Ditte Sloth Møller1, Tine Bjørn Nielsen2, Carsten Brink2, Lone Hoffmann3, Christina Maria Lutz3, Mikkel Drøgemüller Lund4, Olfred Hansen2, Tine Schytte2, Azza Ahmed Khalil3, Marianne Marquard Knap3, Christa Haugaard Nyhus4, Wiviann Ottosson5, Patrik Sibolt6, Svetlana Borissova5, Mirjana Josipovic7, Gitte Persson8, Ane Lindegaard Appelt9. 1. Department of Oncology, Aarhus University Hospital, Denmark. Electronic address: dittmoel@rm.dk. 2. Laboratory of Radiation Physics and Department of Oncology, Odense University Hospital, Odense, Denmark. 3. Department of Oncology, Aarhus University Hospital, Denmark. 4. Department of Oncology, Vejle Hospital, Vejle, Denmark. 5. Radiotherapy Research Unit, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark. 6. Radiotherapy Research Unit, Department of Oncology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark; Center for Nuclear Technologies, Technical University of Denmark, Roskilde, Denmark. 7. Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Niels Bohr Institute, University of Copenhagen, Copenhagen, Denmark. 8. Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. 9. Department of Oncology, Vejle Hospital, Vejle, Denmark; Leeds Institute of Cancer and Pathology, University of Leeds and Leeds Cancer Centre, St James's University Hospital, Leeds, UK.
Abstract
BACKGROUND AND PURPOSE:Local recurrence is frequent in locally advanced NSCLC and is primarily located in FDG-avid parts of tumour and lymph nodes. Aiming at improving local control without increasing toxicity, we designed a multi-centre phase-III trial delivering inhomogeneous dose-escalation driven by FDG-avid volumes, while respecting normal tissue constraints and requiring no increase in mean lung dose. Dose-escalation driven by FDG-avid volumes, delivering mean doses of 95Gy (tumour) and 74Gy (lymph nodes), was pursued and compared to standard 66Gy/33F plans. MATERIAL AND METHODS: Dose plans for the first thirty patients enroled were analysed. Standard and escalated plans were created for all patients, blinded to randomization, and compared for each patient in terms of the ability to escalate while protecting normal tissue. RESULTS: The median dose-escalation in FDG-avid areas was 93.9Gy (tumour) and 73.0Gy (lymph nodes). Escalation drove the GTV and CTV to mean doses for the tumour of 87.5Gy (GTV-T) and 81.3Gy (CTV-T) in median. No significant differences in mean dose to lung and heart between standard and escalated were found, but small volumes of e.g. the bronchi received doses between 66 and 74Gy due to escalation. CONCLUSIONS: FDG-driven inhomogeneous dose-escalation achieves large increment in tumour and lymph node dose, while delivering similar doses to normal tissue as homogenous standard plans.
RCT Entities:
BACKGROUND AND PURPOSE: Local recurrence is frequent in locally advanced NSCLC and is primarily located in FDG-avid parts of tumour and lymph nodes. Aiming at improving local control without increasing toxicity, we designed a multi-centre phase-III trial delivering inhomogeneous dose-escalation driven by FDG-avid volumes, while respecting normal tissue constraints and requiring no increase in mean lung dose. Dose-escalation driven by FDG-avid volumes, delivering mean doses of 95Gy (tumour) and 74Gy (lymph nodes), was pursued and compared to standard 66Gy/33F plans. MATERIAL AND METHODS: Dose plans for the first thirty patients enroled were analysed. Standard and escalated plans were created for all patients, blinded to randomization, and compared for each patient in terms of the ability to escalate while protecting normal tissue. RESULTS: The median dose-escalation in FDG-avid areas was 93.9Gy (tumour) and 73.0Gy (lymph nodes). Escalation drove the GTV and CTV to mean doses for the tumour of 87.5Gy (GTV-T) and 81.3Gy (CTV-T) in median. No significant differences in mean dose to lung and heart between standard and escalated were found, but small volumes of e.g. the bronchi received doses between 66 and 74Gy due to escalation. CONCLUSIONS: FDG-driven inhomogeneous dose-escalation achieves large increment in tumour and lymph node dose, while delivering similar doses to normal tissue as homogenous standard plans.
Authors: Lotte Nygård; Marianne C Aznar; Barbara M Fischer; Gitte F Persson; Charlotte B Christensen; Flemming L Andersen; Mirjana Josipovic; Seppo W Langer; Andreas Kjær; Ivan R Vogelius; Søren M Bentzen Journal: Am J Nucl Med Mol Imaging Date: 2018-04-25
Authors: Katherina P Farr; Katrina West; Roland Yeghiaian-Alvandi; David Farlow; Rachel Stensmyr; Andrew Chicco; Eric Hau Journal: Phys Imaging Radiat Oncol Date: 2019-09-20