Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study

Feddock, Jonathan; Arnold, Susanne M.; Shelton, Brent J.; Sinha, Partha; Conrad, Gary; Chen, Li; Rinehart, John J.; McGarry, Ronald C.

doi:10.1016/j.ijrobp.2012.11.011

Cited by 93 publications

(79 citation statements)

References 12 publications

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“…In addition, doses larger than 2 Gy per fraction can be delivered to shorten the overall radiotherapy duration, counterbalancing tumor cell proliferation and increasing the probability of cure. A prospective feasibility study of stereotaxic body radiotherapy after conventional therapy, increasing the total dose to residual disease above 100 Gy, showed no increase in acute toxicity compared with what was expected after conventional chemoradiotherapy (21). Table 3 is a comparison with previous works.…”

Section: Discussionmentioning

confidence: 95%

“…An alternative approach could be to delineate smaller target volumes, based on 18 F-FDG uptake (e.g., .70% SUV max ), that could receive total doses much higher than the conventional range (60-74 Gy). Very high precision in radiotherapy delivery is therefore required to avoid excessive irradiation of the normal tissues surrounding the target volume (6,7,21). In addition, doses larger than 2 Gy per fraction can be delivered to shorten the overall radiotherapy duration, counterbalancing tumor cell proliferation and increasing the probability of cure.…”

Section: Discussionmentioning

confidence: 99%

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Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

et al. 2015

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The high rates of failure in the radiotherapy target volume suggest that patients with stage II or III non-small cell lung cancer (NSCLC) should receive an increased total dose of radiotherapy. Areas of high 18 F-FDG uptake on preradiotherapy 18 F-FDG PET/CT have been reported to identify intratumor subvolumes at high risk of relapse after radiotherapy. We wanted to confirm these observations on a cohort of patients included in 3 sequential prospective studies. Our aim was to assess an appropriate threshold (percentage of maximum standardized uptake value [SUV max ]) to delineate subvolumes on staging 18 F-FDG PET/CT scans assuming that a smaller target volume would facilitate isotoxic radiotherapy dose escalation. Methods: Thirty-nine patients with inoperable stage II or III NSCLC, treated with chemoradiation or with radiotherapy alone, were extracted from 3 prospective studies (ClinicalTrials. gov identifiers NCT01261585, NCT01261598, and RECF0645). All patients underwent 18 F-FDG PET/CT at initial staging, before radiotherapy, during radiotherapy, and during systematic follow-up in a single institution. All 18 F-FDG PET/CT acquisitions were coregistered on the initial scan. Various subvolumes in the initial acquisition (30%, 40%, 50%, 60%, 70%, 80%, and 90% SUV max thresholds) and in the 3 subsequent acquisitions (40% and 90% SUV max thresholds) were pasted on the initial scan and compared. Results: Seventeen patients had a local relapse. The SUV max measured during radiotherapy was significantly higher in locally relapsed tumors than in locally controlled tumors (mean, 6.8 vs. 4.6; P 5 0.02). The subvolumes delineated on initial PET/CT scans with 70%-90% SUV max thresholds were in good agreement with the recurrent volume at a 40% SUV max threshold (common volume/baseline volume, 0.60-0.80). The subvolumes delineated on initial PET/CT scans with 30%-60% SUV max thresholds were in good to excellent agreement with the core volume of the relapse (90% SUV max threshold) (common volume/recurrent volume and overlap fraction indices, 0.60-0.93). The agreement was moderate (.0.51) when a 70% SUV max threshold was used to delineate on initial PET/CT scans. Conclusion: High 18 F-FDG uptake areas on pretreatment PET/ CT scans identify tumor subvolumes at greater risk of relapse in patients with NSCLC treated by concomitant chemoradiation. We propose a 70% SUV max threshold to delineate areas of high 18 F-FDG uptake on initial PET/CT scans as the target volumes for potential radiotherapy dose escalation.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

et al. 2015

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“…The SBRT boost was delivered at a median of 2.0 months after chemoradiotherapy. 53 The treatment was well-tolerated, with 4 patients (11%) developing acute grade 3 pneumonitis and 1 patient (3%) developing late grade 3 pneumonitis. Early follow-up suggested a local control rate of 83%.…”

Section: Sbrt For Locally Advanced Nsclcmentioning

confidence: 86%

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

Chehade

Palma

2015

Reports of Practical Oncology & Radiotherapy

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“…SBRT has been investigated as a boost for persistent disease after chemoradiation of locally advanced NSCLC (35,36), or for salvage of recurrent disease (35,(37)(38)(39)(40). Most of the studies are retrospective, and the reported local control rate at 1 year ranged from 65% to 88%.…”

Section: Locally Advanced Non-small Cell Lung Cancer (Nsclc) or Recurmentioning

confidence: 99%

Stereotactic body radiotherapy: current strategies and future development

Tsang

2016

J. Thorac. Dis.

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Stereotactic body radiotherapy (SBRT) has emerged as the standard treatment for medically inoperable early-staged non-small cell lung cancer (NSCLC). The local control rate after SBRT is over 90%. Some forms of tumour motion management and image-guided radiation delivery techniques are the prerequisites for fulfilment of its goal to deliver a high radiation dose to the tumour target without overdosing surrounding normal tissues. In this review, the current strategies of tumour motion management will be discussed, followed by an overview of various image-guided radiotherapy (RT) systems and devices available for clinical practice. Besides medically inoperable stage I NSCLC, SBRT has also been widely adopted for treatment of oligometastasis involving the lungs. Its possible applications in various other cancer illnesses are under extensive exploration. The progress of SBRT is critically technology-dependent. With advancement of technology, the ideal of personalised, effective and yet safe SBRT is already on the horizon.

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Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study

Cited by 93 publications

References 12 publications

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

Stereotactic body radiotherapy: current strategies and future development

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Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study

Cited by 93 publications

References 12 publications

Areas of High 18F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Areas of High 18F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Stereotactic radiotherapy for early lung cancer: Evidence-based approach and future directions

Stereotactic body radiotherapy: current strategies and future development

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Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer

Areas of High ¹⁸F-FDG Uptake on Preradiotherapy PET/CT Identify Preferential Sites of Local Relapse After Chemoradiotherapy for Non–Small Cell Lung Cancer