BACKGROUND: Sequential chemotherapy and individualised accelerated radiotherapy (INDAR) has been shown to be effective in non-small cell lung cancer (NSCLC), allowing delivering of high biological doses. We therefore performed a phase II trial (clinicaltrials.gov; NCT00572325) investigating the same strategy in concurrent chemo-radiation in stage III NSCLC. METHODS: 137 stage III patients fit for concurrent chemo-radiation (PS 0-2; FEV(1) and DLCO ≥ 30%) were included from April 2006 till December 2009. An individualised prescribed dose based on normal tissue dose constraints was applied: mean lung dose (MLD) 19 Gy, spinal cord 54 Gy, brachial plexus 66 Gy, central structures 74 Gy. A total dose between 51 and 69 Gy was delivered in 1.5 Gy BID up to 45 Gy, followed by 2 Gy QD. Radiotherapy was started at the 2nd or 3rd course of chemotherapy. Primary end-point was overall survival (OS) and secondary end-point toxicity common terminology criteria for adverse events v3.0 (CTCAEv3.0). FINDINGS: The median tumour volume was 76.4 ± 94.1 cc; 49.6% of patients had N2 and 32.1% N3 disease. The median dose was 65.0 ± 6.0 Gy delivered in 35 ± 5.7 days. Six patients (4.4%) did not complete radiotherapy. With a median follow-up of 30.9 months, the median OS was 25.0 months (2-year OS 52.4%). Severe acute toxicity (≥ G3, 35.8%) consisted mainly of G3 dysphagia during radiotherapy (25.5%). Severe late toxicity (≥ G3) was observed in 10 patients (7.3%). INTERPRETATION: INDAR in concurrent chemo-radiation based on normal tissue constraints is feasible, even in patients with large tumour volumes and multi-level N2-3 disease, with acceptable severe late toxicity and promising 2-year survival.
BACKGROUND: Sequential chemotherapy and individualised accelerated radiotherapy (INDAR) has been shown to be effective in non-small cell lung cancer (NSCLC), allowing delivering of high biological doses. We therefore performed a phase II trial (clinicaltrials.gov; NCT00572325) investigating the same strategy in concurrent chemo-radiation in stage III NSCLC. METHODS: 137 stage III patients fit for concurrent chemo-radiation (PS 0-2; FEV(1) and DLCO ≥ 30%) were included from April 2006 till December 2009. An individualised prescribed dose based on normal tissue dose constraints was applied: mean lung dose (MLD) 19 Gy, spinal cord 54 Gy, brachial plexus 66 Gy, central structures 74 Gy. A total dose between 51 and 69 Gy was delivered in 1.5 Gy BID up to 45 Gy, followed by 2 Gy QD. Radiotherapy was started at the 2nd or 3rd course of chemotherapy. Primary end-point was overall survival (OS) and secondary end-point toxicity common terminology criteria for adverse events v3.0 (CTCAEv3.0). FINDINGS: The median tumour volume was 76.4 ± 94.1 cc; 49.6% of patients had N2 and 32.1% N3 disease. The median dose was 65.0 ± 6.0 Gy delivered in 35 ± 5.7 days. Six patients (4.4%) did not complete radiotherapy. With a median follow-up of 30.9 months, the median OS was 25.0 months (2-year OS 52.4%). Severe acute toxicity (≥ G3, 35.8%) consisted mainly of G3 dysphagia during radiotherapy (25.5%). Severe late toxicity (≥ G3) was observed in 10 patients (7.3%). INTERPRETATION:INDAR in concurrent chemo-radiation based on normal tissue constraints is feasible, even in patients with large tumour volumes and multi-level N2-3 disease, with acceptable severe late toxicity and promising 2-year survival.
Authors: Marie Wanet; Antoine Delor; François-Xavier Hanin; Benoît Ghaye; Aline Van Maanen; Vincent Remouchamps; Christian Clermont; Samuel Goossens; John Aldo Lee; Guillaume Janssens; Anne Bol; Xavier Geets Journal: Strahlenther Onkol Date: 2017-07-21 Impact factor: 3.621
Authors: Melissa J J Voorn; Loes P A Aerts; Gerbern P Bootsma; Jacques B Bezuidenhout; Vivian E M van Kampen-van den Boogaart; Bart C Bongers; Dirk K de Ruysscher; Maryska L G Janssen-Heijnen Journal: Lung Date: 2021-03-10 Impact factor: 2.584
Authors: Ricky A Sharma; Ruth Plummer; Julie K Stock; Tessa A Greenhalgh; Ozlem Ataman; Stephen Kelly; Robert Clay; Richard A Adams; Richard D Baird; Lucinda Billingham; Sarah R Brown; Sean Buckland; Helen Bulbeck; Anthony J Chalmers; Glen Clack; Aaron N Cranston; Lars Damstrup; Roberta Ferraldeschi; Martin D Forster; Julian Golec; Russell M Hagan; Emma Hall; Axel-R Hanauske; Kevin J Harrington; Tom Haswell; Maria A Hawkins; Tim Illidge; Hazel Jones; Andrew S Kennedy; Fiona McDonald; Thorsten Melcher; James P B O'Connor; John R Pollard; Mark P Saunders; David Sebag-Montefiore; Melanie Smitt; John Staffurth; Ian J Stratford; Stephen R Wedge Journal: Nat Rev Clin Oncol Date: 2016-06-01 Impact factor: 66.675