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Gregory J. Riely, MD, PhD
Gregory J. Riely, MD, PhD
Posted: Wednesday, November 27, 2024
Feng-Ming (Spring) Kong, MD, PhD, of the University of Hong Kong Shenzhen Hospital, China, and colleagues aimed to determine whether midtreatment PET-adapted radiotherapy dose escalation might improve and predict outcomes in patients with non–small cell lung cancer (NSCLC). Published in the Journal of Clinical Oncology, the results of this trial concluded that although this treatment regimen did not improve efficacy, it decreased the radiotherapy field.
“We do not recommend this particular regimen for a phase III study,” the researchers concluded. “However, we suggest that future functional imaging-based adaptive chemoradiotherapy studies, using even more individualized approaches to radiation dose and field selection than in our study, be developed.”
A total of 127 eligible patients with NSCLC were randomly assigned 1:2 to receive standard (60 Gy in 30 fractions) or 18F-fluorodeoxyglucose (FDG)-PET/CT–guided adaptive treatment. Participants were stratified by histology, substage, and primary tumor size. Patients on the adaptive therapy arm underwent intensified boost radiotherapy to metabolically active areas, and all patients had mid-treatment FDG-PET/CT.
The mean dose of radiotherapy in the adaptive arm was 71 Gy in 30 fractions, and the mean lung dose was 17.9 Gy. The centrally reviewed 2-year freedom from local-regional disease progression was similar in the standard and adaptive arms (59.5% and 54.6%). The frequency of grade 3 or higher toxicities was also similar among groups, although the adaptive arm had a higher rate of esophagitis (43% vs 31%).
Of note, the rates of cardiac and pulmonary toxicity were comparable between the arms. The median standardized uptake value peak and metabolic tumor volume among patients in the adaptive therapy arm decreased 49% and 54% from preradiotherapy to midradiotherapy PET, respectively. Further, average metabolic tumor volume and standardized uptake values did not seem to correlate with freedom from local-regional tumor progression.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
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