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dc.contributor.authorCooke, S. A.
dc.contributor.authorDirk de Ruysscher, P.
dc.contributor.authorReymen, B.
dc.contributor.authorLambrecht, M.
dc.contributor.authorFredberg Persson, G.
dc.contributor.authorFaivre-Finn, Corinne
dc.contributor.authorDieleman, E. M. T.
dc.contributor.authorLewensohn, R.
dc.contributor.authorvan Diessen, J. N. A.
dc.contributor.authorSikorska, K.
dc.contributor.authorLalezari, F.
dc.contributor.authorVogel, W.
dc.contributor.authorvan Elmpt, W.
dc.contributor.authorDamen, E. M. F.
dc.contributor.authorSonke, J. J.
dc.contributor.authorBelderbos, J. S. A.
dc.date.accessioned2023-02-23T15:17:19Z
dc.date.available2023-02-23T15:17:19Z
dc.date.issued2023en
dc.identifier.citationCooke SA, Dirk de Ruysscher P, Reymen B, Lambrecht M, Fredberg Persson G, Faivre-Finn Frcr C, et al. (18)F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): results from a randomised clinical trial. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. 2023 Jan 24:109492. PubMed PMID: 36706958. Epub 2023/01/28. eng.en
dc.identifier.pmid36706958en
dc.identifier.doi10.1016/j.radonc.2023.109492en
dc.identifier.urihttp://hdl.handle.net/10541/626026
dc.description.abstractBackground and purpose: We aimed to assess if radiation dose escalation to either the whole primary tumour, or to an 18F-FDG-PET defined subvolume within the primary tumour known to be at high risk of local relapse, could improve local control in patients with locally advanced non-small-cell lung cancer. Materials and methods: Patients with inoperable, stage II-III NSCLC were randomised (1:1) to receive dose-escalated radiotherapy to the whole primary tumour or a PET-defined subvolume, in 24 fractions. The primary endpoint was freedom from local failure (FFLF), assessed by central review of CT-imaging. A phase II 'pick-the-winner' design (alpha = 0.05; beta = 0.80) was applied to detect a 15 % increase in FFLF at 1-year. Clinicaltrials: gov:NCT01024829. Results: 150 patients were enrolled. 54 patients were randomised to the whole tumour group and 53 to the PET-subvolume group. The trial was closed early due to slow accrual. Median dose/fraction to the boosted volume was 3.30 Gy in the whole tumour group, and 3.50 Gy in the PET-subvolume group. The 1-year FFLF rate was 97 % (95 %CI 91-100) in whole tumour group, and 91 % (95 %CI 82-100) in the PET-subvolume group. Acute grade ≥ 3 adverse events occurred in 23 (43 %) and 20 (38 %) patients, and late grade ≥ 3 in 12 (22 %) and 17 (32 %), respectively. Grade 5 events occurred in 19 (18 %) patients in total, of which before disease progression in 4 (7 %) in the whole tumour group, and 5 (9 %) in the PET-subvolume group. Conclusion: Both strategies met the primary objective to improve local control with 1-year rates. However, both strategies led to unexpected high rates of grade 5 toxicity. Dose differentiation, improved patient selection and better sparing of central structures are proposed to improve dose-escalation strategies.en
dc.language.isoenen
dc.relation.urlhttps://dx.doi.org/10.1016/j.radonc.2023.109492en
dc.title(18)F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): results from a randomised clinical trialen
dc.typeArticleen
dc.contributor.departmentDepartment of Radiation Oncology, Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlandsen
dc.identifier.journalRadiotherapy and Oncologyen
dc.description.noteen]


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