments in an ever easier and faster way, thus improving the efficacy, safety, and accessibility of radiation therapy. While these changes are improving quality of cancer care, they are also enormously increasing complexity of decision making, thus challenging the ability to deliver quality affordable cancer care. In this review, we provide an updated outline of the role of radiation oncology in the modern multidisciplinary treatment of cancer. Particularly, we focus on the way some developments in key areas of cancer management are challenging multidisciplinary cancer care in the different clinical settings of early, locally advanced, and metastatic disease, thus highlighting some priority areas of research.

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The acute and late toxicity results of a randomized phase II dose-escalation trial in non-small cell lung cancer (PET-boost trial)

Abstract: The acute and late toxicity results of a randomized phase II dose-escalation trial in non-small cell lung cancer (PET-boost trial).

Cited by 60 publications

References 37 publications

Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG–PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis

Multiple Testing, Cut-Point Optimization, and Signs of Publication Bias in Prognostic FDG–PET Imaging Studies of Head and Neck and Lung Cancer: A Review and Meta-Analysis

Chemoradiotherapy by intensity-modulated radiation therapy with simultaneous integrated boost in locally advanced or oligometastatic non-small-cell lung cancer—a two center experience

Role of radiation oncology in modern multidisciplinary cancer treatment

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