Three-dimensional conformal radiation may deliver considerable dose of incidental nodal irradiation in patients with early stage node-negative non-small cell lung cancer when the tumor is large and centrally located

Zhao, Lujun; Chen, Ming; Haken, Randall K. Ten; Chetty, Indrin J.; Chapet, O.; Hayman, James A.; Kong, Feng-Ming

doi:10.1016/j.radonc.2007.01.006

Cited by 36 publications

(14 citation statements)

References 27 publications

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“…This analysis is important because of the possibility of increased nodal failures with proton IFRT compared to photon IFRT as a result of decreased scatter to adjacent nodal regions. With photon IFRT, incidental dose to uninvolved nodal stations can reach as high as 40 Gy for node-positive patients and 13 Gy for hilar stations in node-negative patients, 26–28 doses likely to contribute to control of microscopic disease.…”

Section: Discussionmentioning

confidence: 99%

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Kesarwala

Ning

et al. 2015

Clinical Lung Cancer

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Background Photon involved-field radiation therapy (IFRT), the standard for locally advanced non-small cell lung cancer (LA-NSCLC), results in favorable outcomes without increased isolated nodal failures, perhaps from scattered dose to elective nodal stations. Given the high conformality of intensity-modulated proton therapy (IMPT), proton IFRT could increase nodal failures. We investigated the feasibility of IMPT for elective nodal irradiation (ENI) in LA-NSCLC. Materials and Methods IMPT IFRT plans were generated to the same total dose of 66.6–72 Gy received by 20 LA-NSCLC patients treated with photon IFRT. IMPT ENI plans were generated to 46 CGE to elective nodal (EN) planning treatment volumes (PTV) plus 24 CGE to involved field (IF)-PTVs. Results Proton IFRT and ENI both improved D95 involved field (IF)-PTV coverage by 4% (p<0.01) compared to photon IFRT. All evaluated dosimetric parameters improved significantly with both proton plans. Lung V20 and mean lung dose decreased 18% (p<0.01) and 36% (p<0.01), respectively, with proton IFRT and 11% (p=0.03) and 26% (p<0.01) with ENI. Mean esophagus dose decreased 16% with IFRT and 12% with ENI; heart V25 decreased 63% with both (all p<0.01). Conclusions This study demonstrates the feasibility of IMPT for LA-NSCLC ENI. Potential decreased toxicity indicates IMPT could allow ENI while maintaining a favorable therapeutic ratio compared to photon IFRT.

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Section: Discussionmentioning

confidence: 99%

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Kesarwala

Ning

et al. 2015

Clinical Lung Cancer

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“…Therefore, their radiation sensitivity was better (17). In radiotherapy, the incidental dose to the ipsilateral hilus pulmonis, the mediastinal and paratracheal nodes could be <40-50 Gy when these regions were not in the radiotherapy target volume (18). The subclinical lesions received enough to be eliminated by the incidental dose.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the smaller target volume for stage III non-small cell lung cancer treated with intensity-modulated radiotherapy

Liang¹,

Yu²,

Yu³

et al. 2015

Molecular and Clinical Oncology

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Abstract. The present study reports the local recurrence, distant metastasis, progression-free survival, overall survival and radiation toxicity between two arms of stage III non-small cell lung cancer (NSCLC) treated with intensity-modulated radiotherapy (IMRT); one arm with clinical target volume (CTV) and the other without CTV. The two arms of local recurrence, distant metastasis, progression-free survival, overall survival, grade 3-4 radiation esophagitis and hematological toxicity had no statistical significance. However, the grade 3-4 radiation pneumonia rate of the group without CTV was significantly decreased. This supports the concept that stage III NSCLC treated with IMRT, which omitted CTV, can reduce the occurrence of radiation pneumonia. The aim of the present study was to analyze the feasibility of the smaller target volume for stage III NSCLC treated with IMRT. Data from 105 patients with stage III NSCLC who were hospitalized and received IMRT between January 1, 2008 and November 30, 2012 were retrospectively analyzed. A total of 55 cases were irradiated with target volume without CTV and 50 cases were irradiated with CTV. Dose prescription was 100% PTV at 54-63 Gy/27-35 F/5.4-7 weeks. The two arms of the patient characteristics and treatment deliveries had no statistical significance. The two arms of the patients were compared for local recurrence, distant metastasis, progression-free survival, overall survival and radiation-related toxicity. In the arms without and with CTV, the local relapse and distant metastases rates were 32.7 and 32.0% (P=1.000) and 56.4 and 48.0% (P=0.946), respectively. The median progression-free survival time for the two arms was 9 months (P=0.619). The 1-, 2-and 3-year survival rates of the arms without and with CTV were 74.5, 43.6 and 23.6%, and 70.0, 46.0 and 20.0% (P=0.956), respectively. In the two arms, grade 3-4 radiation esophagitis and hematological toxicity had no statistical significance. However, in the arm without CTV, grade 3-4 radiation pneumonia was only 5.5%, compared with 18.0% in the arm with CTV (P=0.044). In conclusion, the smaller target volume for stage III NSCLC treated with IMRT was feasible.

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“…Similarly, among patients receiving conventionally fractionated external beam radiation therapy (EBRT; with 3D conformal RT [3D-CRT], or intensity modulated RT [IMRT]), the regional nodal failure rate, even when these nodes are not intentional targets, is 5-15% [3][4][5][6][7]. Recurrent or second primary mediastinal lymph node metastases (R/SP-MLNMs) are challenging for physicians to treat, given their proximity to critical structures (e.g.…”

Section: Introductionmentioning

confidence: 99%

Clinical Evaluation Stereotactic Radiation Therapy for Recurrent or Second Primary Mediastinal Lymph Node Metastases Originating From Non-Small Cell Lung Cancer

Mao

Wang

Zaorsky

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Three-dimensional conformal radiation may deliver considerable dose of incidental nodal irradiation in patients with early stage node-negative non-small cell lung cancer when the tumor is large and centrally located

Cited by 36 publications

References 27 publications

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Intensity-Modulated Proton Therapy for Elective Nodal Irradiation and Involved-Field Radiation in the Definitive Treatment of Locally Advanced Non–Small-Cell Lung Cancer: A Dosimetric Study

Efficacy of the smaller target volume for stage III non-small cell lung cancer treated with intensity-modulated radiotherapy

Clinical Evaluation Stereotactic Radiation Therapy for Recurrent or Second Primary Mediastinal Lymph Node Metastases Originating From Non-Small Cell Lung Cancer

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