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Cooke SA, de Ruysscher D, Sonke JJ, Belderbos JSA. In Response to Anselmo et al.: "Should dose intensification be discontinued or should accelerated schemes remain an important area of clinical research?". Radiother Oncol 2023:109690. [PMID: 37164108 DOI: 10.1016/j.radonc.2023.109690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/24/2023] [Indexed: 05/12/2023]
Affiliation(s)
- Saskia A Cooke
- Department of Radiation Oncology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands.
| | - Dirk de Ruysscher
- Department of Radiation Oncology (MAASTRO Clinic), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jan-Jakob Sonke
- Department of Radiation Oncology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - José S A Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
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Ajdari A, Liao Z, Mohan R, Wei X, Bortfeld T. Personalized mid-course FDG-PET based adaptive treatment planning for non-small cell lung cancer using machine learning and optimization. Phys Med Biol 2022; 67:10.1088/1361-6560/ac88b3. [PMID: 35947984 PMCID: PMC9579961 DOI: 10.1088/1361-6560/ac88b3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/10/2022] [Indexed: 11/12/2022]
Abstract
Objective. Traditional radiotherapy (RT) treatment planning of non-small cell lung cancer (NSCLC) relies on population-wide estimates of organ tolerance to minimize excess toxicity. The goal of this study is to develop a personalized treatment planning based on patient-specific lung radiosensitivity, by combining machine learning and optimization.Approach. Sixty-nine non-small cell lung cancer patients with baseline and mid-treatment [18]F-fluorodeoxyglucose (FDG)-PET images were retrospectively analyzed. A probabilistic Bayesian networks (BN) model was developed to predict the risk of radiation pneumonitis (RP) at three months post-RT using pre- and mid-treatment FDG information. A patient-specific dose modifying factor (DMF), as a surrogate for lung radiosensitivity, was estimated to personalize the normal tissue toxicity probability (NTCP) model. This personalized NTCP was then integrated into a NTCP-based optimization model for RT adaptation, ensuring tumor coverage and respecting patient-specific lung radiosensitivity. The methodology was employed to adapt the treatment planning of fifteen NSCLC patients.Main results. The magnitude of the BN predicted risks corresponded with the RP severity. Average predicted risk for grade 1-4 RP were 0.18, 0.42, 0.63, and 0.76, respectively (p< 0.001). The proposed model yielded an average area under the receiver-operating characteristic curve (AUROC) of 0.84, outperforming the AUROCs of LKB-NTCP (0.77), and pre-treatment BN (0.79). Average DMF for the radio-tolerant (RP grade = 1) and radiosensitive (RP grade ≥ 2) groups were 0.8 and 1.63,p< 0.01. RT personalization resulted in five dose escalation strategies (average mean tumor dose increase = 6.47 Gy, range = [2.67-17.5]), and ten dose de-escalation (average mean lung dose reduction = 2.98 Gy [0.8-5.4]), corresponding to average NTCP reduction of 15% [4-27].Significance. Personalized FDG-PET-based mid-treatment adaptation of NSCLC RT could significantly lower the RP risk without compromising tumor control. The proposed methodology could help the design of personalized clinical trials for NSCLC patients.
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Affiliation(s)
- Ali Ajdari
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation BioPhysics, Boston, MA
| | - Zhongxing Liao
- University of Texas’ MD Anderson Cancer Center, Department of Radiation Oncology, Division of Radiation Oncology, Houston, TX
| | - Radhe Mohan
- University of Texas’ MD Anderson Cancer Center, Department of Radiation Physics, Division of Radiation Oncology, Houston, TX
| | - Xiong Wei
- University of Texas’ MD Anderson Cancer Center, Department of Radiation Oncology, Division of Radiation Oncology, Houston, TX
| | - Thomas Bortfeld
- Massachusetts General Hospital and Harvard Medical School, Department of Radiation Oncology, Division of Radiation BioPhysics, Boston, MA
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3
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Kepka L, Socha J. Dose and fractionation schedules in radiotherapy for non-small cell lung cancer. Transl Lung Cancer Res 2021; 10:1969-1982. [PMID: 34012807 PMCID: PMC8107746 DOI: 10.21037/tlcr-20-253] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the field of radiotherapy (RT), the issues of total dose, fractionation, and overall treatment time for non-small cell lung cancer (NSCLC) have been extensively investigated. There is some evidence to suggest that higher treatment intensity of RT, when given alone or sequentially with chemotherapy (CHT), is associated with improved survival. However, there is no evidence that the outcome is improved by RT at a higher dose and/or higher intensity when it is used concurrently with CHT. Moreover, some reports on the combination of full dose CHT with a higher biological dose of RT warn of the significant risk posed by such intensification. Stereotactic body radiotherapy (SBRT) provides a high rate of local control in the management of early-stage NSCLC through the use of high ablative doses. However, in centrally located tumors the use of SBRT may carry a risk of serious damage to the great vessels, bronchi, and esophagus, owing to the high ablative doses needed for optimal tumor control. There is a similar problem with moderate hypofractionation in radical RT for locally advanced NSCLC, and more evidence needs to be gathered regarding the safety of such schedules, especially when used in combination with CHT. In this article, we review the current evidence and questions related to RT dose/fractionation in NSCLC.
