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Zhang C, Zhao G, Wu H, Jiang J, Duan W, Fan Z, Wang Z, Wang R. Application of postoperative adjuvant radiotherapy in limited-stage small cell lung cancer: A systematic review and meta-analysis. Radiother Oncol 2024; 193:110123. [PMID: 38309584 DOI: 10.1016/j.radonc.2024.110123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND AND PURPOSE One of the most important treatments for small cell lung cancer (SCLC) is radiation therapy. Currently, the criteria for administering postoperative adjuvant radiotherapy (PORT) in SCLC remain uncertain. Therefore, we conducted a meta-analysis to investigate the influence of PORT on the prognosis of limited-stage SCLC (LS-SCLC). METHODS We conducted a comprehensive search across three databases, PubMed, Embase, and the Cochrane Library. Data analysis involved utilizing both random-effects and fixed-effects models for pooling the results. A comparative analysis was performed to assess the prognostic outcomes of patients with LS-SCLC who did and did not undergo PORT. The primary outcome assessed was overall survival (OS), while the secondary outcome was disease-free survival (DFS). RESULTS This analysis included 11 retrospective studies comprising 7694 eligible participants. Among the entire population of LS-SCLC patients, the OS was superior in those receiving PORT than in those not receiving it (hazard ratio [HR]: 0.79, 95 % confidence interval [CI]: 0.71-0.87; P < 0.0001). In pN0 stage LS-SCLC patients, PORT was associated with a detrimental effect on OS (HR: 1.22, 95 % CI: 1.04-1.43; P = 0.01). In pN1 stage LS-SCLC patients, additionally administering PORT did not provide a significant OS advantage as compared to not administering it (HR: 0.82, 95 % CI: 0.60-1.12; P = 0.21). In pN2 stage LS-SCLC patients, those receiving PORT demonstrated a significant improvement in OS (HR: 0.59; 95 % CI: 0.50-0.70; P < 0.0001) as compared to those not receiving it. Regarding DFS in LS-SCLC patients, the difference in the protective effect with and without the administration of PORT was less pronounced (HR: 0.76, 95 % CI: 0.58-1.00; P = 0.053). CONCLUSIONS With respect to OS, PORT is not advisable in patients with pN0 or pN1 stage LS-SCLC but is highly recommended in pN2 stage LS-SCLC. Further research is warranted to confirm these findings.
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Affiliation(s)
- Chuanhao Zhang
- Graduate School of Dalian Medical University, Dalian 116044, PR China; Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
| | - Genghao Zhao
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
| | - Huajian Wu
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China; The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Dalian University, Dalian 116001, PR China
| | - Jianing Jiang
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
| | - Wenyue Duan
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
| | - Zhijun Fan
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China
| | - Zhe Wang
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China; The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Dalian University, Dalian 116001, PR China.
| | - Ruoyu Wang
- Departement of Medical Oncology, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, PR China; The Key Laboratory of Biomarker High Throughput Screening and Target Translation of Breast and Gastrointestinal Tumor, Dalian University, Dalian 116001, PR China.
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Yadav P, DesRosiers CM, Mitra RK, Srivastava SP, Das IJ. Variability of Low-Z Inhomogeneity Correction in IMRT/SBRT: A Multi-Institutional Collaborative Study. J Clin Med 2023; 12:jcm12030906. [PMID: 36769553 PMCID: PMC9918128 DOI: 10.3390/jcm12030906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 01/25/2023] Open
Abstract
Dose-calculation algorithms are critical for radiation treatment outcomes that vary among treatment planning systems (TPS). Modern algorithms use sophisticated radiation transport calculation with detailed three-dimensional beam modeling to provide accurate doses, especially in heterogeneous medium and small fields used in IMRT/SBRT. While the dosimetric accuracy in heterogeneous mediums (lung) is qualitatively known, the accuracy is unknown. The aim of this work is to analyze the calculated dose in lung patients and compare the validity of dose-calculation algorithms by measurements in a low-Z phantom for two main classes of algorithms: type A (pencil beam) and type B (collapse cone). The CT scans with volumes (target and organs at risk, OARs) of a lung patient and a phantom build to replicate the human lung data were sent to nine institutions for planning. Doses at different depths and field sizes were measured in the phantom with and without inhomogeneity correction across multiple institutions to understand the impact of clinically used dose algorithms. Wide dosimetric variations were observed in target and OAR coverage in patient plans. The correction factor for collapsed cone algorithms was less than pencil beam algorithms in the small fields used in SBRT. The pencil beam showed ≈70% variations between measured and calculated correction factors for various field sizes and depths. For large field sizes the trends of both types of algorithms were similar. The differences in measured versus calculated dose for type-B algorithms were within ±10%. Significant variations in the target and OARs were observed among various TPS. The results suggest that the pencil beam algorithm does not provide an accurate dose and should not be considered with small fields (IMRT/SBRT). Type-B collapsed-cone algorithms provide better agreement with measurements, but still vary among various systems.
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Affiliation(s)
- Poonam Yadav
- Department of Radiation Oncology, Northwest Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Colleen M. DesRosiers
- Department of Radiation Oncology, Indiana University Health, Indianapolis, IN 46202, USA
| | - Raj K. Mitra
- Department of Radiation Oncology, Ochsner Health System, New Orleans, LA 70121, USA
| | - Shiv P. Srivastava
- Department of Radiation Oncology, Dignity Health System, Phoenix, AZ 85013, USA
| | - Indra J. Das
- Department of Radiation Oncology, Northwest Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Correspondence: ; Tel.: +1-312-926-6448 or +1-215-385-4523
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Limited-Stage Small-Cell Lung Cancer: Current Progress and the Next Frontier. RADIATION 2021. [DOI: 10.3390/radiation1040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Limited-stage (LS) small-cell lung cancer (SCLC) is defined as disease confined to a tolerable radiation portal without extrathoracic metastases. Despite clinical research over two decades, the prognosis of LS-SCLC patients remains poor. The current standard of care for LS-SCLC patients is concurrent platinum-based chemotherapy with thoracic radiotherapy (RT). Widespread heterogeneity on the optimal radiation dose and fractionation regimen among physicians highlights the logistical challenges of administering BID regimens. Prophylactic cranial irradiation (PCI) is recommended to patients following a good initial response to chemoradiation due to improved overall survival from historical trials and the propensity for LS-SCLC to recur with brain metastases. However, PCI utilization is being debated due to the greater availability of magnetic resonance imaging (MRI) and data in extensive-stage SCLC regarding close MRI surveillance in lieu of PCI while spurring novel RT techniques, such as hippocampal-avoidance PCI. Additionally, novel treatment combinations incorporating targeted small molecule therapies and immunotherapies with or following radiation for LS-SCLC have seen recent interest and some concepts are being investigated in clinical trials. Here, we review the landscape of progress, limitations, and challenges for LS-SCLC including current standard of care, novel radiation techniques, and the integration of novel therapeutic strategies for LS-SCLC.
