ArticleMedical physics2017
Functional lung avoidance and response-adaptive escalation (FLARE) RT: Multimodality plan dosimetry of a precision radiation oncology strategy.
Article in Medical physics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Incorporation of Functional Lung Imaging Into Radiation Therapy Planning in Patients With Lung Cancer: A Systematic Review and Meta-Analysis.International journal of radiation oncology, biology, physics · 2024Pooled it
- Mature Outcomes and Patterns of Failure in the Phase II FLARE-RT Trial of Biological Image-Guided and Risk-Adaptive Chemoradiation for Unresectable NSCLC.Clinical cancer research : an official journal of the American Association for Cancer Research · 2026Trial
- Primary Results of NRG-RTOG1106/ECOG-ACRIN 6697: A Randomized Phase II Trial of Individualized Adaptive (chemo)Radiotherapy Using MidtreatmentJournal of clinical oncology : official journal of the American Society of Clinical Oncology · 2024Trial
- Evaluation of variables predicting PFT changes for lung cancer patients treated on a prospective 4DCT-ventilation functional avoidance clinical trial.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2023Trial
- Independent association of metabolic tumor response on FDG-PET with pulmonary toxicity following risk-adaptive chemoradiation for unresectable non-small cell lung cancer: Inherent radiosensitivity or immune response?Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2023Trial
- Results of a Multi-Institutional Phase 2 Clinical Trial for 4DCT-Ventilation Functional Avoidance Thoracic Radiation Therapy.International journal of radiation oncology, biology, physics · 2022Trial
- Comparison of regional lung perfusion response on longitudinal MAA SPECT/CT in lung cancer patients treated with and without functional tissue-avoidance radiation therapy.The British journal of radiology · 2019Trial
- Quantitative lung tissue functional analysis for pulmonary adverse event risk assessment prior to thoracic radiotherapy.Physics and imaging in radiation oncology · 2026Article
- A review on functional lung avoidance radiotherapy plan for lung cancer.Frontiers in oncology · 2024Review
- Functional lung avoidance in radiotherapy using optimisation of biologically effective dose with non-coplanar beam orientations.Physics and imaging in radiation oncology · 2023Article
- Mid-treatment adaptive planning during thoracic radiation using 68 Ventilation-Perfusion Positron emission tomography.Clinical and translational radiation oncology · 2023Article
- Clinical use of positron emission tomography for radiotherapy planning - Medical physics considerations.Zeitschrift fur medizinische Physik · 2023Review
- Article
- Radiation and immune checkpoint inhibitor-mediated pneumonitis risk stratification in patients with locally advanced non-small cell lung cancer: role of functional lung radiomics?Discover oncology · 2022Article
- A Transfer Learning Framework for Deep Learning-Based CT-to-Perfusion Mapping on Lung Cancer Patients.Frontiers in oncology · 2022Article
- HyperpolarizedInternational journal of radiation oncology, biology, physics · 2021Article
- Feasibility of function-guided lung treatment planning with parametric response mapping.Journal of applied clinical medical physics · 2021Article
- Characterizing spatial differences between SPECT-ventilation and SPECT-perfusion in patients with lung cancer undergoing radiotherapy.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2021Article
- Treatment Intensification in Locally Advanced/Unresectable NSCLC Through Combined Modality Treatment and Precision Dose Escalation.Seminars in radiation oncology · 2021Review
- Investigation of a Novel Deep Learning-Based Computed Tomography Perfusion Mapping Framework for Functional Lung Avoidance Radiotherapy.Frontiers in oncology · 2021Article
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10 authors.
Funding
Abstract
purposeNonsmall cell lung cancer (NSCLC) patient radiation therapy (RT) is planned without consideration of spatial heterogeneity in lung function or tumor response. We assessed the dosimetric and clinical feasibility of functional lung avoidance and response-adaptive escalation (FLARE) RT to reduce dose to [
methodsEight stage IIB-IIIB NSCLC patients underwent FDG-PET/CT and MAA-SPECT/CT treatment planning scans. Perfused lung objectives were derived from scatter/collimator/attenuation-corrected MAA-SPECT uptake relative to ITV-subtracted lung to maintain < 20 Gy mean lung dose (MLD). Prescriptions included 60 Gy to the planning target volume (PTV) and concomitant boost of 74 Gy mean to biological target volumes (BTV = GTV + PET gradient segmentation) scaled to each BTV voxel by relative FDG-PET SUV. Dose-painting-by-numbers prescriptions were integrated into commercial treatment planning systems via uptake threshold discretization. Dose constraints for lung, heart, cord, and esophagus were defined. FLARE RT plans were optimized with volumetric modulated arc therapy (VMAT), proton pencil beam scanning (PBS) with 3%-3 mm robust optimization, and combination of PBS (avoidance) plus VMAT (escalation). The high boost dose region was evaluated within a standardized SUV
resultsNo unacceptable violations of PTV and normal tissue objectives were observed in 24 FLARE RT plans. Compared to reference VMAT plans, FLARE VMAT plans achieved a higher mean dose to BTV (73.7 Gy 98195. 61.3 Gy), higher mean dose to SUV
conclusionsFLARE RT is clinically feasible with VMAT and PBS. A combination of PBS for functional lung avoidance and VMAT for FDG PET dose escalation balanced target and normal tissue objective tradeoffs. These results provide a technical platform for testing of FLARE RT safety and efficacy within a precision radiation oncology trial.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.