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Affiliation(s)
- Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
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Wang J, Xu W, Zhang N, Yang C, Xu H, Wang Z, Li B, Ding J, Chen X. X-ray-responsive polypeptide nanogel for concurrent chemoradiotherapy. J Control Release 2021; 332:1-9. [PMID: 33561483 DOI: 10.1016/j.jconrel.2021.02.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/30/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023]
Abstract
Concurrent chemoradiotherapy (CCRT) is a standard treatment regimen for medically inoperable stage III non-small-cell lung carcinoma (NSCLC) owing to its superior prognostics compared with the sequential modality. Nevertheless, the current pattern of CCRT still fails to provide satisfactory survival outcome. Furthermore, CCRT is always accompanied by a higher risk of severe side effects, limiting the dose escalation. Herein, an X-ray-responsive polypeptide nanogel (PNG) was developed for on-demand delivery of chemotherapeutic agent triggered by radiotherapy to synergistically improve the efficacy of CCRT with reduced side effects. The smart PNG was formed by crosslinking methoxy poly(ethylene glycol)-block-poly(L-glutamic acid-co-γ-2-chloroethyl-L-glutamate) (mPEG-b-P(LG-co-CELG)) with a diselenide (Se-Se) bond. The doxorubicin (DOX)-loaded polypeptide nanogel (PNG/DOX) exhibited accelerated drug release when exposed to X-ray irradiation as a result of Se-Se bond degradation. With prolonged circulation and enhanced intratumoral accumulation in vivo, PNG/DOX combined with X-ray irradiation exhibited better synergistic antitumor efficacy and fewer side effects toward human A549 lung carcinoma-bearing nude mice. The smart X-ray-responsive nanogel provides a promising bridge between chemotherapy and radiotherapy and enhances the potential application of CCRT in clinic.
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Affiliation(s)
- Juan Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Ji'nan 250117, PR China; Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Weiguo Xu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
| | - Ning Zhang
- Department of Foot and Ankle Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Beiyuan Street, Ji'nan 250033, PR China
| | - Changsheng Yang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Ji'nan 250117, PR China
| | - Hengwei Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Ji'nan 250117, PR China
| | - Zhongtang Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Ji'nan 250117, PR China
| | - Baosheng Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, 440 Jiyan Road, Ji'nan 250117, PR China.
| | - Jianxun Ding
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China.