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4
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Guillemin F, Berger L, Lapeyre M, Bellière-Calandry A. [Dosimetric and toxicity comparison of IMRT and 3D-CRT of non-small cell lung cancer]. Cancer Radiother 2021; 25:747-754. [PMID: 34183268 DOI: 10.1016/j.canrad.2021.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE Although three-dimensional conformal radiotherapy (3D-CRT) remains the gold standard as a curative treatment for NSCLC when surgery is not possible, intensity modulated radiotherapy (IMRT) is increasingly used routinely. The purpose of this study was to assess the clinical (immediate toxicities) and dosimetric impact of IMRT compared to 3D-CRT in the treatment of locally advanced (stages IIIA to IIIC) non-small cell lung cancer (NSCLC) treated with concomitant radiochemotherapy, while IMRT in lung cancer was implemented in the radiotherapy department of the Jean-Perrin Center. PATIENTS AND METHODS Between March 2015 and October 2019, 64 patients treated with concomitant radiochemotherapy were retrospectively included. Thirty-two received 3D-CRT and 32 IMRT. The radiotherapy prescription was 66Gy in 33 fractions of 2Gy. RESULTS IMRT has improved coverage of target volumes (V95 increased by 14.81% in IMRT; P<0.001) without increasing doses to OARs and reducing dysphagia (RR=0.67; P=0.027). Low doses to the lung were not significantly increased in IMRT (pulmonary V5 increased by 7.46% in IMRT). CONCLUSION Intensity modulated radiotherapy, compared with the standard RC3D technique, improve the coverage of target volumes without increasing the dose to the OARs. It also improves the immediate tolerance of the treatment by reducing the number of dysphagia.
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Affiliation(s)
- F Guillemin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France.
| | - L Berger
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
| | - A Bellière-Calandry
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France
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Levy A, Botticella A, Le Péchoux C, Faivre-Finn C. Thoracic radiotherapy in small cell lung cancer-a narrative review. Transl Lung Cancer Res 2021; 10:2059-2070. [PMID: 34012814 PMCID: PMC8107758 DOI: 10.21037/tlcr-20-305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Small-cell lung cancer (SCLC) represents 10–15% of all lung cancers and has a poor prognosis. Thoracic radiotherapy plays a central role in current SCLC management. Concurrent chemoradiotherapy (CTRT) is the standard of care for localised disease (stage I−III, limited-stage, LS). Definitive thoracic radiotherapy may be offered in metastatic patients (stage IV, extensive stage, ES-SCLC) after chemotherapy. For LS-SCLC, the gold standard is early accelerated hyperfractionated twice-daily CTRT (4 cycles of cisplatin etoposide, starting with the first or second chemotherapy cycle). Modern radiation techniques should be used with involved-field radiotherapy based on baseline CT and PET/CT scans. In ES-SCLC, thoracic radiotherapy should be discussed in cases of initial bulky mediastinal disease/residual thoracic disease not progressing after induction chemotherapy. This strategy was however not assessed in recent trials establishing chemo-immunotherapy as the standard first line treatment in ES-SCLC. Future developments include technical radiotherapy advances and the incorporation of new drugs. Thoracic irradiation is delivered more precisely given technical developments (IMRT, image-guided radiotherapy, stereotactic radiotherapy), reducing the risks of severe adverse events. Stereotactic ablative radiotherapy may be discussed in rare early stage (T1 to 2, N0) inoperable patients. A number of current clinical trials are investigating immunoradiotherapy. In this review, we highlight the current role of thoracic radiotherapy and describe ongoing research in the integration of biological surrogate markers, advanced radiotherapy technologies and novel drugs in SCLC patients.
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Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France.,Univ Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust and Division of Cancer Sciences, University of Manchester, Manchester, UK
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Couñago F, de la Pinta C, Gonzalo S, Fernández C, Almendros P, Calvo P, Taboada B, Gómez-Caamaño A, Guerra JLL, Chust M, González Ferreira JA, Álvarez González A, Casas F. GOECP/SEOR radiotherapy guidelines for small-cell lung cancer. World J Clin Oncol 2021; 12:115-143. [PMID: 33767969 PMCID: PMC7968106 DOI: 10.5306/wjco.v12.i3.115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/12/2021] [Indexed: 02/06/2023] Open
Abstract
Small cell lung cancer (SCLC) accounts for approximately 20% of all lung cancers. The main treatment is chemotherapy (Ch). However, the addition of radiotherapy significantly improves overall survival (OS) in patients with non-metastatic SCLC and in those with metastatic SCLC who respond to Ch. Prophylactic cranial irradiation reduces the risk of brain metastases and improves OS in both metastatic and non-metastatic patients. The 5-year OS rate in patients with limited-stage disease (non-metastatic) is slightly higher than 30%, but less than 5% in patients with extensive-stage disease (metastatic). The present clinical guidelines were developed by Spanish radiation oncologists on behalf of the Oncologic Group for the Study of Lung Cancer/Spanish Society of Radiation Oncology to provide a current review of the diagnosis, planning, and treatment of SCLC. These guidelines emphasise treatment fields, radiation techniques, fractionation, concomitant treatment, and the optimal timing of Ch and radiotherapy. Finally, we discuss the main indications for reirradiation in local recurrence.
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Affiliation(s)
- Felipe Couñago
- Department of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, Hospital La Luz, Universidad Europea de Madrid, Madrid 28223, Madrid, Spain
| | - Carolina de la Pinta
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid 28034, Spain
| | - Susana Gonzalo
- Department of Radiation Oncology, Hospital Universitario La Princesa, Madrid 28006, Spain
| | - Castalia Fernández
- Department of Radiation Oncology, GenesisCare Madrid, Madrid 28043, Spain
| | - Piedad Almendros
- Department of Radiation Oncology, Hospital General Universitario, Valencia 46014, Spain
| | - Patricia Calvo
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Begoña Taboada
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela 15706, Spain
| | - José Luis López Guerra
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla 41013, Spain
| | - Marisa Chust
- Department of Radiation Oncology, Fundación Instituto Valenciano de Oncología, Valencia 46009, Spain
| | | | | | - Francesc Casas
- Department of Radiation Oncology, Thoracic Unit, Hospital Clinic, Barcelona 08036, Spain
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Chiang JS, Yu NY, Daniels TB, Liu W, Schild SE, Sio TT. Proton beam radiotherapy for patients with early-stage and advanced lung cancer: a narrative review with contemporary clinical recommendations. J Thorac Dis 2021; 13:1270-1285. [PMID: 33717598 PMCID: PMC7947490 DOI: 10.21037/jtd-20-2501] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although lung cancer rates are decreasing nationally, lung cancer remains the leading cause of cancer related death. Despite advancements in treatment and technology, overall survival (OS) for lung cancer remains poor. Proton beam therapy (PBT) is an advanced radiation therapy (RT) modality for treatment of lung cancer with the potential to achieve dose escalation to tumor while sparing critical structures due to higher target conformality. In early and late-stage non-small cell lung cancer (NSCLC), dosimetric studies demonstrated reduced doses to organs at risk (OARs) such as the lung, spinal cord, and heart, and clinical studies report limited toxicities with PBT, including hypofractionated regimens. In limited-stage SCLC, studies showed that regimens chemo RT including PBT were well tolerated, which may help optimize clinical outcomes. Improved toxicity profiles may be beneficial in post-operative radiotherapy, for which initial dosimetric and clinical data are encouraging. Sparing of OARs may also increase the proportion of patients able to complete reirradiation for recurrent disease. However, there are various challenges of using PBT including a higher financial burden on healthcare and limited data supporting its cost-effectiveness. Further studies are needed to identify subgroups that benefit from PBT based on prognostic factors, and to evaluate PBT combined with immunotherapy, in order to elucidate the benefit that PBT may offer future lung cancer patients.
