A current review of dose-escalated radiotherapy in locally advanced non-small cell lung cancer
, , , , , , and | Mar 03, 2019
About this article
Article Category: Review
Published Online: Mar 03, 2019
Page range: 6 - 14
Received: Aug 31, 2018
Accepted: Jan 05, 2019
DOI: https://doi.org/10.2478/raon-2019-0006
© 2019 Li Ma, Yu Men, Lingling Feng, Jingjing Kang, Xin Sun, Meng Yuan, Wei Jiang, Zhouguang Hui published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Researches on proton and heavy ion radiotherapy in NSCLC
| Author | Regimen | No. | Stage | Treatment outcome | p value | RE | p value | RP | p value |
|---|---|---|---|---|---|---|---|---|---|
| Higgins |
Median dose of photon radiotherapy: 59.4Gy | 243474 | I- IV | 13.5% (5-year OS) | 0.01 | - | - | - | - |
| Median dose of PSPT: 60Gy (RBE) | 348 | 23.1% (5-year OS) | |||||||
| Chung |
74Gy (RBE) PSPT concurrent with chemotherapy | 64 | III | 26.5 months (median OS) | - | 8% (G3) | - | 14% (G3-4) | - |
| Liao |
IMRT: 66-74Gy | 92 | LANSCLC | 10.9% (LRF) | 0.86 | - | - | 6.5% | 0.40 |
| PSPT: 74Gy (RBE) | 57 | 10.5% (LRF) | 10.5% | ||||||
| Takahashi |
68-76Gy (RBE) carbon ion radiotherapy | 72 | LANSCLC | 93.1% (2-year LRC), 51.9% (2-year OS) | - | 1.4% (G3) | - | 1.4% (G3) | - |
| Karube |
52.8-72Gy (RBE) carbon ion radiotherapy | 64 | II- III | 81.8% (2-year LRC), 62.2% (2 -year OS) | - | 0 (≥G2) | - | 0 (≥G2) | - |
| Shirai |
52.8-70.4Gy (RBE)/4-16f carbon ion radiotherapy | 23 | T2b-4N0M0 | 81% (2-yearLRC), 70% (2-year OS) | - | 0 (≥G3) | - | 0 (≥G3) | - |
Researches on personalized dose escalation radiotherapy in NSCLC
| Author | Regimen | No. | Stage | Treatment outcome | p value | RE | p value | RP | p value |
|---|---|---|---|---|---|---|---|---|---|
| Van Baardwijk |
Initially 1.5Gy bid to 45Gy, then 2Gy per fraction daily increments until reaching the limit dose of normal tissue | 137 | III | 52.4% (2-year OS) | - | acute: 25.5% (G3); late: 4.6% (G3) | - | late: 3% (≥G3) | - |
| Van Elmpt |
Initially 2.75Gy to 66Gy,then boost to the entire primary tumor | 15 | I- III | - | - | - | - | - | - |
| Initially 2.75Gy to 66Gy,then boost in the high FDG uptake area | 15 | ||||||||
| Vera |
20 | LANSCLC | 95% (1-year OS) 85% (1-year DFS) | p=0.10 (1-year OS) | acute: 75% (G1-3) | - | acute: 15% (G1-2) late: 5% (G1-2) | - | |
| 24 | 81% (1-year OS) 50% (1-year DFS) | p=0.01 (1-year DFS) | acute: 75% (G1-3) | acute: 12.5% (≥G3) | |||||
| 10 | 50% (1-year DFS) | acute: 100% (G1-5) | acute: 0 | ||||||
| Kong |
Initially 50Gy, then adapt target basing on midtreatment PET-CT and escalate dose to the constraints of normal tissue concurrent with chemotherapy | 42 | Inoperable stage I- III | 2-year LRC: 62%; median OS: 25 months | - | 12% (G3) | - | 7% (G3) | - |