| | - Xuesi Chen
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, 5625 Renmin Street, Changchun 130022, PR China
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Lutz CM, Knap MM, Hoffmann L, Møller DS, Hansen O, Brink C, Schytte T, Nyhus CH, McCulloch T, Borissova S, Alber M, Khalil AA. Prospectively scored pulmonary toxicities in non-small cell lung cancer: Results from a randomized phase II dose escalation trial. Clin Transl Radiat Oncol 2021; 27:8-14. [PMID: 33385069 PMCID: PMC7770437 DOI: 10.1016/j.ctro.2020.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 10/26/2022] Open
Abstract
Purpose Prospectively scored radiation pneumonitis (RP) observed in a national, randomized phase II dose-escalation trial for patients with locally advanced non-small cell lung cancer (NSCLC) was investigated. Methods Patients with stage IIB-IIIB histologically proven NSCLC were treated with concomitant chemo-radiotherapy (oral Vinorelbine 3times/week) at 60 Gy/30fx (A-59pts) and 66 Gy/33fx (B-58pts) from 2009 to 2013 at five Danish RT centers. Grade 2 RP (CTCAEv3.0) was investigated with univariate analysis for association with clinical and dosimetric parameters, including dyspnea and cough at baseline and during RT. Multivariable logistic regression and Cox regression with regularization were used to find a multivariable model for RP ≥ G2. Results Despite a tendency of higher mean lung dose in the high-dose arm (median[range] A = 14.9 Gy[5.8,23.1], B = 17.5 Gy[8.6,24.8], p = 0.075), pulmonary toxicities were not significantly different (RP ≥ G2 41%(A) and 52%(B), p = 0.231). A Kaplan Meier analysis of the time to RP ≥ G2 between the two arms did not reach statistical significance (p = 0.180). Statistically significant risk factors for RP ≥ G2 were GTV size (OR = 2.091/100 cm3, p = 0.002), infection at baseline or during RT (OR = 8.087, p = 0.026), dyspnea at baseline (OR = 2.184, p = 0.044) and increase of cough during RT (OR = 2.787, p = 0.008). In the multivariable logistic regression and the Cox regression analysis, the deviances of the most predictive models were within one standard deviation of the null model. Conclusion No statistical difference between the high- and low dose arm was found in the risk of developing RP. The univariate analysis identified target volume, infection, dyspnea at baseline, and increase of cough during RT as risk factors for RP. The number of patients was too small to establish a statistically sound multivariable model.
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Affiliation(s)
- Christina M Lutz
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Marianne M Knap
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Lone Hoffmann
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte S Møller
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Olfred Hansen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Carsten Brink
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - Tine McCulloch
- Department of Oncology, Aalborg Hospital, Aalborg, Denmark
| | | | - Markus Alber
- Heidelberg Institute for Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Azza A Khalil
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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Isotoxic Intensity Modulated Radiation Therapy in Stage III Non-Small Cell Lung Cancer: A Feasibility Study. Int J Radiat Oncol Biol Phys 2020; 109:1341-1348. [PMID: 33232772 PMCID: PMC7955281 DOI: 10.1016/j.ijrobp.2020.11.040] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Not all patients with stage III non-small cell lung cancer (NSCLC) are suitable for concurrent chemoradiation therapy (CRT). Local failure rate is high for sequential concurrent CRT. As such, there is a rationale for treatment intensification. METHODS AND MATERIALS Isotoxic intensity modulated radiation therapy (IMRT) is a multicenter feasibility study that combines different intensification strategies including hyperfractionation, acceleration, and dose escalation facilitated by IMRT. Patients with unresectable stage III NSCLC, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 to 2, and unsuitable for concurrent CRT were recruited. A minimum of 2 cycles of platinum-based chemotherapy was compulsory before starting radiation therapy (RT). Radiation dose was increased until a maximum dose of 79.2 Gy was reached or 1 or more of the organs at risk met predefined constraints. RT was delivered in 1.8-Gy fractions twice daily, and an RT quality assurance program was implemented. The primary objective was the delivery of isotoxic IMRT to a dose >60 Gy equivalent dose in 2-Gy fractions (EQD2 assuming an α/β ratio of 10 Gy for acute reacting tissues). RESULTS Thirty-seven patients were recruited from 7 UK centers. Median age was 69.9 years (range, 46-86 years). The male-to-female ratio was 17:18. ECOG PS was 0 to 5 in 14.2% of patients; PS was 1 to 27 in 77.1% of patients; PS was 2 to 3 in 8.6% of patients. Stage IIIA:IIIB ratio was 22:13 (62.9%:37.1%). Of 37 patients, 2 (5.4%) failed to achieve EQD2 > 60 Gy. Median prescribed tumor dose was 77.4 Gy (range, 61.2-79.2 Gy). A maximum dose of 79.2Gy was achieved in 14 patients (37.8%). Grade 3 esophagitis was reported in 2 patients, and no patients developed grade 3 to 4 pneumonitis. There were 3 grade 5 events: acute radiation pneumonitis, bronchopulmonary hemorrhage, and acute lung infection. Median follow-up at time of analysis was 25.4 months (range, 8.0-44.2) months for 11 of 35 survivors. The median survival was 18.1 months (95% confidence interval [CI], 13.9-30.6), 2-year overall survival was 33.6% (95% CI, 17.9-50.1), and progression-free survival was 23.9% (95% CI, 11.3-39.1). CONCLUSIONS Isotoxic IMRT is a well-tolerated and feasible approach to treatment intensification.