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Affiliation(s)
- Jennifer S Chiang
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Thomas B Daniels
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Wei Liu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Terence T Sio
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
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8
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Levy A, Faivre-Finn C. Radiotherapy tumor volume for limited-stage small cell lung cancer: less is more. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1114. [PMID: 33145333 PMCID: PMC7575968 DOI: 10.21037/atm.2020.04.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Villejuif, France.,Univ Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.,INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Corinne Faivre-Finn
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
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9
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Wu S, Wang J, Zhang W, Li J, Wu H, Huang Z, Zhou G, Pan J, Chen M. Analysis of Factors Affecting Brain Metastasis in Limited-Stage Small-Cell Lung Cancer Treated With Definitive Thoracic Irradiation. Front Oncol 2020; 10:556634. [PMID: 33194620 PMCID: PMC7658601 DOI: 10.3389/fonc.2020.556634] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/02/2020] [Indexed: 01/08/2023] Open
Abstract
Background Small-cell lung cancer (SCLC) is the most lethal cancer. With the development of chemotherapy and radiotherapy, brain metastasis (BM) emerged as one most predominant treatment failure. However, the factors affecting BM have not been identified completely. The purpose of this study was to investigate the risk factors involved in the development of BM in patients with limited-stage small-cell lung cancer (LS-SCLC) following definitive thoracic radiotherapy (TRT) and to provide a reference for the planning of a clinical treatment strategy. Methods The clinical data of patients with LS-SCLC treated with neoadjuvant chemotherapy (NAC) followed by TRT were collected and retrospectively reviewed. The factors affecting BM, BM-free survival (BMFS) and overall survival (OS) rates were analyzed statistically. Results A total of 152 patients with LS-SCLC fulfilled the inclusion criteria were reviewed. Following TRT, 31 (20.4%) patients achieved CR, 90 (59.2%) patients reached PR, 31 (20.4%) patients maintained SD, and no patients developed PD. The OS at 1, 3, and 5 years was 80.6, 34.2, and 19.4%, respectively. Multivariate analyses indicated that the greatest dimension of primary tumor (Dmax-T) and short-term response to TRT were risk factors affecting BM. The clinical N stage (cN), greatest dimension of metastatic nodes (Dmax-N), short-term response to TRT, and adjuvant chemotherapy (AC) were identified as independent factors correlated with OS. Conclusions Poor short-term response to TRT and huger Dmax-T were risk factors for BM. AC following TRT improved patient survival, but not decreased BM. However, due to the limitations associated with the retrospective design of the present study, further prospective clinical trials are required to confirm these conclusions.
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Affiliation(s)
- Shuting Wu
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.,College of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jiezhong Wang
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Wei Zhang
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jiancheng Li
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Haishan Wu
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Zhiyu Huang
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Guangrun Zhou
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.,College of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Mingqiu Chen
- Department of Radiation Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
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10
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Simone CB, Bogart JA, Cabrera AR, Daly ME, DeNunzio NJ, Detterbeck F, Faivre-Finn C, Gatschet N, Gore E, Jabbour SK, Kruser TJ, Schneider BJ, Slotman B, Turrisi A, Wu AJ, Zeng J, Rosenzweig KE. Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline. Pract Radiat Oncol 2020; 10:158-173. [PMID: 32222430 PMCID: PMC10915746 DOI: 10.1016/j.prro.2020.02.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Several sentinel phase III randomized trials have recently been published challenging traditional radiation therapy (RT) practices for small cell lung cancer (SCLC). This American Society for Radiation Oncology guideline reviews the evidence for thoracic RT and prophylactic cranial irradiation (PCI) for both limited-stage (LS) and extensive-stage (ES) SCLC. METHODS The American Society for Radiation Oncology convened a task force to address 4 key questions focused on indications, dose fractionation, techniques and timing of thoracic RT for LS-SCLC, the role of stereotactic body radiation therapy (SBRT) compared with conventional RT in stage I or II node negative SCLC, PCI for LS-SCLC and ES-SCLC, and thoracic consolidation for ES-SCLC. Recommendations were based on a systematic literature review and created using a consensus-building methodology and system for grading evidence quality and recommendation strength. RESULTS The task force strongly recommends definitive thoracic RT administered once or twice daily early in the course of treatment for LS-SCLC. Adjuvant RT is conditionally recommended in surgically resected patients with positive margins or nodal metastases. Involved field RT delivered using conformal advanced treatment modalities to postchemotherapy volumes is also strongly recommended. For patients with stage I or II node negative disease, SBRT or conventional fractionation is strongly recommended, and chemotherapy should be delivered before or after SBRT. In LS-SCLC, PCI is strongly recommended for stage II or III patients who responded to chemoradiation, conditionally not recommended for stage I patients, and should be a shared decision for patients at higher risk of neurocognitive toxicities. In ES-SCLC, radiation oncologist consultation for consideration of PCI versus magnetic resonance surveillance is strongly recommended. Lastly, the use of thoracic RT is strongly recommended in select patients with ES-SCLC after chemotherapy treatment, including a conditional recommendation in those responding to chemotherapy and immunotherapy. CONCLUSIONS RT plays a vital role in both LS-SCLC and ES-SCLC. These guidelines inform best clinical practices for local therapy in SCLC.
