New radiotherapy approaches in locally advanced non-small cell lung cancer.
AffiliationThe University of Manchester, Oxford Road, Greater Manchester, United Kingdom
MetadataShow full item record
AbstractRadiotherapy plays a major role in the treatment of patients with locally advanced non-small cell lung cancer (NSCLC), particularly since most patients are not suitable for surgery due to the extent of their disease, advanced age and multiple co-morbidities. Despite advances in local and systemic therapies local control and survival remain poor and there is a sense that a therapeutic plateau has been reached with conventional approaches. Strategies for the intensification of radiotherapy such as dose escalation have shown encouraging results in phase I-II trials, but the outcome of the phase III Radiation Therapy Oncology Group 0617 trial was surprisingly disappointing. Hyperfractionated and/or accelerated fractionating schedules have demonstrated superior survival compared to conventional fractionation at the expense of greater oesophageal toxicity. Modern radiotherapy techniques such as the integration of 4-dimensional computed tomography for planning, intensity modulated radiotherapy and image-guided radiotherapy have substantially enhanced the accuracy of the radiotherapy delivery through improved target conformality and incorporation of tumour respiratory motion. A number of studies are evaluating personalised radiation treatment including the concept of isotoxic radiotherapy and the boosting of the primary tumour based on functional imaging. Proton beam therapy is currently under investigation in locally advanced NSCLC. These approaches, either alone or in combination could potentially allow for further dose escalation and improvement of the therapeutic ratio and survival for patients with NSCLC.
CitationNew radiotherapy approaches in locally advanced non-small cell lung cancer. 2014, 50 (3):525-34 Eur J Cancer
JournalEuropean Journal of Cancer
- Unresected stage III non-small-cell lung cancer. Provincial Lung Cancer Disease Site Group.
- Authors: Okawara G, Rusthoven J, Newman T, Findlay B, Evans W
- Issue date: 1997 Aug
- Results of multifield conformal radiation therapy of nonsmall-cell lung carcinoma using multileaf collimation beams.
- Authors: Bahri S, Flickinger JC, Kalend AM, Deutsch M, Belani CP, Sciurba FC, Luketich JD, Greenberger JS
- Issue date: 1999
- Final results of the randomized phase III CHARTWEL-trial (ARO 97-1) comparing hyperfractionated-accelerated versus conventionally fractionated radiotherapy in non-small cell lung cancer (NSCLC).
- Authors: Baumann M, Herrmann T, Koch R, Matthiessen W, Appold S, Wahlers B, Kepka L, Marschke G, Feltl D, Fietkau R, Budach V, Dunst J, Dziadziuszko R, Krause M, Zips D, CHARTWEL-Bronchus studygroup
- Issue date: 2011 Jul
- A phase II study of cisplatin and 5-fluorouracil with concurrent hyperfractionated thoracic radiation for locally advanced non-small-cell lung cancer: a preliminary report from the Okayama Lung Cancer Study Group.
- Authors: Segawa Y, Ueoka H, Kiura K, Kamei H, Tabata M, Sakae K, Hiraki Y, Kawahara S, Eguchi K, Hiraki S, Harada M
- Issue date: 2000 Jan
- Intraindividual comparison of conventional three-dimensional radiotherapy and intensity modulated radiotherapy in the therapy of locally advanced non-small cell lung cancer a planning study.
- Authors: Marnitz S, Stuschke M, Bohsung J, Moys A, Reng I, Wurm R, Budach V
- Issue date: 2002 Nov