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• W2580135730 abstract "Local failure occurs in >50% of patients with stage III non-small cell lung cancer (NSCLC). Higher doses of radiation therapy (RT) with chemotherapy (ChT) may improve local control but are also associated with more side effects. RTOG 0617 demonstrated that dose escalation to 74 Gy was associated with greater toxicity and inferior survival. Adaptive planning utilizing interim PET-CT may improve the therapeutic ratio by identifying patients most likely to benefit from selective dose escalation. In this prospective study, patients with locally-advanced NSCLC receiving conventionally fractionated RT +/- ChT with definitive intent were eligible. The primary endpoint was feasibility of adaptive planning using interim PET-CT. Initial planning PET-CT was performed and an RT plan (2 Gy qd to 60 Gy) was designed. After 50 Gy an interim PET-CT was performed. A boost to residual FDG-avid disease (10 Gy, total dose 70 Gy) was administered at the discretion of the treating radiation oncologist. Normal tissue dose volume parameters were calculated for the total dose utilizing both adaptive and simulated non-adaptive plans. Paired T-tests were used to compare plans for those patients who received a selective boost based on interim PET-CT. Patients (n=36) were enrolled between 2012 and 2014. Three excluded before planning PET-CT. The planning PET-CT showed new distant metastases (DMs) in 3 patients subsequently removed from study. Thus, 30 patients proceeded with definitive RT- 87% also received ChT. One patient discontinued treatment at 16 Gy due to unrelated co-morbidities. Interim PET-CT was performed in the remaining 29 patients. Of these, 3 had developed DMs and 2 had a complete response (CR) and did not receive any additional RT after 60 Gy. Additional reasons for no boost included normal tissue constraints (n=3), poorly defined residual disease (n=2), acute toxicity (n=1), and refusal of further therapy (n=1, at 50 Gy). Therefore, 17/30 (57%) eligible patients received a selective boost. For these 17, the median pre-RT and interim GTV volumes were 78 cc (range, 19-419) and 29 cc (range, 1-157). Utilization of an adaptive planning approach compared to a simulated non-adaptive approach allowed for significant absolute reductions in lung V20 (median 0.5%, p=0.008), esophageal V60 (median 2.8%, p=0.004), and heart V30 (median 0.75%, p=0.003). Adaptive planning utilizing interim PET-CT at 50 Gy was feasible. Both planning and interim PET-CT identify patients who have developed DMs. CR after 50 Gy is unusual though tumors do shrink by 50 Gy allowing for a smaller target for an adaptive boost. Adaptive planning allowed for significant reductions in normal lung, heart, and esophageal doses compared to traditional planning techniques. Interim PET-CT may be an effective tool for selective RT dose escalation in patients with locally-advanced NSCLC." @default.
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• W2580135730 date "2015-11-01" @default.
• W2580135730 modified "2023-09-25" @default.
• W2580135730 title "A Prospective Study of Adaptive Planning Utilizing Interim PET-CT for Locally Advanced Lung Cancer" @default.
• W2580135730 doi "https://doi.org/10.1016/j.ijrobp.2015.07.1559" @default.
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