ArticleInternational journal of radiation oncology, biology, physics2021
Isotoxic Intensity Modulated Radiation Therapy in Stage III Non-Small Cell Lung Cancer: A Feasibility Study.
Article in International journal of radiation oncology, biology, physics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
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13 citing papers in PubMed, 21 citations in OpenAlex.
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- National survey on definitive radiotherapy practices for locally advanced non-small cell lung cancer in Japan: JROSG 23-3.Journal of radiation research · 2025Article
- Pelvic stereotactic ablative body radiotherapy (SABR) reirradiation: UK SABR consortium guidance for use in routine clinical care.Technical innovations & patient support in radiation oncology · 2025Article
- Dosimetric comparison of four radiotherapy techniques for stage III non‑small cell lung cancer.Oncology letters · 2023Article
- Potential Applications of Nanoparticles in Improving the Outcome of Lung Cancer Treatment.Genes · 2023Review
- P21 facilitates macrophage chemotaxis by promoting CCL7 in the lung epithelial cell lines treated with radiation and bleomycin.Journal of translational medicine · 2023Article
- Pulmonary magnetic resonance-guided online adaptive radiotherapy of locally advanced: the PUMA trial.Radiation oncology (London, England) · 2023Article
- Dosimetric benefits of adaptive radiation therapy for patients with stage III non-small cell lung cancer.Radiation oncology (London, England) · 2023Article
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- Direct incorporation of patient-specific efficacy and toxicity estimates in radiation therapy plan optimization.Medical physics · 2022Article
- Locally advanced NSCLC: a plea for sparing the ipsilateral normal lung-prospective, clinical trial with DART-bid (dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily) by VMAT.Radiation oncology (London, England) · 2022Article
- Cardiac-sparing radiotherapy for locally advanced non-small cell lung cancer.Radiation oncology (London, England) · 2021Article
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Authors and funding
13 authors at 10 institutions in 2 countries.
Funding
Abstract
purposeNot all patients with stage III non-small cell lung cancer (NSCLC) are suitable for concurrent chemoradiation therapy (CRT). Local failure rate is high for sequential concurrent CRT. As such, there is a rationale for treatment intensification. METHODS AND MATERIALS: Isotoxic intensity modulated radiation therapy (IMRT) is a multicenter feasibility study that combines different intensification strategies including hyperfractionation, acceleration, and dose escalation facilitated by IMRT. Patients with unresectable stage III NSCLC, Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 to 2, and unsuitable for concurrent CRT were recruited. A minimum of 2 cycles of platinum-based chemotherapy was compulsory before starting radiation therapy (RT). Radiation dose was increased until a maximum dose of 79.2 Gy was reached or 1 or more of the organs at risk met predefined constraints. RT was delivered in 1.8-Gy fractions twice daily, and an RT quality assurance program was implemented. The primary objective was the delivery of isotoxic IMRT to a dose >60 Gy equivalent dose in 2-Gy fractions (EQD2 assuming an α/β ratio of 10 Gy for acute reacting tissues).
resultsThirty-seven patients were recruited from 7 UK centers. Median age was 69.9 years (range, 46-86 years). The male-to-female ratio was 17:18. ECOG PS was 0 to 5 in 14.2% of patients; PS was 1 to 27 in 77.1% of patients; PS was 2 to 3 in 8.6% of patients. Stage IIIA:IIIB ratio was 22:13 (62.9%:37.1%). Of 37 patients, 2 (5.4%) failed to achieve EQD2 > 60 Gy. Median prescribed tumor dose was 77.4 Gy (range, 61.2-79.2 Gy). A maximum dose of 79.2Gy was achieved in 14 patients (37.8%). Grade 3 esophagitis was reported in 2 patients, and no patients developed grade 3 to 4 pneumonitis. There were 3 grade 5 events: acute radiation pneumonitis, bronchopulmonary hemorrhage, and acute lung infection. Median follow-up at time of analysis was 25.4 months (range, 8.0-44.2) months for 11 of 35 survivors. The median survival was 18.1 months (95% confidence interval [CI], 13.9-30.6), 2-year overall survival was 33.6% (95% CI, 17.9-50.1), and progression-free survival was 23.9% (95% CI, 11.3-39.1).
conclusionsIsotoxic IMRT is a well-tolerated and feasible approach to treatment intensification.
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