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Affiliation(s)
| | - Jeffrey A Bogart
- Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY
| | - Alvin R Cabrera
- Department of Radiation Oncology, Kaiser Permanente, Seattle, WA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis, Sacramento, CA
| | - Nicholas J DeNunzio
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - Corinne Faivre-Finn
- Division of Cancer Science, University of Manchester and The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elizabeth Gore
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers University, New Brunswick, NJ
| | - Tim J Kruser
- Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL
| | - Bryan J Schneider
- Department of Medical Oncology, University of Michigan, Ann Arbor, MI
| | - Ben Slotman
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, Netherlands
| | - Andrew Turrisi
- Department of Radiation Oncology, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Abraham J Wu
- Department of Radiation Oncology, Memorial Sloan Kettering, New York, NY
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington, Seattle, WA
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11
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Hu X, Xia B, Bao Y, Xu YJ, Wang J, Ma HL, Peng F, Jin Y, Fang M, Tang HR, Chen MY, Dong BQ, Jin JN, Fu XL, Chen M. Timing of thoracic radiotherapy is more important than dose intensification in patients with limited-stage small cell lung cancer: a parallel comparison of two prospective studies. Strahlenther Onkol 2019; 196:172-181. [PMID: 31784801 DOI: 10.1007/s00066-019-01539-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 10/23/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE The optimal radiotherapy dose/fraction for limited-stage small cell lung cancer (SCLC) is undefined. Our objectives were to compare efficacy between hyperfractionated thoracic radiotherapy (TRT; 1.5 Gy 2 times per day [bid] in 30 fractions) and hypofractionated TRT (2.5 Gy once per day [qd] in 22 fractions), and to explore prognostic factors influencing the prognosis, such as the timing of TRT. METHODS Patients enrolled in two independent prospective studies were combined and analyzed. The primary endpoint was local/regional control (LRC). The prognosis was analyzed using the Cox proportional hazards regression model. RESULTS Ninety-two and 96 patients were treated with hyperfractionated TRT and hypofractionated TRT, respectively. The 1‑ and 2‑year LRC rates of the two arms were 82.1 and 60.7%, and 84.9 and 68.8% (P = 0.27), respectively. The median overall survival (OS) times (months) were 28.3 (95% confidence interval, CI 16.4-40.1) and 22.0 (95% CI 16.4-27.5), while the 1‑year, 3‑year, and 5‑year OS rates were 85.2, 40.8, and 27.1%, and 76.9, 34.3, and 26.8% (P = 0.37), respectively. Using a multivariate Cox regression study, time (days) from the initiation of chemotherapy to TRT (TCT) ≤43 was associated with improved LRC (hazard radio, HR 0.39, 95% CI 0.20-0.76; P = 0.005). Time (days) from the start of chemotherapy to the end of TRT (SER) ≤63 (HR 0.50, 95% CI 0.32-0.80; P = 0.003) and prophylactic cranial irradiation (HR 0.43; 95% CI 0.29-0.63; P = 0.000) were favorably related to OS. Grade 2/3 acute radiation esophagitis was observed in 37.0 and 17.7% of patients in the hyperfractionated and hypofractionated arms, respectively (P = 0.003). CONCLUSION Both hyperfractionated and hypofractionated TRT schedules achieved good LRC and OS for patients with limited-stage SCLC in this study. Keeping TCT ≤43 and SER ≤63 resulted in a better prognosis. The incidence of acute esophagitis was significantly higher in the hyperfractionated arm.
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Affiliation(s)
- Xiao Hu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Bing Xia
- Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China.,Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai, China
| | - Yong Bao
- Department of Radiation Oncology, The First affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu-Jin Xu
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Jin Wang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Hong-Lian Ma
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Fang Peng
- Department of Radiation Oncology, The First affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ying Jin
- Department of Medical Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Medical Oncology, Zhejiang Cancer Hospital, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, Hangzhou, China
| | - Min Fang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Hua-Rong Tang
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Meng-Yuan Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Bai-Qiang Dong
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Jia-Nan Jin
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Cancer Hospital of Fudan University, Shanghai, China. .,Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Chest Hospital, 241 Huaihai Road West, 200030, Shanghai, China.
| | - Ming Chen
- Department of Radiation Oncology, Cancer Hospital of the University of Chinese Academy of Sciences, Department of Radiation Oncology, Zhejiang Cancer Hospital, Zhejiang Provincial Key Laboratory of Radiation Oncology, Institute of Cancer Research and Basic Medical Sciences, Chinese Academy of Sciences, 1 Banshan Road East, 310022, Hangzhou, China.
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12
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Appel S, Bar J, Ben-Nun A, Perelman M, Alezra D, Urban D, Ben-Ayun M, Honig N, Ofek E, Katzman T, Onn A, Chatterji S, Dubinski S, Tsvang L, Felder S, Kraitman J, Haisraely O, Rabin Alezra T, Lieberman S, Marom EM, Golan N, Simansky D, Symon Z, Lawrence YR. Comparative effectiveness of intensity modulated radiation therapy to 3-dimensional conformal radiation in locally advanced lung cancer: pathological and clinical outcomes. Br J Radiol 2019; 92:20180960. [PMID: 30864828 DOI: 10.1259/bjr.20180960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Intensity-modulated radiotherapy (IMRT) has better normal-tissue sparing compared with 3-dimensional conformal radiation (3DCRT). We sought to assess the impact of radiation technique on pathological and clinical outcomes in locally advanced non-small cell lung cancer (LANSCLC) treated with a trimodality strategy. METHODS Retrospective review of LANSCLC patients treated from August 2012 to August 2018 at Sheba Medical Center, Israel. The trimodality strategy consisted of concomitant chemoradiation to 60 Gray (Gy) followed by completion surgery. The planning target volume (PTV) was defined by co-registered PET/CT. Here we compare the pathological regression, surgical margin status, local control rates (LC), disease free (DFS) and overall survival (OS) between 3DCRT and IMRT. RESULTS Our cohort consisted of 74 patients with mean age 62.9 years, male in 51/74 (69%), adenocarcinoma in 46/74 (62.1%), stage 3 in 59/74 (79.7%) and chemotherapy in 72/74 (97.3%). Radiation mean dose: 59.2 Gy (SD ± 3.8). Radiation technique : 3DCRT in 51/74 (68.9%), IMRT in 23/74 (31%). Other variables were similar between groups.Major pathological response (including pathological complete response or less than 10% residual tumor cells) was similar: 32/51 (62.7%) in 3DCRT and 15/23 (65.2%) in IMRT, p=0.83. Pathological complete response (pCR) rates were similar: 17/51 (33.3%) in 3DCRT and 8/23 (34.8%) in IMRT, p=0.9. Surgical margins were negative in 46/51 (90.1%) in 3DCRT vs. 17/19 (89.4%) in IMRT (p=1.0).The 2-year LC rates were 81.6% (95% CI 69-89.4%); DFS 58.3% (95% CI 45.5-69%) and 3-year OS 70% (95% CI57-80%). Comparing radiation techniques, there were no significant differences in LC (p=0.94), DFS (p=0.33) and OS (p=0.72). CONCLUSION When used to treat LANSCLC in the neoadjuvant setting, both IMRT and 3DCRT produce comparable pathological and clinical outcomes. ADVANCES IN KNOWLEDGE This study validates the real-world effectiveness of IMRT compared to 3DCRT.
