International Journal of Radiation Oncology*Biology*Physics
Clinical InvestigationStereotactic Body Radiation Therapy Boost After Concurrent Chemoradiation for Locally Advanced Non-Small Cell Lung Cancer: A Phase 1 Dose Escalation Study
Introduction
Lung cancer remains the leading cause of cancer death for both men and women in the United States (1). Although outcomes for early-stage lung cancer are encouraging, nearly half of all patients will present with stage III disease, in which the expected overall survival with standard therapy is only 15% to 30% 2, 3, 4. Patterns of failure have shown that as many as 50% of these patients will experience local (in-field) failure as a component of recurrence. Stereotactic body radiation therapy (SBRT) is a technique by which a high dose of radiation can be delivered in a highly conformal fashion in just a few treatments. We therefore postulated that using SBRT as a boost to standard chemoradiation therapy potentially can improve disease control for locally advanced lung cancer. A phase 1 dose escalation study was undertaken to evaluate the safety and define the maximum tolerated dose for this approach.
Section snippets
Methods
Between 2012 and 2014, eligible patients were accrued to this prospective phase 1 study. This study was reviewed and approved by our institutional review board (Rhode Island Hospital) and was monitored by the Brown University Oncology Research Group data safety monitoring board.
Results
The trial completed accrual with 12 patients enrolled and treated. All patients met the planning dose constraints and completed protocol treatment. Treatment was delivered between 19 and 44 days after chemoradiation. Patient demographics are shown in Table 2. The mean age was 64 years. Sixty-seven percent were men, and 50% had adenocarcinoma histology. Stage III disease accounted for 92% of patients, and all patients but 1 were medically inoperable. Two-thirds of patients received concurrent
Discussion
Standard therapy for locally advanced lung cancer remains suboptimal. Overall survival with definitive chemoradiation is expected to be 15% to 30% at 5 years 2, 3, 4. Patterns of failure show that local failure will develop in nearly half of these patients (3). The addition of surgery has potential for a modest improvement in local control and overall survival but comes at the expense of morbidity (4). Additionally, many patients are not candidates for surgery because they have underlying
Acknowledgment
The authors thank Justin Peter and Oluwademilade Osibanjo for their assistance.
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2020, Radiotherapy and OncologyCitation Excerpt :To our knowledge we are the first to report about a successful simultaneous treatment planning procedure of SBRT and FRT, without increasing the overall treatment time. There are several studies reporting about the feasibility and tolerability of a sequential SBRT boost after CCRT in LA-NSCLC [21–24]. All these studies aim at a biological equivalent dose ≥100 Gy in order to achieve superior local control [25].
Stereotactic body radiation therapy with higher biologically effective dose is associated with improved survival in stage II non-small cell lung cancer
2019, Lung CancerCitation Excerpt :Coverage of peribronchial or hilar nodal disease would result in potentially high doses of radiation to central intrathoracic organs at risk (OARs), including the proximal bronchial tree, hilar vessels, and the esophagus [10,21]. However, there are a few reports using SBRT boost to nodal disease in locally advanced NSCLC after definitive chemoradiation [22,23]. In a phase I dose escalation study, Hepel et al. delivered 16–28 Gy in two fractions as an SBRT boost to residual primary and nodal disease (up to 60cc) after chemotherapy with concurrent radiation (50.4 Gy) [22].
Conflict of interest: none.