The relationship between local dose and loss of function for irradiated lung

Gopal, Ramesh; Tucker, Susan L.; Komaki, Ritsuko; Liao, Zhongxing; Forster, Kenneth; Stevens, Craig W.; Kelly, James; Starkschall, George

doi:10.1016/s0360-3016(03)00094-4

Cited by 78 publications

(48 citation statements)

References 36 publications

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“…Increasing conventional RT dose from 40 -60 Gy and dose intensification with continuous hyperfractionated accelerated radiotherapy (CHART) result in improved local control and survival in patients treated with radical RT 1,2 . Increasing dose beyond the tolerance limits of normal lung, however, leads to an increased risk of radiation-induced pulmonary toxicity [3][4][5] . The addition of sequential or concomitant cisplatin-based chemotherapy to RT improves survival by 4-5% at 2 years.…”

Section: Introductionmentioning

confidence: 99%

Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters

Panakis

McNair

Christian

et al. 2008

Radiotherapy and Oncology

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Section: Introductionmentioning

confidence: 99%

Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters

Panakis

McNair

Christian

et al. 2008

Radiotherapy and Oncology

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“…A number of studies have reported potential deleterious effects of low-dose radiation. Gopal et al (2003) reported losses in the diffusing capacity of carbon monoxide in lung exposed to low-dose radiation. In addition, Hall (Hall, 2006) and Brenner et al (2003) suggested that more radiation-induced secondary cancers might be expected in long-term survivors treated with intensity-modulated RT.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcome of Helical Tomotherapy for Inoperable Non-Small Cell Lung Cancer: The Kyung Hee University Medical Center Experience

Kong¹,

Hong²

2014

Asian Pacific Journal of Cancer Prevention

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Background: Published studies on clinical outcome of helical tomotherapy for lung cancer are limited. The purpose of this study was to evaluate clinical outcomes and treatment-related toxicity in inoperable non-small cell lung cancer (NSCLC) patients treated with helical tomotherapy in Korea. Materials and Methods: Twentyseven patients with NSCLC were included in this retrospective study. Radiotherapy was performed using helical tomotherapy with a daily dose of 2.1-3 Gy delivered at 5 fractions per week resulting in a total dose of 62.5-69.3 Gy. We assessed radiation-related lung and esophageal toxicity, and analyzed overall survival, locoregional recurrence-free survival, distant metastasis-free survival, and prognostic factors for overall survival. Results: The median follow-up period was 28.9 months (range, 10.1-69.4). The median overall survival time was 28.9 months, and 1-, 2-, and 3-year overall survival rates were 96.2%, 92.0%, and 60.0%. The median locoregional recurrence-free survival time was 24.3 months, and 1-, 2-, and 3-year locoregional recurrence-free survival rates were 85.2%, 64.5%, and 50.3%. The median distant metastasis-free survival time was 26.7 months, and 1-, 2-, and 3-year distant metastasis-free survival rates were 92.3%, 83.9%, and 65.3%, respectively. Gross tumor volume was the most significant prognostic factor for overall survival. No grade 4 or more toxicity was observed. Conclusions: Helical tomotherapy in patients with inoperable NSCLC resulted in high survival rates with an acceptable level of toxicity, suggesting it is an effective treatment option in patients with medically inoperable NSCLC.

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“…42 Gopal et al demonstrated that local functional loss was nonexistent in lung subvolumes that received <10 Gy. 43 Compared with dose-escalated concurrent chemoradiation, the overall RTOG grade !3 late lung toxicity was equal to the 25% reported using CRT. 44 The reported 14% in DCs I, II, and III was in line with a retrospective analysis of IMRT for concurrent chemoradiation that even demonstrated an advantage over CRT.…”

Section: Discussionmentioning

confidence: 99%

Toxicity report of a phase 1/2 dose‐escalation study in patients with inoperable, locally advanced nonsmall cell lung cancer with helical tomotherapy and concurrent chemotherapy

Bral

Duchateau

Versmessen

et al. 2009

Cancer

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BACKGROUND:The objective of the current study was to evaluate the feasibility and toxicity of radiation dose escalation with concurrent chemotherapy using helical tomotherapy (HT) in patients with inoperable, locally advanced, stage III nonsmall cell lung cancer (LANSCLC) (grading determined according to the American Joint Committee on Cancer 6th edition grading system).METHODS:This phase 1/2 study was designed to determine the maximum tolerated dose (MTD) of radiotherapy in patients with LANSCLC administered concurrently with docetaxel and cisplatin. Radiotherapy was delivered using HT. A dose per fraction escalation was applied starting at 2 grays (Gy), with an increase of 6% per dose cohort (DC). The Radiation Therapy Oncology Group acute radiation morbidity score was used to monitor pulmonary, esophageal, and cardiac toxicity.RESULTS:Dose escalation was performed in 34 patients over 5 DCs to a dose per fraction of 2.48 Gy. No differences were observed in acute toxicity between the different DCs. However, a significant increase in late lung toxicity in DC IV, which received a fraction size of 2.36 Gy, necessitated a halt in further dose escalation with the MTD defined as 2.24 Gy per fraction. The overall incidence of acute grade ≥3 esophageal and pulmonary toxicity was 24% and 3%, respectively (grading determined according to the Radiation Therapy Oncology Group‐European Organisation for Research and Treatment of Cancer toxicity scoring system). The overall incidence of late lung toxicity was 21%, but the incidence was an acceptable 13% in DCs I, II, and III. The local response rate was 61% on computed tomography images.CONCLUSIONS:The use of HT to 67.2 Gy with concurrent cisplatin/docetaxel was feasible and resulted in acceptable toxicity. A full phase 2 study has been initiated to establish the true local response rate at the MTD of 2.24 Gy per fraction. Cancer 2010. © 2010 American Cancer Society.

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The relationship between local dose and loss of function for irradiated lung

Cited by 78 publications

References 36 publications

Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters

Defining the margins in the radical radiotherapy of non-small cell lung cancer (NSCLC) with active breathing control (ABC) and the effect on physical lung parameters

Clinical Outcome of Helical Tomotherapy for Inoperable Non-Small Cell Lung Cancer: The Kyung Hee University Medical Center Experience

Toxicity report of a phase 1/2 dose‐escalation study in patients with inoperable, locally advanced nonsmall cell lung cancer with helical tomotherapy and concurrent chemotherapy

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