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Affiliation(s)
- Sarit Appel
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Jair Bar
- 2 Department of Medical Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel.,3 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Alon Ben-Nun
- 3 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,4 Department of Thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Marina Perelman
- 5 Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Dror Alezra
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Damien Urban
- 2 Department of Medical Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Maoz Ben-Ayun
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Nir Honig
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Efrat Ofek
- 5 Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Tamar Katzman
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Amir Onn
- 2 Department of Medical Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel.,6 Department of Pulmonology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramt Gan , Israel
| | - Sumit Chatterji
- 6 Department of Pulmonology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramt Gan , Israel
| | - Sergey Dubinski
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Lev Tsvang
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Shira Felder
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Judith Kraitman
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Ory Haisraely
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Tatiana Rabin Alezra
- 7 Department of Radiation Oncology, Tel-Aviv Sourasky Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Sivan Lieberman
- 8 Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Edith M Marom
- 3 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,8 Department of Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Nir Golan
- 4 Department of Thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - David Simansky
- 4 Department of Thoracic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel
| | - Zvi Symon
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel.,3 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel
| | - Yaacov Richard Lawrence
- 1 Department of Radiation Oncology, Institute Of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler Faculty of Medicine, Tel Aviv University , Ramat Gan , Israel.,3 Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.,9 Department of Radiation Oncology Sidney Kimmel Medical College, Thomas Jefferson University , Philadelphia , USA
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13
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Chandarana H, Wang H, Tijssen RHN, Das IJ. Emerging role of MRI in radiation therapy. J Magn Reson Imaging 2018; 48:1468-1478. [PMID: 30194794 DOI: 10.1002/jmri.26271] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 12/12/2022] Open
Abstract
Advances in multimodality imaging, providing accurate information of the irradiated target volume and the adjacent critical structures or organs at risk (OAR), has made significant improvements in delivery of the external beam radiation dose. Radiation therapy conventionally has used computed tomography (CT) imaging for treatment planning and dose delivery. However, magnetic resonance imaging (MRI) provides unique advantages: added contrast information that can improve segmentation of the areas of interest, motion information that can help to better target and deliver radiation therapy, and posttreatment outcome analysis to better understand the biologic effect of radiation. To take advantage of these and other potential advantages of MRI in radiation therapy, radiologists and MRI physicists will need to understand the current radiation therapy workflow and speak the same language as our radiation therapy colleagues. This review article highlights the emerging role of MRI in radiation dose planning and delivery, but more so for MR-only treatment planning and delivery. Some of the areas of interest and challenges in implementing MRI in radiation therapy workflow are also briefly discussed. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;48:1468-1478.
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Affiliation(s)
- Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University School of Medicine, New York, New York, USA.,Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Hesheng Wang
- Department of Radiation Oncology, New York University School of Medicine & Laura and Isaac Perlmutter Cancer Center, New York, New York, USA
| | - R H N Tijssen
- Department of Radiotherapy, University Medical Center Utrecht, the Netherlands
| | - Indra J Das
- Department of Radiation Oncology, New York University School of Medicine & Laura and Isaac Perlmutter Cancer Center, New York, New York, USA
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14
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Verma V, Fakhreddine MH, Haque W, Butler EB, Teh BS, Simone CB. Cardiac mortality in limited-stage small cell lung cancer. Radiother Oncol 2018; 128:492-497. [PMID: 29934110 DOI: 10.1016/j.radonc.2018.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Life expectancy of patients with limited-stage small cell lung cancer (LS-SCLC) continues to rise; thus, characterization of long-term toxicities is essential. Although there are emerging data linking cardiac irradiation doses with survival for non-small cell lung cancer, there are currently minimal data on cardiac-specific mortality (CSM) in LS-SCLC. The goal of this investigation was to evaluate CSM between left- and right-sided cases. METHODS The Surveillance, Epidemiology, and End Results database was queried for stage I-III primary SCLC patients receiving radiotherapy; CSM was compared between left- and right-sided diseases. Accounting for mortality from other causes, Gray's test compared cumulative incidences of CSM between both groups. Multiple multivariate models examined the independent effect of laterality on CSM, including the Fine and Gray competing risk model and the Cox proportional hazards model. RESULTS Of 19,692 patients, 7991 (41%) were left-sided and 11,701 (59%) were right-sided. Left-sided patients experienced significantly higher CSM overall (3.3% vs. 2.6%, p = 0.004). Laterality was an independent predictor of CSM in the overall population in the Fine and Gray competing risk model (p = 0.006) as well as the Cox proportional hazards model (p = 0.007). The overall hazard ratio for CSM by disease laterality was 1.27 (95% confidence interval, 1.08-1.50). Laterality had no statistical association with non-cardiac mortality in the Fine and Gray competing risk model (p = 0.130). CONCLUSIONS Although causation between radiotherapy and CSM in LS-SCLC cannot be stated based on these data, we encourage clinical attentiveness to cardiac-sparing radiotherapy for LS-SCLC, along with further investigation evaluating dosimetric correlates for cardiotoxicity.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, United States
| | | | - Waqar Haque
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - Bin S Teh
- Department of Radiation Oncology, Houston Methodist Hospital, United States
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, United States.
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15
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Chen MJ, Novaes PE, Gadia R, Motta R. Guidelines for the treatment of lung cancer using radiotherapy. ACTA ACUST UNITED AC 2018; 63:729-732. [PMID: 29239460 DOI: 10.1590/1806-9282.63.09.729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 12/25/2022]
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16
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Verma V, Choi JI, Simone CB. Proton therapy for small cell lung cancer. Transl Lung Cancer Res 2018; 7:134-140. [PMID: 29876312 PMCID: PMC5960657 DOI: 10.21037/tlcr.2018.04.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/28/2018] [Indexed: 12/15/2022]
Abstract
The prognosis of limited-stage small cell lung cancer (LS-SCLC) continues to improve and is now roughly comparable to that of locally advanced non-small cell lung cancer (NSCLC). This shift, taken together with the decreased toxicities of modern radiotherapy (RT) for LS-SCLC compared with those reported in historical trials, necessitates further evaluation of whether proton beam therapy (PBT) could further reduce both acute and late toxicities for patients receiving concurrent chemoradiotherapy for LS-SCLC. These notions are discussed theoretically, with an emphasis on cardiac events. This is followed by a review of the published evidence to date demonstrating improved dosimetry with PBT over intensity-modulated RT and encouraging safety and efficacy profiles seen in early clinical reports. In addition to covering technical aspects of PBT for LS-SCLC such as intensity-modulated PBT, image-guidance for PBT, and adaptive planning, this review also discusses the need for increased data on intensity-modulated PBT for LS-SCLC, economic and quality of life analyses for future PBT SCLC studies, careful categorization of cardiac events in these patients, and the role for immunotherapy combined with photon- or proton-based RT for LS-SCLC.
