Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

Cho, Won Kyung; Noh, Jae Myoung; Ahn, Yong Chan; Oh, Dongryul; Pyo, Hongryull

doi:10.4143/crt.2015.391

Cited by 13 publications

(11 citation statements)

References 21 publications

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“…Less toxicity was reported in the 15-fraction arm. Cho et al [21] retrospectively reviewed hypofractionated radiotherapy for medically inoperable T1eT3 N0 NSCLC using a risk-adaptive dose schedule (60 Gy in four, 15 or 20 fractions depending on location, size and geometry of the tumour in relation to the oesophagus). In total, 124 patients were included in the study: 72.6% had T1e2 N0 tumours; 65.3% had centrally located disease; 44.1% had performance status 2e3; and 20.2% received 60 Gy/15 fractions.…”

Section: Evidencementioning

confidence: 99%

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

et al. 2020

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Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dosefractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic.Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/ 03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should

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Section: Evidencementioning

confidence: 99%

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

et al. 2020

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“…However, due to the lack of confirmatory level I trial evidence, caution needs to be exercised when using this schedule concurrent with chemotherapy in patients with bulky mediastinal disease. Other options available are 60−72 Gy at 20-24 fx [16]. For those patients with concurrent chemotherapy, RT should be started on day 1 of chemotherapy, so only two cycles will be needed [17].…”

Section: Methodsmentioning

confidence: 99%

“…Multiple older studies [19] showed no survival benefit to PORT but recent data suggest benefit of modern PORT for pN2 patients [20]. PORT in pN2 or incompletely resected stage II and III NSCLC could be reasonably delayed with an imaging re-evaluation before treatment at 2−3 months or treated in 20 fractions (55−60 Gy) [15,16,21]. 5 In NSCLC patients with limited metastases, local consolidative therapy with RT could be either delayed or even omitted since there is no phase III evidence showing a survival benefit in this subset of patients.…”

Section: Suggested Recommendations (mentioning

confidence: 99%

“…To optimize resources, shorter schedules should be privileged, allowing access to more T3 tumors with chest wall invasion, synchronous multiple primary lung cancer, and as a salvage therapy after prior RT[14]. Consider 55−60 Gy in 15−20 fractions in early-stage patients not suitable for SABR[15,16]. 3 Offer RT in 20 fractions (55 Gy) for stage II-III patients requiring thoracic RT with NSCLC.…”

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confidence: 99%

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Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

et al. 2020

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COVID-19 has spread around the planet, sending billions of people into lockdown as health services struggle to cope. Meanwhile in Asia, where the disease began, the spread continues, in China it seems for now to have passed its peak. Italy, Spain, France, UK, and the US have been the countries more affected in terms of deaths. The coronavirus is more dangerous to the elderly and those with certain pre-existing medical conditions which is precisely the profile of lung cancer patients. Essential cancer services should be delivered but all steps should be taken to protect patients and the health workforce from infection with COVID-19. This presents a major challenge to radiotherapy (RT) departments worldwide. An international panel with expertise in the management of lung cancer in high-volume comprehensive centres has come together to share its experience on COVID-19 preparedness to deliver optimal care in such exceptional circumstances. A comprehensive systematic review of the literature through a PubMed search was undertaken. Twelve recommendations including, among others, the consideration of shorter courses, delays, and the omission of RT for lung cancer are proposed by the panel. In summary, we recommend the screening of every single person accessing the treatment room, the consideration of hypofractionation and to delay postoperative RT for non-small cell lung cancer, to avoid twice-daily treatments and delay or deliver prophylactic cranial irradiation during radio(chemo)therapy for limited-stage small cell lung cancer, review image guided RT images for suspicious image findings, and the use of single-fraction RT for the palliative treatment of stage IV lung cancer patients. Given that lung cancer is one of the most common and severe pathologies in radiation oncology departments, the following recommendations require particularly urgent consideration. The decision-making paths strongly depend on locally available resources, and a tailored approach should be used to attend lung cancer patients during this pandemic.

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“…The planning target volume or block margin was determined based on the RT modalities: 5 mm for IMRT, stereotactic body radiotherapy (SBRT), and PBT; and 1.0-1.5 cm for three-dimensional conformal radiotherapy (3D-CRT). RT doses were administered in various fractionated schedules based on the treatment conditions, including the estimated risk of esophagitis: 60-70 Gy with 2-2.2 Gy per fraction for concurrent chemoradiotherapy, 50-66 Gy with 2-8 Gy per fraction for RT alone, and 48-60 Gy with 12-15 Gy per fraction for SBRT [3,5,10,11]. Generally, the dose fractionation schedules did not differ between XRT and PBT or between the two centers.…”

Section: Re-irradiationmentioning

confidence: 99%

Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer

Yang

Suh

Shin

et al. 2022

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This study evaluated the toxicity associated with radiation techniques on curative re-irradiation (re-RT) in patients with thoracic recurrence of non-small cell lung cancer (NSCLC). From 2011 to 2019, we retrospectively reviewed the data of 63 patients with salvage re-RT for in-field or marginal recurrence of NSCLC at two independent institutions. Re-RT techniques using X-ray beams and proton beam therapy (PBT) were also included. Re-RT had a 2-year overall survival (OS) and local progression-free survival of 48.0% and 52.0%, respectively. Fifteen patients experienced grade 3 or higher toxicity after re-RT. The complication rates were 18.2% (4/22) and 26.8% (11/41) in PBT patients and X-ray patients, respectively. Airway or esophageal fistulas occurred in seven patients (11.1%). Fistulas or severe airway obstruction occurred in patients with tumors adjacent to the proximal bronchial tree and esophagus, who underwent hypofractionated radiotherapy (RT) or concurrent chemotherapy, and with a higher dose exposure to the esophagus. In conclusion, salvage re-RT was feasible even in patients with local recurrence within the previous RT field. PBT showed similar survival outcomes and toxicity to those of other techniques. However, thoracic re-RT should be performed carefully considering tumor location and RT regimens such as the fraction size and concurrent chemotherapy.

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Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

Cited by 13 publications

References 21 publications

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

Reduced Fractionation in Lung Cancer Patients Treated with Curative-intent Radiotherapy during the COVID-19 Pandemic

Optimizing lung cancer radiation treatment worldwide in COVID-19 outbreak

Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer

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