(Singapore – January 29, 2021 9:35 am SPT / January 28, 2021 8:35 pm EST) – Two radiation oncology tests presented at the IALSC World Conference on Lung Cancer Singapore clarify how some Researchers studying the use of higher-dose radiation directly increased PET-advanced regions in advanced non-small cell lung cancer (NSCLC). A previous large-scale RTOG phase III test showed that informally high-dose delivery to the entire tumor resulted in worse survival.
In one study, Professor Feng-Ming (Spring) Kong, University of Western Refugee University Medical School, in Cleveland, Ohio presented the results of a multicenter test aimed at determining whether there was an increase a variable dose to medium-dose isotoxic radiation dose of FDG-PET provides advanced local tumor control compared with a standard dressing dose of 60 Gy in patients with stage III NSCLC.
Professor Kong and the research centers involved in the trials enrolled 138 patients with medically appropriate stage III NSCLC for concomitant chemoradiation. Patients were randomly assigned with a ratio of 1: 2 to a normal arm (60 Gy) or to a therapeutic adaptive arm, with a dose personalized to 20 Gy meaning lung dose (MLD), and adjusted to a tumor that remained on the mid-treatment FDG. -PET / CT. All patients had approximately 40 Gy median FDG-PET treatment, and radiation therapy was delivered in 30 daily fractions (Fx).
Of the 138 patients enrolled between February 2012 and March 2017, 127 were eligible for analysis, with 43 and 84 patients in the normal and variable arms, respectively, with a follow-up of 3.7 and 3.4 years for surviving patients, also individually.
The adaptive arm included an initial plan of 2.2 Gy / Fx for 21 Fx followed by an increase in variable radiation therapy to a mid-treatment FDG-PET target using a variable order of 2.2-3.8 Gy / Fx for the last 9 Fx. The main point of this report was the progression of 2-year local-regional tumor (LRPF), with total and internal LRPF induction, independently and blindly evaluated by radiologists.
There was no significant difference in lung, esophagus, and heart toxins, although higher average doses of these organs in the altered arm were at risk. Total 2-year LRPF levels were 59.5% (95% CI: 37.9, 75.7) on the normal arm, and 54.6% (95% CI: 39.9, 67.0) on the variable arm. The median LRPF duration was 27.5 months (95% CI: 14.3, not reached) on the normal arm and 28.4 months (95% CI: 19.1, not reached) on the variable arm. There was no significant difference in overall survival, undeveloped survival, or specific lung cancer survival between the two arms, according to the presentation by Dr. Kong.
“This is the first randomized trial that demonstrated the feasibility and safety performance of a biological adaptive radiation enhancer in a multicenter setting in patients with stage III NSCLC. This initial analysis showed no improvement in control. local regional tumors as a whole, “Dr. Kong recited.
In the second study, Dr Saskia Cooke, of the Dutch Cancer Institute in Amsterdam, the Netherlands, reports on local and regional failure in the phase II PET-Boost test (NCT01024829). In this study, patients with stage II-III non-small cell lung cancer (NSCLC) were treated with a hypofractionated dose increase to either the whole primary tumor (Arm A) or the high-grade fluorodeoxyglucose (FDG) region. ) within the PT (> 50% SUVmax; Arm B).
The trial identified 107 randomized patients – 82% had stage III disease and the majority of patients (72%) received concomitant chemoradiotherapy. In Armor A and B, the mean total tumor size (GTV) for the primary tumor was 100 and 115 cm3, respectively; mean GTV for the involved lymph nodes was 18 and 20 cm3, respectively. The median fractional dose was 3.25 Gy to design target size (PTV) to the entire primary tumor and 3.50 Gy to 50% SUVmax PTV, resulting in a total planned body dose of 78.0 and 84.0 Gy, in 24 fractions . The median treatment time was 34 days in each arm, and median follow-up for CT scans in a median study was 12.6 months.
In a previous report, the authors found that the primary tumor was not measured in 27% of patients [Cooke S, 2020]. Of the 12 patients in Army A who had local failure, 2 (LF) had local failure without regional failure (RF) and 9 had RF without LF. Of the 15 patients in Army B, 4 had LF without RF and 10 had RF without LF. In Armor A and B, respectively, the 2-year cumulative incidence of LF was 11% and 18%, and 28% and 25% for RF. The authors concluded that “increasing the dose to all PT or 50% SUVmax in patients with NSCLC resulted in excellent local control levels in both treatment arms”. However, few patients were valued for assessing local failure at 2-year-old, 5% toxicity levels were reported at 16% [van Diessen J, 2018], with 3-year OS levels of just 37% in armA and 33% in armB, respectively.
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About the IASLC:
The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association’s membership includes nearly 7,500 lung cancer specialists across all disciplines in more than 100 countries, creating a global network working together to overcome lung and thoracic cancers all over the world. The association also publishes the Journal of Thoracic Oncology, the leading educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancy. Visit http: // www.
About the WCLC:
The WCLC is the world’s largest meeting dedicated to lung cancer and other thoracic malignancies, attracting nearly 7,500 researchers, physicians and experts from more than 100 countries. The goal is to increase awareness, collaboration, and understanding of lung cancer, and to help participants implement the latest developments across the globe. The conference will cover a wide range of topics and highlight a number of research studies and clinical trial results. For more information, visit wclc2020.iaslc.org.
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