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Affiliation(s)
- Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - J. Isabelle Choi
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Charles B. Simone
- Department of Radiation Oncology, University of Maryland Medical Center, Baltimore, Maryland, USA
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17
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Les big data , généralités et intégration en radiothérapie. Cancer Radiother 2018; 22:73-84. [DOI: 10.1016/j.canrad.2017.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 04/11/2017] [Accepted: 04/19/2017] [Indexed: 12/25/2022]
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18
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Rwigema JCM, Verma V, Lin L, Berman AT, Levin WP, Evans TL, Aggarwal C, Rengan R, Langer C, Cohen RB, Simone CB. Prospective study of proton-beam radiation therapy for limited-stage small cell lung cancer. Cancer 2017; 123:4244-4251. [PMID: 28678434 DOI: 10.1002/cncr.30870] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/09/2017] [Accepted: 05/30/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Existing data supporting the use of proton-beam therapy (PBT) for limited-stage small cell lung cancer (LS-SCLC) are limited to a single 6-patient case series. This is the first prospective study to evaluate clinical outcomes and toxicities of PBT for LS-SCLC. METHODS This study prospectively analyzed patients with primary, nonrecurrent LS-SCLC definitively treated with PBT and concurrent chemotherapy from 2011 to 2016. Clinical backup intensity-modulated radiotherapy (IMRT) plans were generated for each patient and were compared with PBT plans. Outcome measures included local control (LC), recurrence-free survival (RFS), and overall survival (OS) rates and toxicities. RESULTS Thirty consecutive patients were enrolled and evaluated. The median dose was 63.9 cobalt gray equivalents (range, 45-66.6 cobalt gray equivalents) in 33 to 37 fractions delivered daily (n = 18 [60.0%]) or twice daily (n = 12 [40.0%]). The concurrent chemotherapy was cisplatin/etoposide (n = 21 [70.0%]) or carboplatin/etoposide (n = 9 [30.0%]). In comparison with the backup IMRT plans, PBT allowed statistically significant reductions in the cord, heart, and lung mean doses and the volume receiving at least 5 Gy but not in the esophagus mean dose or the lung volume receiving at least 20 Gy. At a median follow-up of 14 months, the 1-/2-year LC and RFS rates were 85%/69% and 63%/42%, respectively. The median OS was 28.2 months, and the 1-/2-year OS rates were 72%/58%. There was 1 case each (3.3%) of grade 3 or higher esophagitis, pneumonitis, anorexia, and pericardial effusion. Grade 2 pneumonitis and esophagitis were seen in 10.0% and 43.3% of patients, respectively. CONCLUSIONS In the first prospective registry study and largest analysis to date of PBT for LS-SCLC, PBT was found to be safe with a limited incidence of high-grade toxicities. Cancer 2017;123:4244-4251. © 2017 American Cancer Society.
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Affiliation(s)
- Jean-Claude M Rwigema
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Vivek Verma
- Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Liyong Lin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Abigail T Berman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William P Levin
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tracey L Evans
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charu Aggarwal
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington Medical Center, Seattle, Washington
| | - Corey Langer
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roger B Cohen
- Division of Hematology/Oncology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Charles B Simone
- Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland
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State of dose prescription and compliance to international standard (ICRU-83) in intensity modulated radiation therapy among academic institutions. Pract Radiat Oncol 2017; 7:e145-e155. [DOI: 10.1016/j.prro.2016.11.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 11/03/2016] [Accepted: 11/10/2016] [Indexed: 11/24/2022]
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20
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Farooqi AS, Holliday EB, Allen PK, Wei X, Cox JD, Komaki R. Prophylactic cranial irradiation after definitive chemoradiotherapy for limited-stage small cell lung cancer: Do all patients benefit? Radiother Oncol 2017; 122:307-312. [PMID: 28073578 DOI: 10.1016/j.radonc.2016.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 10/31/2016] [Accepted: 11/12/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Prophylactic cranial irradiation (PCI) can improve overall survival (OS) and suppress brain metastases (BM) in patients with limited-stage small cell lung cancer (LS-SCLC) after complete response to primary therapy. However, PCI can be toxic. We sought to identify characteristics of patients who may not benefit from PCI. METHODS We identified 658 patients who received chemoradiotherapy at MD Anderson in 1986-2012; 364 received PCI and 294 did not. Median follow-up time was 21.2months (range 1.2-240.8months). Cox proportional hazards regression, competing-risk regression, and Kaplan-Meier analyses were used to identify factors influencing OS and BM. RESULTS PCI reduced risks of death [HR 0.73, 95% CI 0.61-0.88, P=0.001] and BM [HR 0.54, 95% CI 0.39-0.76, P<0.001]. Having tumors ⩾5cm increased the risk of BM [HR 1.77, 95% CI 1.22-2.55, P=0.002] but not death [HR 1.16, 95% CI 0.96-1.40, P=0.114]. Among patients ⩾70years with ⩾5-cm tumors, PCI did not improve OS [2-year rates 39.4% vs 40.9%, P=0.739]. CONCLUSIONS PCI remains standard therapy after complete response to chemoradiotherapy for LS-SCLC. However, older patients may be at risk from comorbidity or extracranial disease. Further work is warranted to identify patients who may not benefit from PCI.
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Affiliation(s)
- Ahsan S Farooqi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Emma B Holliday
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Xiong Wei
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - James D Cox
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
| | - Ritsuko Komaki
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States.
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21
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Moore K, Paterson C, Hicks J, Harrow S, McJury M. Stereotactic ablative body radiotherapy for non-small-cell lung cancer: setup reproducibility with novel arms-down immobilization. Br J Radiol 2016; 89:20160227. [PMID: 27706946 DOI: 10.1259/bjr.20160227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE A clinical evaluation of the intrafraction and interfraction setup accuracy of a novel thermoplastic mould immobilization device and patient position in early-stage lung cancer being treated with stereotactic radiotherapy at the Beatson West of Scotland Cancer Centre, Glasgow, UK. METHODS 35 patients were immobilized in a novel, arms-down position, with a four-point Klarity™ (Klarity Medical Products, Ohio, US) clear thermoplastic mould fixed to a SinMed (CIVCO Medical solutions, lowa, US) head and neck board. A knee support was also used for patient comfort and support. Pre- and post-treatment kilovoltage cone beam CT (CBCT) images were fused with the planning CT scan to determine intra- and interfraction motion. A total of 175 CBCT scans were analysed in the longitudinal, vertical and lateral directions. RESULTS The mean intrafraction errors were 0.05 ± 0.77 mm (lateral), 0.44 ± 1.2 mm (superior-inferior) and -1.44 ± 1.35 mm (anteroposterior), respectively. Mean composite three-dimensional displacement vector was 2.14 ± 1.2 mm. Interfraction errors were -0.66 ± 2.35 mm (lateral), -0.13 ± 3.11 mm (superior-inferior) and 0.00 ± 2.94 mm (anteroposterior), with three-dimensional vector 4.08 ± 2.73 mm. CONCLUSION Setup accuracy for lung image-guided stereotactic ablative radiotherapy using a unique immobilization device, where patients have arms by their sides, has been shown to be safe and favourably comparable to other published setup data where more complex and cumbersome devices were utilised. There was no arm toxicity reported and low arm doses. Advances in knowledge: We report on the accuracy of a novel patient immobilization device.
