Stereotactic Body Radiation Therapy Boost After Concurrent Chemoradiation for Locally Advanced Non-Small Cell Lung Cancer: A Phase 1 Dose Escalation Study

Hepel, Jaroslaw T.; Leonard, Kara L.; Safran, Howard; Ng, Tony; Taber, Angela Marie; Khurshid, Humera; Birnbaum, Ariel E.; Wazer, David E.; DiPetrillo, Thomas A.

doi:10.1016/j.ijrobp.2016.08.032

Cited by 41 publications

(50 citation statements)

References 25 publications

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“…4,5 For example, it has been demonstrated that dose escalation for non-small cell lung cancer (NSCLC) patients improves the overall survival but at the risk of toxicity in the lungs and heart. 6–8 For centrally located early-stage NSCLC, proximity of the mediastinum can preclude the use of ablative radiation techniques like stereotactic body radiation therapy (SBRT). 9 This is exacerbated by the large movements exhibited by some lung tumors due to respiration during therapy.…”

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confidence: 99%

Ultrasmall Silica-Based Bismuth Gadolinium Nanoparticles for Dual Magnetic Resonance–Computed Tomography Image Guided Radiation Therapy

et al. 2017

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Selective killing of cancer cells while minimizing damage to healthy tissues is the goal of clinical radiation therapy. This therapeutic ratio can be improved by image-guided radiation delivery and selective radiosensitization of cancer cells. Here, we have designed and tested a novel trimodal theranostic nanoparticle made of bismuth and gadolinium for on-site radiosensitization and image contrast enhancement to improve the efficacy and accuracy of radiation therapy. We demonstrate in vivo magnetic resonance (MR), computed tomography (CT) contrast enhancement, and tumor suppression with prolonged survival in a non-small cell lung carcinoma model during clinical radiation therapy. Histological studies show minimal off-target toxicities due to the nanoparticles or radiation. By mimicking existing clinical workflows, we show that the bismuth–gadolinium nanoparticles are highly compatible with current CT-guided radiation therapy and emerging MR-guided approaches. This study reports the first in vivo proof-of-principle for image-guided radiation therapy with a new class of theranostic nanoparticles.

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confidence: 99%

Ultrasmall Silica-Based Bismuth Gadolinium Nanoparticles for Dual Magnetic Resonance–Computed Tomography Image Guided Radiation Therapy

et al. 2017

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“…Four studies have looked at a SBRT boost to residual disease after conventional chemoradiation therapy to 50-60 Gy. In these small series with limited follow-up, local control at one year has been approximately 80% (43)(44)(45)(46), comparable to that of RTOG 0617, which was a mixed group that contained patients who had a complete response. Of the 80 patients in these four studies of SBRT boosts, there have been 5 (6.3%) lethal toxicities such as pulmonary hemorrhage, particularly with boosts to central disease near the main airways and mediastinum.…”

Section: Adapted Therapymentioning

confidence: 82%

Optimizing radiation dose and fractionation for the definitive treatment of locally advanced non-small cell lung cancer

Roach¹,

Bradley²,

Robinson³

2018

J. Thorac. Dis.

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Radiation therapy is the foundation for treatment of locally advanced non-small cell lung cancer (NSCLC), a disease that is often inoperable and has limited long term survival. Local control of disease is strongly linked to patient survival and continues to be problematic despite continued attempts at changing the dose and fractionation of radiation delivered. Technological advancements such as 4-dimensional computed tomography (CT) based planning, positron emission tomography (PET) based target delineation, and daily image guidance have allowed for ever more accurate and conformal treatments. A limit to dose escalation with conventional fractions of 2 Gy once per day appears to have been reached at 60 Gy in the randomized trial Radiation Therapy Oncology Group (RTOG) 0617. Higher doses were surprisingly associated with worse overall survival. Approaches other than conventional dose escalation have been explored to better control disease including accelerating treatment to limit tumor repopulation both with hyperfractionation and its multiple small (<2 Gy) fractions each day and with hypofractionation and its single larger (>2 Gy) fraction each day. These accelerated regimens are increasingly being used with concurrent chemotherapy, and multiple institutions have reported it as tolerable. Tailoring treatment to individual patient disease and normal anatomic characteristics has been explored with isotoxic dose escalation up to the tolerance of organs at risk, with both hyperfractionation and hypofractionation. Metabolic imaging during and after treatment is increasingly being used to boost doses to residual disease. Boost doses have included moderate hypofractionation of 2-4 Gy, and more recently extreme hypofractionation with stereotactic body radiation therapy (SBRT). In spite of all these changes in dose and fractionation, lung and cardiovascular toxicity remain obstacles that limit disease control and patient survival.

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“…To our knowledge we are the first to report about a successful simultaneous treatment planning procedure of SBRT and FRT, without increasing the overall treatment time. There are several studies reporting about the feasibility and tolerability of a sequential SBRT boost after CCRT in LA-NSCLC [21][22][23][24]. All these studies aim at a biological equivalent dose !100 Gy in order to achieve superior local control [25].…”

Section: Discussionmentioning

confidence: 99%

SBRT combined with concurrent chemoradiation in stage III NSCLC: Feasibility study of the phase I Hybrid trial

Peulen

Franssen

Belderbos

et al. 2020

Radiotherapy and Oncology

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Stereotactic Body Radiation Therapy Boost After Concurrent Chemoradiation for Locally Advanced Non-Small Cell Lung Cancer: A Phase 1 Dose Escalation Study

Cited by 41 publications

References 25 publications

Ultrasmall Silica-Based Bismuth Gadolinium Nanoparticles for Dual Magnetic Resonance–Computed Tomography Image Guided Radiation Therapy

Ultrasmall Silica-Based Bismuth Gadolinium Nanoparticles for Dual Magnetic Resonance–Computed Tomography Image Guided Radiation Therapy

Optimizing radiation dose and fractionation for the definitive treatment of locally advanced non-small cell lung cancer

SBRT combined with concurrent chemoradiation in stage III NSCLC: Feasibility study of the phase I Hybrid trial

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