Intensity-Modulated Radiotherapy for Lung Cancer: Current Status and Future Developments

Chan, Clara C.; Lang, Stephanie; Rowbottom, C.; Gückenberger, Matthias; Faivre-Finn, Corinne

doi:10.1097/jto.0000000000000346

Cited by 66 publications

(44 citation statements)

References 79 publications

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“…Several studies have shown reduced toxicity for head and neck (4, 25) and breast cancer (26). For many clinical indications, superiority of IMRT has not been proven, or was proven only after IMRT was widely adopted (27). Also, the impact of an increase in the volume proximal to the tumor receiving a low radiation dose on the induction of secondary tumors has been insufficiently investigated.…”

Section: Discussionmentioning

confidence: 99%

R-IDEAL: A Framework for Systematic Clinical Evaluation of Technical Innovations in Radiation Oncology

et al. 2017

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The pace of innovation in radiation oncology is high and the window of opportunity for evaluation narrow. Financial incentives, industry pressure, and patients’ demand for high-tech treatments have led to widespread implementation of innovations before, or even without, robust evidence of improved outcomes has been generated. The standard phase I–IV framework for drug evaluation is not the most efficient and desirable framework for assessment of technological innovations. In order to provide a standard assessment methodology for clinical evaluation of innovations in radiotherapy, we adapted the surgical IDEAL framework to fit the radiation oncology setting. Like surgery, clinical evaluation of innovations in radiation oncology is complicated by continuous technical development, team and operator dependence, and differences in quality control. Contrary to surgery, radiotherapy innovations may be used in various ways, e.g., at different tumor sites and with different aims, such as radiation volume reduction and dose escalation. Also, the effect of radiation treatment can be modeled, allowing better prediction of potential benefits and improved patient selection. Key distinctive features of R-IDEAL include the important role of predicate and modeling studies (Stage 0), randomization at an early stage in the development of the technology, and long-term follow-up for late toxicity. We implemented R-IDEAL for clinical evaluation of a recent innovation in radiation oncology, the MRI-guided linear accelerator (MR-Linac). MR-Linac combines a radiotherapy linear accelerator with a 1.5-T MRI, aiming for improved targeting, dose escalation, and margin reduction, and is expected to increase the use of hypofractionation, improve tumor control, leading to higher cure rates and less toxicity. An international consortium, with participants from seven large cancer institutes from Europe and North America, has adopted the R-IDEAL framework to work toward coordinated, evidence-based introduction of the MR-Linac. R-IDEAL holds the promise for timely, evidence-based introduction of radiotherapy innovations with proven superior effectiveness, while preventing unnecessary exposure of patients to potentially harmful interventions.

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Section: Discussionmentioning

confidence: 99%

R-IDEAL: A Framework for Systematic Clinical Evaluation of Technical Innovations in Radiation Oncology

et al. 2017

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“…For example, does VMAT with full Arc possibly increase toxicity compared with three-dimensional conformal radiation therapy? 42 Investigating this research question would be very meaningful. We are convinced, however, that a systematic collaboration between centres, e.g.…”

Section: Discussionmentioning

confidence: 99%

What is the degree of innovation routinely implemented in Dutch radiotherapy centres? A multicentre cross-sectional study

Jacobs¹,

Boersma²,

Dekker³

et al. 2016

BJR

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Objective:To study the implementation of innovation activities in Dutch radiotherapy (RT) centres in a broad sense (product, technological, market and organizational innovations).Methods:A descriptive cross-sectional study was conducted in 15 Dutch RT centres. A list of innovations implemented from 2011 to 2013 was drawn up for each centre using semi-structured interviews. These innovations were classified into innovation categories according to previously defined innovation indicators. Where applicable, each innovation was rated by each centre on the effort required to implement it and on its expected effects, to get an impression of how far reaching and radical the innovations were and to be able to compare the number of innovations between centres.Results:The participating RT centres in the Netherlands implemented 12 innovations per year on average (range 5–25); this number was not significantly different for academic (n = 13) or non-academic centres (n = 10). Several centres were dealing with the same innovations at the same time. The average required effort and expected output did not differ significantly between product, technological and organizational innovation or between academic and non-academic centres.Conclusion:The number of innovations observed per centre varied across a large range, with a large overlap in terms of the type of innovations that were implemented. Registering innovations using the innovation indicators applied in our study would make it possible to improve collaboration between centres, e.g. with common training modules, to avoid duplication of work.Advances in knowledge:This study is the first of its kind investigating innovation implementation in RT in a broad sense.

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“…3 This can be achieved through the use of advanced radiotherapy techniques. 84,85 Both the lung V20 (volume of lungs minus the planning target volume receiving 20 Gy) and the mean lung dose (volumes of lungs minus the gross tumor volume) correlate with the risk of radiation pneumonitis. 3 The V20 or the mean lung dose should be kept below 35%e37% and 20 Gy, respectively.…”

Section: Radiotherapy Techniques and Chemotherapy Adjustments To Prevmentioning

confidence: 99%

Recommendation for supportive care in patients receiving concurrent chemotherapy and radiotherapy for lung cancer

et al. 2020

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Concurrent chemotherapy and radiotherapy (CCRT) followed by durvalumab immune therapy in appropriate patients is considered to be the standard of care in most fit stage III non-small-cell lung cancer (NSCLC) patients. However, CCRT is a toxic treatment that affects all organ systems and may cause acute and permanent side effects, some of which may be lethal. Supportive care is therefore of utmost importance in this clinical setting. A group of experts from the European Society for Therapeutic Radiology and Oncology (ESTRO) and the European Society of Medical Oncology (ESMO) identified the following items of importance for further improvement of supportive care: smoking cessation; nutrition before and during CCRT (including treatment and prevention of anorexia); physical exercise before and during CCRT; prevention and treatment of acute esophagitis and dysphagia; treatment of cough and dyspnea; treatment of skin reactions; treatment of fatigue; prophylaxis of nausea and emesis; prevention, diagnosis, and treatment of cardiac disease and damage; and optimization of radiotherapy techniques and chemotherapy adjustments to reduce toxicity in the era of immune therapy. The resulting recommendations are summarized in this manuscript and knowledge gaps identified, in which future investments are needed to improve supportive care and hence quality of life and survival for our stage III NSCLC patients.

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Intensity-Modulated Radiotherapy for Lung Cancer: Current Status and Future Developments

Cited by 66 publications

References 79 publications

R-IDEAL: A Framework for Systematic Clinical Evaluation of Technical Innovations in Radiation Oncology

R-IDEAL: A Framework for Systematic Clinical Evaluation of Technical Innovations in Radiation Oncology

What is the degree of innovation routinely implemented in Dutch radiotherapy centres? A multicentre cross-sectional study

Recommendation for supportive care in patients receiving concurrent chemotherapy and radiotherapy for lung cancer

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