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Safety and efficacy of reduced dose and margins to involved lymph node metastases in locally advanced NSCLC patients. Radiother Oncol 2020; 143:66-72. [DOI: 10.1016/j.radonc.2019.07.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/12/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
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Taugner J, Käsmann L, Eze C, Dantes M, Roengvoraphoj O, Gennen K, Karin M, Petruknov O, Tufman A, Belka C, Manapov F. Survival score to characterize prognosis in inoperable stage III NSCLC after chemoradiotherapy. Transl Lung Cancer Res 2019; 8:593-604. [PMID: 31737496 DOI: 10.21037/tlcr.2019.09.19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Stage III non-small cell lung cancer (NSCLC) represents a heterogeneous disease regarding principal patient- and tumor characteristics. A simple score may aid in personalizing multimodal therapy. Methods The data of 99 consecutive patients with performance status ECOG 0-1 treated until the end of 2016 with multimodal approach for inoperable NSCLC (UICC 7th edition stage IIIA/B) were evaluated. Patient- and tumor-related factors were examined for their impact on overall survival. Factors showing a negative association with prognosis were then included in the score. Three subgroups with low, intermediate and high-risk score were defined. The results were then validated in the prospective cohort, which includes 45 patients. Results Most Patients were treated with concurrent (78%) or sequential (11%) chemoradiotherapy. 53% received induction chemotherapy. Median survival for the entire cohort was 20.8 (range: 15.3-26.3) months. Age (P=0.020), gender (P=0.007), pack years (P=0.015), tumor-associated atelectasis (P=0.004) and histology (P=0.004) had a significant impact on overall survival and were scored with one point each. Twelve, 59 and 28 patients were defined to have a low (0-1 points), intermediate (2-3 points) and high-risk (4-5 points) score. Median survival, 1-, 2- and 3-year survival rates were not reached, 100%, 83% and 67% in the low, 22.9 months, 80%, 47% and 24% intermediate and 13.7 months, 57%, 25% and 18% high-risk patients, respectively (P<0.001). Median survival was not reached in prospective cohort; analysis has revealed a trend for the 1-year survival rates with 100% for the low, 93% intermediate and 69% high-risk patients (P=0.100). Conclusions The score demonstrated remarkable survival differences in inoperable stage III NSCLC patients with good performance status receiving multimodal therapy.
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Affiliation(s)
- Julian Taugner
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany
| | - Lukas Käsmann
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich, Munich, Germany
| | - Chukwuka Eze
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Maurice Dantes
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | - Olarn Roengvoraphoj
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany
| | - Kathrin Gennen
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany
| | - Monika Karin
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany
| | - Oleg Petruknov
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany
| | - Amanda Tufman
- Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany.,Division of Respiratory Medicine and Thoracic Oncology, Department of Internal Medicine V, Thoracic Oncology Centre Munich, Ludwig-Maximilians University, München, Germany
| | - Claus Belka
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany
| | - Farkhad Manapov
- Department of Radiation Oncology, University Hospital Munich (LMU), München, Germany.,Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
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Functional perfusion image guided radiation treatment planning for locally advanced lung cancer. PHYSICS & IMAGING IN RADIATION ONCOLOGY 2019; 11:76-81. [PMID: 33458283 PMCID: PMC7807615 DOI: 10.1016/j.phro.2019.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 01/28/2023]
Abstract
Background and purpose Functional avoidance radiation therapy (RT) aims at sparing functional lung regions. The purpose of this simulation study was to evaluate the feasibility of functional lung avoidance methodology in RT of lung cancer and to characterize the achievable dosimetry of single photon emission computed tomography (SPECT) guided treatment planning. Materials and methods Fifteen consecutive lung cancer patients were included and planned for definitive RT of 60–66 Gy in 2-Gy fractions. Two plans were optimized: a standard CT-plan, and functional SPECT-plan. The objective was to reduce dose to the highly functional lung subvolumes without compromising tumour coverage, and respecting dose to other organs at risk. For each patient a 3D-conformal, intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy plans were created for standard and functional avoidance. Standard versus functional dose-volume parameters for functional lung (FL) subvolumes, organs at risk and tumour coverage were compared. Results The largest dose reduction was achieved with IMRT plans. Functional plans resulted in dose reduction from 9.0 Gy to 6.7 Gy (mean reduction of 2.3 Gy or 26%) to the highest functional subvolume FL80% (95%CI 1.1; 3.5). Dose to FL40% was reduced from 13.3 Gy to 11.6 Gy with functional planning. Dose reduction to FL40% was 1.7 Gy (95%CI 0.9; 2.6). Functional volume of lung receiving over 20 Gy improved by 5% (standard 22%, functional 17%). Dose to organs at risk and tumour coverage were not significantly different between plans. Conclusions SPECT/CT-guided planning resulted in improved dose-volumetric outcomes for functional lung. This methodology may lead to potential reduction in radiation-induced lung toxicity.