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Affiliation(s)
- Karen Moore
- 1 Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Claire Paterson
- 2 Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Jonathan Hicks
- 2 Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Stephen Harrow
- 2 Department of Clinical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Mark McJury
- 3 Radiotherapy Physics Section, Department of Clinical Physics and Bio-engineering, Beatson West of Scotland Cancer Centre, Glasgow, UK
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22
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Ling DC, Hess CB, Chen AM, Daly ME. Comparison of Toxicity Between Intensity-Modulated Radiotherapy and 3-Dimensional Conformal Radiotherapy for Locally Advanced Non-small-cell Lung Cancer. Clin Lung Cancer 2015; 17:18-23. [PMID: 26303127 DOI: 10.1016/j.cllc.2015.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/05/2015] [Accepted: 07/21/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND The role of intensity-modulated radiotherapy (IMRT) in reducing treatment-related toxicity for locally advanced non-small-cell lung cancer (NSCLC) remains incompletely defined. We compared acute toxicity and oncologic outcomes in a large cohort of patients treated with IMRT or 3-dimensional conformal radiotherapy (3-DCRT), with or without elective nodal irradiation (ENI). METHODS A single-institution retrospective review was performed evaluating 145 consecutive patients with histologically confirmed stage III NSCLC treated with definitive chemoradiotherapy. Sixty-five (44.8%) were treated with 3-DCRT using ENI, 43 (30.0%) with 3-DCRT using involved-field radiotherapy (IFRT), and 37 (25.5%) with IMRT using IFRT. All patients received concurrent chemotherapy. Comparison of acute toxicities by treatment technique (IMRT vs. 3-DCRT) and extent of nodal irradiation (3-DCRT-IFRT vs. 3-DCRT-ENI) was performed for grade 2 or higher esophagitis or pneumonitis, number of acute hospitalizations, incidence of opioid requirement, percutaneous endoscopic gastrostomy utilization, and percentage weight loss during treatment. Local control and overall survival were analyzed by the Kaplan-Meier method. RESULTS We identified no significant differences in any measures of acute toxicity by treatment technique or extent of nodal irradiation. There was a trend toward lower rates of grade 2 or higher pneumonitis among IMRT patients compared to 3-DCRT patients (5.4% vs. 23.0%; P = .065). Local control and overall survival were similar between cohorts. CONCLUSION Acute and subacute toxicities were similar for patients treated with IMRT and with 3-DCRT with or without ENI, with a nonsignificant trend toward a reduction in pneumonitis with IMRT. Larger studies are needed to better define which patients will benefit from IMRT.
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Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Clayton B Hess
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA
| | - Allen M Chen
- Department of Radiation Oncology, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA.
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Zhu Z, Fu X. The radiation techniques of tomotherapy & intensity-modulated radiation therapy applied to lung cancer. Transl Lung Cancer Res 2015. [PMID: 26207214 DOI: 10.3978/j.issn.2218-6751.2015.01.07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Radiotherapy (RT) plays an important role in the management of lung cancer. Development of radiation techniques is a possible way to improve the effect of RT by reducing toxicities through better sparing the surrounding normal tissues. This article will review the application of two forms of intensity-modulated radiation therapy (IMRT), fixed-field IMRT and helical tomotherapy (HT) in lung cancer, including dosimetric and clinical studies. The advantages and potential disadvantages of these two techniques are also discussed.
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Affiliation(s)
- Zhengfei Zhu
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China ; 3 Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Xiaolong Fu
- 1 Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China ; 2 Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200433, China ; 3 Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China
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24
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Grant JD, Shirvani SM, Tang C, Juloori A, Rebueno NC, Allen PK, Chang JY. Incidence and predictors of severe acute esophagitis and subsequent esophageal stricture in patients treated with accelerated hyperfractionated chemoradiation for limited-stage small cell lung cancer. Pract Radiat Oncol 2015; 5:e383-91. [PMID: 25731965 DOI: 10.1016/j.prro.2015.01.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/31/2014] [Accepted: 01/12/2015] [Indexed: 12/25/2022]
Abstract
PURPOSE Clinical and dosimetric predictors of severe (grade 3 or greater) acute esophageal toxicity and subsequent esophageal dilation were explored in patients with limited-stage small cell lung cancer treated with accelerated hyperfractionated chemoradiation. METHODS AND MATERIALS A total of 130 patients were identified who were treated to 45 Gy in 1.5-Gy twice-daily fractions with concurrent platinum-based chemotherapy between 2000 and 2009. Data on clinical, disease-related, and treatment-related variables were collected. Patients with percutaneous endoscopic gastrostomy tube insertion or intravenous hydration because of poor oral intake were designated as having acute grade 3 esophagitis. Univariate and multivariate analyses that associated treatment characteristics with esophagitis were assessed via logistic regression, and optimal cut points were identified with recursive partitioning analysis. RESULTS Twenty-five patients developed severe acute esophagitis, at a rate of 26% (18/69) in patients treated with earlier 3-dimensional conformal radiation therapy techniques and 11.5% (7/61) in patients treated with intensity modulated radiation therapy techniques and omission of elective nodal irradiation. The incidence of esophageal stricture was 6% overall (8 of 128 eligible) but 26% (6/23) among those who experienced prior grade 3 acute esophagitis and 2% (2/105) among those with acute esophagitis less than or equal to grade 2. Significant multivariate predictors of acute esophagitis were mean dose and volume of esophagus receiving at least 5% to 35% of the prescribed dose (V5 to V40). Patients with V5 ≥ 74% had a 44.4% risk of severe acute esophagitis (12/27) versus 12.6% (13/103) among those with V5 < 74%. V45 was the only dosimetric predictor for esophageal stricture, with 13.7% of patients in whom V45 was ≥37.5% requiring subsequent dilation. CONCLUSIONS Modern radiation techniques are associated with a lower frequency of severe acute esophagitis than previous paradigms. The proportion of esophagus receiving low- to moderate-range doses (mean, V5 through V40) predicts acute esophagitis, whereas the proportion of esophagus that receives high doses (V45) predicts the development of esophageal stricture that requires dilation. Patients who develop grade 3 acute esophagitis are at significant risk for subsequent esophageal stricture, whereas those with acute esophagitis of grade 2 or less display minimal risk.
