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21.07.2017 | Original Article

An individualized radiation dose escalation trial in non-small cell lung cancer based on FDG-PET imaging

verfasst von: Marie Wanet, M.D. Ph.D., Antoine Delor, François-Xavier Hanin, Benoît Ghaye, Aline Van Maanen, Vincent Remouchamps, Christian Clermont, Samuel Goossens, John Aldo Lee, Guillaume Janssens, Anne Bol, Xavier Geets

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 10/2017

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Abstract

Aim

The aim of the study was to assess the feasibility of an individualized 18F fluorodeoxyglucose positron emission tomography (FDG-PET)-guided dose escalation boost in non-small cell lung cancer (NSCLC) patients and to assess its impact on local tumor control and toxicity.

Patients and methods

A total of 13 patients with stage II–III NSCLC were enrolled to receive a dose of 62.5 Gy in 25 fractions to the CT-based planning target volume (PTV; primary turmor and affected lymph nodes). The fraction dose was increased within the individual PET-based PTV (PTV_PET) using intensity modulated radiotherapy (IMRT) with a simultaneous integrated boost (SIB) until the predefined organ-at-risk (OAR) threshold was reached. Tumor response was assessed during follow-up by means of repeat FDG-PET/computed tomography. Acute and late toxicity were recorded and classified according to the CTCAE criteria (Version 4.0). Local progression-free survival was determined using the Kaplan-Meier method.

Results

The average dose to PTV_PET reached 89.17 Gy for peripheral and 75 Gy for central tumors. After a median follow-up period of 29 months, seven patients were still alive, while six had died (four due to distant progression, two due to grade 5 toxicity). Local progression was seen in two patients in association with further recurrences. One and 2-year local progression free survival rates were 76.9% and 52.8%, respectively. Three cases of acute grade 3 esophagitis were seen. Two patients with central tumors developed late toxicity and died due to severe hemoptysis.

Conclusion

These results suggest that a non-uniform and individualized dose escalation based on FDG-PET in IMRT delivery is feasible. The doses reached were higher in patients with peripheral compared to central tumors. This strategy enables good local control to be achieved at acceptable toxicity rates. However, dose escalation in centrally located tumors with direct invasion of mediastinal organs must be performed with great caution in order to avoid severe late toxicity.

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Titel: An individualized radiation dose escalation trial in non-small cell lung cancer based on FDG-PET imaging
verfasst von: Marie Wanet, M.D. Ph.D.
Antoine Delor
François-Xavier Hanin
Benoît Ghaye
Aline Van Maanen
Vincent Remouchamps
Christian Clermont
Samuel Goossens
John Aldo Lee
Guillaume Janssens
Anne Bol
Xavier Geets
Publikationsdatum: 21.07.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 10/2017
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-017-1168-z

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An individualized radiation dose escalation trial in non-small cell lung cancer based on FDG-PET imaging

Abstract