Failure Patterns and Toxicity of Concurrent Proton Therapy and Chemotherapy for Stage III Non–small Cell Lung Cancer

Chang, John; Komaki, Ritsuko; Bucci, M. Kara; Lü, Chao; Wen, Huiyu; Degracia, B.; Gillin, Michael; Mohan, Radhe; Cox, J.D.

doi:10.1016/j.ijrobp.2009.07.1021

Cited by 8 publications

(3 citation statements)

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“…Chang et al reported the initial data on 42 patients diagnosed with stage III non-small cell lung cancer and treated with thoracic radiotherapy using proton beam therapy to a total dose of 74 CGE (Cobalt-Gray Equivalent) with concurrent carboplatin and paclitaxel. Esophagitis was reported in only 6.7% of the cases [40]. While these results are encouraging, the use of proton beam radiotherapy for lung cancer should be validated in prospective studies.…”

Section: Strategies Used To Prevent or Treat Esophagitismentioning

confidence: 99%

Esophagitis, Treatment-Related Toxicity in Non-Small Cell Lung Cancer

Bar‐Ad¹,

Ohri²,

Werner‐Wasik³

2012

RRCT

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Objectives Radiation esophagitis represents a significant complication experienced by non-small cell cancer (NSCLC) patients receiving thoracic irradiation. The objective of the current review was to assess the clinical and dosimetrical parameters that may predict radiation esophagitis. Methods Studies were identified by searching PubMed electronic databases. Both prospective and retrospective studies were included. Information regarding clinical and dosimetrical parameters predicting for radiation-induced esophagitis was extracted and analyzed. Results The esophageal clinical and dosimetric parameters that best predict acute esophagitis remain unclear. In many reports, Vx (the volume of esophagus receiving x Gy) stands out, with values of x ranging from 20–70 Gy. Other studies conclude that the maximal dose received by any point of the esophagus is the best predictor of esophagitis. Another metric implicated with esophageal toxicity in some reports is the proportion of the esophageal circumference or surface area that receives high doses of radiation. Conclusions Technological advancements in patient immobilization, setup verification, and radiotherapy delivery are increasingly being employed to limit the toxicity of thoracic irradiation. Future efforts are required to determine how these complex techniques should best be implemented to minimize the risks of acute and long-term esophageal injury.

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Section: Strategies Used To Prevent or Treat Esophagitismentioning

confidence: 99%

Esophagitis, Treatment-Related Toxicity in Non-Small Cell Lung Cancer

Bar‐Ad¹,

Ohri²,

Werner‐Wasik³

2012

RRCT

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“…The first phase II clinical trial using concurrent chemo and proton therapy to 74 Gy (RBE) in 42 patients with stage III NSCLC was presented recently and 87% local control was achieved with no grade 4 and above toxicity and minimal grade 3 esophagitis/pneumonitis. 18 Some technical issues unique to proton beam therapy have been discussed. There is some geometric uncertainty about the range of a given proton beam, and differences in tissue density between tumors and surrounding normal lung tissue can have a profound effect on proton beam planning.…”

Section: Proton Beam Radiotherapymentioning

confidence: 99%

ACR Appropriateness Criteria® Nonsurgical Treatment for Non-Small-Cell Lung Cancer: Good Performance Status/Definitive Intent

Gewanter¹,

Rosenzweig²,

Chang³

et al. 2010

Current Problems in Cancer

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The optimal strategy for the non-surgical definitive treatment of patients with good performance status non-small cell lung cancer (mostly with locally advanced disease) has dramatically evolved over time. This article presents evidence-based data to review this literature. Several decades ago, the standard treatment for most stage III inoperable NSCLC was definitive radiation therapy alone. Randomized trials have since shown superior results with sequential chemotherapy and radiation, and more recently with concurrent chemoradiation, the current standard of care. Studies suggest a limited role for induction or adjuvant systemic therapy in addition to concurrent chemoradiation. The role of altered radiation fractionation techniques, such as hyperfractionation for locally advanced disease or hypofractionation for early stage disease is also discussed. More recently, the application of more advanced radiation techniques has been explored, including intensity modulated radiation therapy (IMRT) and proton beam radiation. Finally, various case variants are presented as examples of state-of-the-art treatment approaches.

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“…Three main factors contribute to local treatment failure after radiotherapy: (1) geographic misses due to inadequacy of imaging tools for staging and radiotherapy planning; (2) geographic misses due to respiration-induced tumor motion and anatomic changes during radiation delivery; and (3) inadequate radiation dose due to concerns about toxicity. Three-dimensional conformal radiotherapy (3-D CRT) 2–3 and, recently, stereotactic body radiation therapy (SBRT)4–9, intensity-modulated radiation therapy (IMRT) 10, 11, and proton therapy 12–15 using dose-escalated treatment appear to improve local disease control and possibly survival with reduced toxicity in NSCLC.…”

Section: Introductionmentioning

confidence: 99%

Improving Radiation Conformality in the Treatment of Non–Small-Cell Lung Cancer

Chang

Cox

2010

Seminars in Radiation Oncology

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One of the many challenges of lung cancer radiotherapy is conforming the radiation dose to the target due to tumor/organ motion and the need to spare surrounding critical structures. Evolving radiotherapy technologies, such as four-dimensional (4-D) image-based motion management, daily on-board imaging and adaptive radiotherapy, have enabled us to improve the therapeutic index of radiation therapy for lung cancer by permitting the design of personalized treatments that deliver adequate doses conforming to the target while sparing the surrounding critical normal tissues. Four-dimensional computed tomography (CT) image-based motion management provides an opportunity to individualize target motion margins and reduce the risk of a geographical target miss. Daily on-board imaging and adaptive radiotherapy reduce set-up and motion/anatomy uncertainties over the course of radiotherapy. These achievements in image guidance have permitted the implementation in lung cancer patients of highly conformal treatment delivery techniques that are exquisitely sensitive to organ motion and anatomic change such as intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton therapy. More clinical studies are needed to further optimize conformal radiotherapy using individualized treatment adaptations based on changes in anatomy and tumor motion during the course of radiotherapy and using functional and biological imaging to selectively escalate doses to radioresistant subregions within the tumor.

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Failure Patterns and Toxicity of Concurrent Proton Therapy and Chemotherapy for Stage III Non–small Cell Lung Cancer

Cited by 8 publications

References 0 publications

Esophagitis, Treatment-Related Toxicity in Non-Small Cell Lung Cancer

Esophagitis, Treatment-Related Toxicity in Non-Small Cell Lung Cancer

ACR Appropriateness Criteria® Nonsurgical Treatment for Non-Small-Cell Lung Cancer: Good Performance Status/Definitive Intent

Improving Radiation Conformality in the Treatment of Non–Small-Cell Lung Cancer

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