• Application of a tool for bulk treatment plan evaluation in advanced treatment planning training

      van Herk, Marcel; Burnet, Neil G; Dinapoli, N; Meijer, G; Nestle, U; van den Bongard, D; Stock, M; University of Manchester Radiotherapy Related Research, Manchester (2019)
    • Consolidative thoracic radiotherapy in stage IV small cell lung cancer: selection of patients amongst European IASLC and ESTRO experts

      Putora, P; Glatzer, M; De Ruysscher, D; Faivre-Finn, Corinne; Belderbos, J; Besse, B; Blackhall, Fiona H; Califano, Raffaele; Cappuzzo, F; de Marinis, F; et al. (2019)
      BACKGROUND: The role of consolidative thoracic radiotherapy (TRT) in stage IV small cell lung cancer (SCLC) is not uniformly accepted. METHODS: We obtained a list of 13 European medical oncologists from the International Association for the Study of Lung Cancer (IASLC) and 13 European radiation oncologists from the European Society for Therapeutic Radiation Oncology (ESTRO). The strategies in decision making for TRT in stage IV SCLC were collected. Decision trees were created representing these strategies. Frequencies of recommending TRT were analysed for various parameter combinations based on the objective consensus methodology. RESULTS: The factors associated with the recommendation for TRT included fitness of the patient, limited extrathoracic tumour burden, initial bulky thoracic disease and response to chemotherapy. The highest consensus for TRT was in fit patients with limited extrathoracic tumour burden and initial bulky disease with either a complete extrathoracic response or partial thoracic response (92% recommend TRT). For these patients the recommendations were the same for medical and radiation oncologists. In the setting of partial response (intra- and extra-thoracically) without initial bulky thoracic disease radiation oncologists were more likely to recommend TRT than medical oncologists. For unfit patients or for patients with poor overall response to chemotherapy, the majority did not recommend TRT. CONCLUSION: European radiation and medical oncologists specializing in lung cancer recommend TRT in selected patients with stage IV SCLC and restrict its use primarily to fit patients who responded to chemotherapy with limited extrathoracic tumour burden.
    • EORTC 22113-8113 Lungtech trial on SBRT of central lung tumors

      Adebahr, S; Liu, Y; Colette, S; Faivre-Finn, Corinne; Ahmad, S; Ahmed, M; Belderbos, J; Andratschke, N; Franks, K; Geets, X; et al. (2019)
    • Erratum to 'Consolidative thoracic radiotherapy in stage IV small cell lung cancer: Selection of patients amongst European IASLC and ESTRO experts' [Radiother. Oncol. 135 (2019) 74-77]

      Putora, PM; Glatzer, M; De Ruysscher, D; Faivre-Finn, Corinne; Belderbos, J; Besse, B; Blackhall, Fiona H; Califano, Raffaele; Cappuzzo, F; de Marinis, F; et al. (2019)
    • ESTRO ACROP guidelines for target volume definition in the treatment of locally advanced non-small cell lung cancer.

      Nestle, U; De Ruysscher, D; Ricardi, U; Geets, X; Belderbos, J; Pöttgen, C; Dziadziuszko, R; Peeters, S; Lievens, Y; Hurkmans, C; et al. (2018-04)
      Radiotherapy (RT) plays a major role in the curative treatment of locally advanced non-small cell lung cancer (NSCLC). Therefore, the ACROP committee was asked by the ESTRO to provide recommendations on target volume delineation for standard clinical scenarios in definitive (chemo)radiotherapy (RT) and adjuvant RT for locally advanced NSCLC. The guidelines given here are a result of the evaluation of a structured questionnaire followed by a consensus discussion, voting and writing procedure within the committee. Hence, we provide advice for methods and time-points of diagnostics and imaging before the start of treatment planning and for the mandatory and optional imaging to be used for planning itself. Concerning target volumes, recommendations are given for GTV delineation of primary tumour and lymph nodes followed by issues related to the delineation of CTVs for definitive and adjuvant radiotherapy. In the context of PTV delineation, recommendations about the management of geometric uncertainties and target motion are given. We further provide our opinions on normal tissue delineation and organisational and responsibility questions in the process of target volume delineation. This guideline intends to contribute to the standardisation and optimisation of the process of RT treatment planning for clinical practice and prospective studies.
    • European Organization for Research and Treatment of Cancer (EORTC) recommendations for planning and delivery of high-dose, high precision radiotherapy for lung cancer.

      De Ruysscher, D; Faivre-Finn, Corinne; Moeller, D; Nestle, U; Hurkmans, C; Le Péchoux, C; Belderbos, J; Guckenberger, M; Senan, S; Maastricht University Medical Center, Department of Radiation Oncology (Maastro Clinic), GROW Research Institute, The Netherland (2017-07)
      To update literature-based recommendations for techniques used in high-precision thoracic radiotherapy for lung cancer, in both routine practice and clinical trials.
    • In Regard to Koshy et al.

      Levy, A; Guckenberger, M; Hurkmans, C; Nestle, U; Belderbos, J; De Ruysscher, D; Faivre-Finn, Corinne; Le Péchoux, C; Department of Radiation Oncology, Gustave-Roussy, Paris Sud University, Villejuif, France (2015-07-15)
    • LungTech, an EORTC Phase II trial of stereotactic body radiotherapy for centrally located lung tumours: a clinical perspective.