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Deutsch E, Chargari C, Galluzzi L, Kroemer G. Optimising efficacy and reducing toxicity of anticancer radioimmunotherapy. Lancet Oncol 2019; 20:e452-e463. [DOI: 10.1016/s1470-2045(19)30171-8] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
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Vera P, Mihailescu SD, Lequesne J, Modzelewski R, Bohn P, Hapdey S, Pépin LF, Dubray B, Chaumet-Riffaud P, Decazes P, Thureau S. Radiotherapy boost in patients with hypoxic lesions identified by 18F-FMISO PET/CT in non-small-cell lung carcinoma: can we expect a better survival outcome without toxicity? [RTEP5 long-term follow-up]. Eur J Nucl Med Mol Imaging 2019; 46:1448-1456. [PMID: 30868230 DOI: 10.1007/s00259-019-04285-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 02/06/2019] [Indexed: 12/25/2022]
Abstract
PURPOSE Chemoradiotherapy is the reference curative-intent treatment for nonresectable locally advanced non-small-cell lung carcinoma (NSCLC), with unsatisfactory survival, partially due to radiation resistance in hypoxic tissues. The objective was to update survival and toxicity at 3 years following radiotherapy boost to hypoxic tumours in NSCLC patients treated with curative-intent chemoradiotherapy. METHODS This was an open-label, nonrandomized, multicentre, phase II clinical trial. 18F-Fluoromisonidazole (18F-FMISO) PET/CT was used to determine the hypoxic profile of the patients. 18F-FMISO-positive patients and those without organ-at-risk constraints received a radiotherapy boost (70-84 Gy); the others received standard radiotherapy (66 Gy). Overall survival (OS), progression-free survival (PFS) and safety were assessed. RESULTS A total of 54 patients were evaluated. OS and PFS rates at 3 years were 48.5% and 28.8%, respectively. The median OS in the 18F-FMISO-positive patients was 25.8 months and was not reached in the 18F-FMISO-negative patients (p = 0.01). A difference between the groups was also observed for PFS (12 months vs. 26.2 months, p = 0.048). In 18F-FMISO-positive patients, no difference was observed in OS in relation to dose, probably because of the small sample size (p = 0.30). However, the median OS seemed to be in favour of patients who received the radiotherapy boost (26.5 vs. 15.3 months, p = 0.71). In patients who received the radiotherapy boost, no significant late toxicities were observed. CONCLUSION 18F-FMISO uptake in NSCLC patients is strongly associated with features indicating a poor prognosis. In 18F-FMISO-positive patients, the radiotherapy boost seemed to improve the OS by 11.2 months. A further clinical trial is needed to investigate the efficacy of a radiotherapy boost in patients with hypoxic tumours.
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Affiliation(s)
- Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France.
| | - Sorina-Dana Mihailescu
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Justine Lequesne
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Romain Modzelewski
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Pierre Bohn
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Hapdey
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Louis-Ferdinand Pépin
- Department of Statistics and Clinical Research Unit, Henri Becquerel Cancer Center, Rouen, France
| | - Bernard Dubray
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
| | | | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Nuclear Medicine, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108 - FR CNRS 3638], Faculty of Medicine, University of Rouen, Rouen, France
- Department of Radiation Oncology, Henri Becquerel Cancer Center and Rouen University Hospital, & QuantIF - LITIS [EA (Equipe d'Accueil) 4108], Rouen, France
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Radiation Therapy in Non-small-Cell Lung Cancer. Radiat Oncol 2019. [DOI: 10.1007/978-3-319-52619-5_34-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Guckenberger M. Radiotherapy dose escalation in locally advanced NSCLC - The limits of conventional radiochemotherapy. Lung Cancer 2018; 126:208-209. [PMID: 30471812 DOI: 10.1016/j.lungcan.2018.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/08/2018] [Accepted: 11/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich (USZ), University of Zurich (UZH), Rämistrasse 100, CH - 8091, Zurich, Switzerland.
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