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Affiliation(s)
- Jonathan D Grant
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aditya Juloori
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Neal C Rebueno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joe Y Chang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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25
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Yuan L, Wu QJ, Yin F, Li Y, Sheng Y, Kelsey CR, Ge Y. Standardized beam bouquets for lung IMRT planning. Phys Med Biol 2015; 60:1831-43. [PMID: 25658486 DOI: 10.1088/0031-9155/60/5/1831] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The selection of the incident angles of the treatment beams is a critical component of intensity modulated radiation therapy (IMRT) planning for lung cancer due to significant variations in tumor location, tumor size and patient anatomy. We investigate the feasibility of establishing a small set of standardized beam bouquets for planning. The set of beam bouquets were determined by learning the beam configuration features from 60 clinical lung IMRT plans designed by experienced planners. A k-medoids cluster analysis method was used to classify the beam configurations in the dataset. The appropriate number of clusters was determined by maximizing the value of average silhouette width of the classification. Once the number of clusters had been determined, the beam arrangements in each medoid of the clusters were designated as the standardized beam bouquet for the cluster. This standardized bouquet set was used to re-plan 20 cases randomly selected from the clinical database. The dosimetric quality of the plans using the beam bouquets was evaluated against the corresponding clinical plans by a paired t-test. The classification with six clusters has the largest average silhouette width value and hence would best represent the beam bouquet patterns in the dataset. The results shows that plans generated with a small number of standardized bouquets (e.g. 6) have comparable quality to that of clinical plans. These standardized beam configuration bouquets will potentially help improve plan efficiency and facilitate automated planning.
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Affiliation(s)
- Lulin Yuan
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
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26
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Xia B, Hong LZ, Cai XW, Zhu ZF, Liu Q, Zhao KL, Fan M, Mao JF, Yang HJ, Wu KL, Fu XL. Phase 2 study of accelerated hypofractionated thoracic radiation therapy and concurrent chemotherapy in patients with limited-stage small-cell lung cancer. Int J Radiat Oncol Biol Phys 2014; 91:517-23. [PMID: 25481679 DOI: 10.1016/j.ijrobp.2014.09.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 08/28/2014] [Accepted: 09/30/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE To prospectively investigate the efficacy and toxicity of accelerated hypofractionated thoracic radiation therapy (HypoTRT) combined with concurrent chemotherapy in the treatment of limited-stage small-cell lung cancer (LS-SCLC), with the hypothesis that both high radiation dose and short radiation time are important in this setting. METHODS AND MATERIALS Patients with previously untreated LS-SCLC, Eastern Cooperative Oncology Group performance status of 0 to 2, and adequate organ function were eligible. HypoTRT of 55 Gy at 2.5 Gy per fraction over 30 days was given on the first day of the second or third cycle of chemotherapy. An etoposide/cisplatin regimen was given to 4 to 6 cycles. Patients who had a good response to initial treatment were offered prophylactic cranial irradiation. The primary endpoint was the 2-year progression-free survival rate. RESULTS Fifty-nine patients were enrolled from July 2007 through February 2012 (median age, 58 years; 86% male). The 2-year progression-free survival rate was 49.0% (95% confidence interval [CI] 35.3%-62.7%). Median survival time was 28.5 months (95% CI 9.0-48.0 months); the 2-year overall survival rate was 58.2% (95% CI 44.5%-71.9%). The 2-year local control rate was 76.4% (95% CI 63.7%-89.1%). The severe hematologic toxicities (grade 3 or 4) were leukopenia (32%), neutropenia (25%), and thrombocytopenia (15%). Acute esophagitis and pneumonitis of grade ≥3 occurred in 25% and 10% of the patients, respectively. Thirty-eight patients (64%) received prophylactic cranial irradiation. CONCLUSION Our study showed that HypoTRT of 55 Gy at 2.5 Gy per fraction daily concurrently with etoposide/cisplatin chemotherapy has favorable survival and acceptable toxicity. This radiation schedule deserves further investigation in LS-SCLC.
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Affiliation(s)
- Bing Xia
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China; Department of Radiation Oncology, Hangzhou Cancer Hospital, Hangzhou, China
| | - Ling-Zhi Hong
- Department of Oncology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xu-Wei Cai
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Zheng-Fei Zhu
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Qi Liu
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Kuai-Le Zhao
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Min Fan
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Jing-Fang Mao
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Huan-Jun Yang
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Kai-Liang Wu
- Department of Radiation Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - Xiao-Long Fu
- Department of Radiation Oncology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
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Intensity-modulated radiotherapy, not 3 dimensional conformal, is the preferred technique for treating locally advanced lung cancer. Semin Radiat Oncol 2014; 25:110-6. [PMID: 25771415 DOI: 10.1016/j.semradonc.2014.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
When used to treat lung cancer, intensity-modulated radiotherapy (IMRT) can deliver higher dose to the targets and spare more critical organs in lung cancer than can 3-dimensional conformal radiotherapy. However, tumor-motion management and optimized radiotherapy planning based on 4-dimensional computed tomography scanning are crucial to maximize the benefit of IMRT and to eliminate or minimize potential uncertainties. This article summarizes these strategies and reviews published findings supporting the safety and efficacy of IMRT for lung cancer.
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28
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Harris JP, Murphy JD, Hanlon AL, Le QT, Loo BW, Diehn M. A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2014; 88:872-84. [DOI: 10.1016/j.ijrobp.2013.12.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 10/21/2013] [Accepted: 12/10/2013] [Indexed: 12/25/2022]
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29
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Amini A, Byers LA, Welsh JW, Komaki RU. Progress in the management of limited-stage small cell lung cancer. Cancer 2013; 120:790-8. [PMID: 24327434 DOI: 10.1002/cncr.28505] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/30/2013] [Accepted: 11/04/2013] [Indexed: 12/25/2022]
Abstract
Approximately 15% of lung cancer cases are of the small cell subtype, but this variant is highly aggressive and is often diagnosed at advanced stages. Outcomes after current treatment regimens have been poor, with 5-year survival rates as low as 25% for patients with limited-stage disease. Advances in therapy for small cell lung cancer have included the development of more effective chemotherapeutic agents and radiation techniques. For example, hyperfractionated radiotherapy given early in the course of the disease can reduce local recurrence and extend survival. Other technologic advances in radiation planning and delivery such as intensity-modulated radiotherapy, image-guided adaptive radiotherapy, and 4-dimensional computed tomography/positron emission tomography have facilitated the design of treatment volumes that closely conform to the shape of the tumor, which allows higher radiation doses to be given while minimizing radiation-induced toxicity to adjacent structures. Future improvements in outcomes will require clarifying the molecular basis for this disease.
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Affiliation(s)
- Arya Amini
- Department, of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas; University of California at Irvine School of Medicine, Irvine, California
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