Chris R Kelsey1, Shiva Das2, Lin Gu3, Frank R Dunphy4, Neal E Ready4, Lawrence B Marks2. 1. Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina. Electronic address: christopher.kelsey@duke.edu. 2. Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. 3. Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina. 4. Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Abstract
PURPOSE: To determine the maximum tolerated dose of radiation therapy (RT) given in an accelerated fashion with concurrent chemotherapy using intensity modulated RT. METHODS AND MATERIALS: Patients with locally advanced lung cancer (non-small cell and small cell) with good performance status and minimal weight loss received concurrent cisplatin and etoposide with RT. Intensity modulated RT with daily image guidance was used to facilitate esophageal avoidance and delivered using 6 fractions per week (twice daily on Fridays with a 6-hour interval). The dose was escalated from 58 Gy to a planned maximum dose of 74 Gy in 4 Gy increments in a standard 3 + 3 trial design. Dose-limiting toxicity (DLT) was defined as acute grade 3-5 nonhematologic toxicity attributed to RT. RESULTS: A total of 24 patients were enrolled, filling all dose cohorts, all completing RT and chemotherapy as prescribed. Dose-limiting toxicity occurred in 1 patient at 58 Gy (grade 3 esophagitis) and 1 patient at 70 Gy (grade 3 esophageal fistula). Both patients with DLTs had large tumors (12 cm and 10 cm, respectively) adjacent to the esophagus. Three additional patients were enrolled at both dose cohorts without further DLT. In the final 74-Gy cohort, no DLTs were observed (0 of 6). CONCLUSIONS: Dose escalation and acceleration to 74 Gy with intensity modulated RT and concurrent chemotherapy was tolerable, with a low rate of grade ≥3 acute esophageal reactions.
PURPOSE: To determine the maximum tolerated dose of radiation therapy (RT) given in an accelerated fashion with concurrent chemotherapy using intensity modulated RT. METHODS AND MATERIALS: Patients with locally advanced lung cancer (non-small cell and small cell) with good performance status and minimal weight loss received concurrent cisplatin and etoposide with RT. Intensity modulated RT with daily image guidance was used to facilitate esophageal avoidance and delivered using 6 fractions per week (twice daily on Fridays with a 6-hour interval). The dose was escalated from 58 Gy to a planned maximum dose of 74 Gy in 4 Gy increments in a standard 3 + 3 trial design. Dose-limiting toxicity (DLT) was defined as acute grade 3-5 nonhematologic toxicity attributed to RT. RESULTS: A total of 24 patients were enrolled, filling all dose cohorts, all completing RT and chemotherapy as prescribed. Dose-limiting toxicity occurred in 1 patient at 58 Gy (grade 3 esophagitis) and 1 patient at 70 Gy (grade 3 esophageal fistula). Both patients with DLTs had large tumors (12 cm and 10 cm, respectively) adjacent to the esophagus. Three additional patients were enrolled at both dose cohorts without further DLT. In the final 74-Gy cohort, no DLTs were observed (0 of 6). CONCLUSIONS: Dose escalation and acceleration to 74 Gy with intensity modulated RT and concurrent chemotherapy was tolerable, with a low rate of grade ≥3 acute esophageal reactions.
Authors: Kyle J Lafata; Michael N Corradetti; Junheng Gao; Corbin D Jacobs; Jingxi Weng; Yushi Chang; Chunhao Wang; Ace Hatch; Eric Xanthopoulos; Greg Jones; Chris R Kelsey; Fang-Fang Yin Journal: Radiol Imaging Cancer Date: 2021-04
Authors: James J Urbanic; Xiaofei Wang; Jeffrey A Bogart; Thomas E Stinchcombe; Lydia Hodgson; Steven E Schild; Lyudmila Bazhenova; Olwen Hahn; Ravi Salgia; Everett E Vokes Journal: Int J Radiat Oncol Biol Phys Date: 2018-01-31 Impact factor: 7.038
Authors: Hao Gao; Chris R Kelsey; John Boyle; Tianyi Xie; Suzanne Catalano; Xiaofei Wang; Fang-Fang Yin Journal: Technol Cancer Res Treat Date: 2019 Jan-Dec
Authors: Michael N Corradetti; Jordan A Torok; Ace J Hatch; Eric P Xanthopoulos; Kyle Lafata; Corbin Jacobs; Christel Rushing; John Calaway; Greg Jones; Chris R Kelsey; Andrew B Nixon Journal: Adv Radiat Oncol Date: 2019-05-22