      Adebahr, S; Collette, S; Shash, E; Lambrecht, M; Le Pechoux, C; Faivre-Finn, Corinne; De Ruysscher, D; Peulen, H; Belderbos, J; Dziadziuszko, R; et al. (2015-07)
      Evidence supports stereotactic body radiotherapy (SBRT) as a curative treatment option for inoperable early stage non-small-cell lung cancer (NSCLC) resulting in high rates of tumour control and low risk of toxicity. However, promising results are mainly derived from SBRT of peripheral pulmonary lesions, whereas SBRT for the central tumours can lead to severe radiation sequelae owing to the spatial proximity to the serial organs at risk. Robust data on the tolerance of mediastinal structures to high-dose hypofractionated radiation are limited; furthermore, there are many open questions regarding the efficiency, safety and response assessment of SBRT in inoperable, centrally located early stage NSCLC, which are addressed in a prospective multicentre study [sponsored by the European Organization for Research and Treatment of Cancer (EORTC 22113-08113-LungTech)]. In this review, we summarize the current status regarding SBRT for centrally located early stage NSCLC that leads to the rationale of the LungTech trial. Outline and some essential features of the study with focus on a summary of current experiences in dose/fraction-toxicity coherences after SBRT to the mediastinal structures that lead to LungTech normal tissue constraints are provided.
    • Prophylactic cranial irradiation in stage IV small cell lung cancer: selection of patients amongst European IASLC and ESTRO experts

      Putora, P; Glatzer, M; Belderbos, J; Besse, B; Blackhall, Fiona H; Califano, Raffaele; Cappuzzo, F; de Marinis, F; Dziadziuszko, R; Felip, E; et al. (2019)
      BACKGROUND: Due to conflicting results between major trials the role of prophylactic cranial irradiation (PCI) in stage IV small cell lung cancer (SCLC) is controversial. METHODS: We obtained a list of 13 European experts from both the European Society for Therapeutic Radiation Oncology (ESTRO) and the International Association for the Study of Lung Cancer (IASLC). The strategies in decision making for PCI in stage IV SCLC were collected. Decision trees were created representing these strategies. Analysis of consensus was performed with the objective consensus methodology. RESULTS: The factors associated with the recommendation for the use of PCI included the fitness of the patient, young age and good response to chemotherapy. PCI was recommended by the majority of experts for non-elderly fit patients who had at least a partial response (PR) to chemotherapy (for complete remission (CR) 85% of radiation oncologists and 69% of medical oncologists, for PR: 85% of radiation oncologists and 54% of medical oncologists). For patients with stable disease after chemotherapy, PCI was recommended by 6 out of 13 (46%) radiation oncologists and only 3 out of 13 medical oncologists (23%). For elderly fit patients with CR, a majority recommended PCI (62%) and no consensus was reached for patients with PR. CONCLUSION: European radiation and medical oncologists specializing in lung cancer recommend PCI in selected patients and restrict its use primarily to fit, non-elderly patients who responded to chemotherapy.
    • Retrospective analyses of registry data for technical radiation oncology questions: apples versus pears or solid evidence?

      Nestle, U; Adebahr, S; van Herk, Marcel; Department of Radiation Oncology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany; (2020)
    • The role of postoperative thoracic radiotherapy and prophylactic cranial irradiation in early stage small cell lung cancer: Patient selection among ESTRO experts

      Putora, PM; De, RD; Glatzer, M; Widder, J; Van, HP; Troost, EGC; Slotman, BJ; Ramella, S; Pottgen, C; Peeters, S; et al. (2019)
      BACKGROUND: The role of prophylactic cranial irradiation (PCI) and thoracic radiotherapy (TRT) is unclear in resected small cell lung cancer (SCLC). METHODS: Thirteen European radiotherapy experts on SCLC were asked to describe their strategies on PCI and TRT for patients with resected SCLC. The treatment strategies were converted into decision trees and analyzed for consensus and discrepancies. RESULTS: For patients with resected SCLC and positive lymph nodes most experts recommend prophylactic cranial irradiation and thoracic radiotherapy. For elderly patients with resected node negative SCLC, most experts do not recommend thoracic radiotherapy or prophylactic cranial irradiation. CONCLUSION: PCI and TRT are considered in patients with resected SCLC and these treatments should be discussed with the patient in the context of shared decision-making.
    • Short communication: management of patients with extensive-stage small-cell lung cancer treated with radiotherapy: a survey of practice.

      Haslett, Kate; De Ruysscher, D; Dziadziuszko, R; Guckenberger, M; Pechoux, C; Nestle, U; Slotman, B; Faivre-Finn, Corinne; Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine & Health, University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK (2018-08-30)
      The results of the randomized phase 3 CREST trial evaluating the use of thoracic radiotherapy for extensive-stage small-cell lung cancer (ES-SCLC) were published in the Lancet in 2015. The primary endpoint (10% overall survival difference at 1-year) was not achieved, but there was significant improvement in 2-year overall survival (13% vs 3%; p = 0.004) and low toxicity rates, suggesting thoracic radiotherapy should be considered for ES-SCLC patients who respond to chemotherapy. Questions have been raised as to whether these results will lead to a change in practice.
    • Stereotactic body radiotherapy for central lung tumours: Author reply.

      Adebahr, S; Collette, S; Shash, E; Lambrecht, M; Le Pechoux, C; Faivre-Finn, Corinne; De Ruysscher, D; Peulen, H; Belderbos, J; Dziadziuszko, R; et al. (2015-09)