Researches on altered fractionation in NSCLC
| Author | Regimen | No. | Stage | Treatment outcome | p value | RE | p value | RP | p value |
|---|---|---|---|---|---|---|---|---|---|
| Saunders |
Conventional radiotherapy: 60Gy/2Gy/30f | 225 | - | 20%(2-year OS) | 0.004 | acute: 7%; late: 5% | - | acute: 19%; late: 4%(symptomatic) | - |
| CHART: 1.5Gy tid, 7 days/week, a total of 54Gy | 339 | 29%(2-year OS) | acute: 9%; late: 7% | - | acute: 10%; late: 16%(symptomatic) | - | |||
| Baumann |
conventional radiotherapy: 66Gy/2Gy/33f | 203 | inoperable | 31%(2-year OS) | 0.43 | acute: 2.2%; late;: 0.7%(≥G2) | acute: 0.17; late: 0.62 | acute: 9.5%; late:11%(≥G2 symptomatic) | acute: 0.32; late: 0.59 |
| CHART: 1.5Gy tid, 5 days/week, a total of 54Gy | 203 | 32%(2-year OS) | acute: 5%l late: 1.9%(≥G2) | acute: 6.6%; late:9.2%(≥G2 symptomatic) | |||||
| Mauguen |
Conventional radiotherapy | 2000 | - | 15.9%(3-yearOS), 8.3%(5-year OS) | <0.04 | 9% | <0.001 | - | - |
| CHART | 19.7%(3-yearOS), 10.8%(5-year OS) | 19% | |||||||
| Din |
55Gy/2.67Gy/20f | 609 | III | 50%(2-year OS) | - | - | - | 15.1%(G1-2 symptomatic) | - |
| Sun |
conventional radiotherapy: 70.8Gy/1.86Gy/38f | 54 | inoperable stage III | 48.1%(RR) | 0.032 | 33.3%(G2) | - | 42.6% (≥G2) | - |
| hypofractionated radiotherapy: 65Gy/2.5Gy/26f | 43 | 69.8%(RR) | 25.6%(G2) | 34.9%(≥G2) | |||||
| Cannon |
57-85.5Gy/2.28-3.42Gy/25f | 79 | LANSCLC | 29%(3-year OS) | - | acute: 48%(G2); late: 28%(G2) | - | 16%(G2)7.6%(G4-5) | - |
| Feddock |
A month after standard radiotherapy to 60Gy with concurrent chemotherapy, an SBRT boost was given in ≤5cm residual primary tumors: 10Gy×2f for peripheral lesions, 6.5Gy×3f for central lesions | 61 | II/III | 82.9%(primary tumor control with a median follow-up of 13 months) | - | 1.6%(G2) | - | acute:17.1%; late: 9.4%(≥G2) | - |
| Karam |
An SBRT boost with 20-30Gy over 5 fractions was prescribed after conventional CCRT to a median dose of 50.4Gy | 16 | LANSCLC , | 78%(1-yearOS) 76%(1-yearLRC) | - | 18% (G2) | - | 25% (G2) | - |
| Higgins |
Standard radiotherapy to 44Gy with concurrent chemotherapy, followed by an SBRT boost in the lung and nodal residuals in four groups: 9Gy×2f, 10Gy×2f, 6Gy×5f and 7Gy×5f | 19 | stageIII(N1/ N2) with ,primary tumors ≤8cm and lymph nodes ≤5cm | 39%(3-yearOS) 59%(3-yearLRC) | - | - | - | - | - |
| Hepel |
Standard radiotherapy to 50.4Gy with concurrent chemotherapy, followed by an SBRT boost in the lung and nodal residuals in four groups: 8Gy×2f, 10Gy×2f, 12Gy×2f and 14Gy×2f | 12 | Stage II/III with primary tumor ≤120cc and lymph node volume ≤ 60cc | 78%(1-yearLRC) | - | 0(≥G3) | - | acute: 0(≥G3); late: 8.33%(G5) | - |