A feasibility study of dynamic adaptive radiotherapy for nonsmall cell lung cancer

ObjectivesStereotactic ablative radiotherapy (SABR) is a well-established treatment for medically inoperable peripheral stage I nonsmall cell lung cancer (NSCLC). Previous nonrandomised evidence supports SABR as an alternative to surgery, but high-quality randomised controlled trial (RCT) evidence is lacking. The SABRTooth study aimed to establish whether a UK phase III RCT was feasible.Design and methodsSABRTooth was a UK multicentre randomised controlled feasibility study targeting patients with peripheral stage I NSCLC considered to be at higher risk of surgical complications. 54 patients were planned to be randomised 1:1 to SABR or surgery. The primary outcome was monthly average recruitment rates.ResultsBetween July 2015 and January 2017, 318 patients were considered for the study and 205 (64.5%) were deemed ineligible. Out of 106 (33.3%) assessed as eligible, 24 (22.6%) patients were randomised to SABR (n=14) or surgery (n=10). A key theme for nonparticipation was treatment preference, with 43 (41%) preferring nonsurgical treatment and 19 (18%) preferring surgery. The average monthly recruitment rate was 1.7 patients against a target of three. 15 patients underwent their allocated treatment: SABR n=12, surgery n=3.ConclusionsWe conclude that a phase III RCT randomising higher risk patients between SABR and surgery is not feasible in the National Health Service. Patients have pre-existing treatment preferences, which was a barrier to recruitment. A significant proportion of patients randomised to the surgical group declined and chose SABR. SABR remains an alternative to surgery and novel study approaches are needed to define which patients benefit from a nonsurgical approach.

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A Feasibility Study of Dynamic Adaptive Radiotherapy for Non-Small Cell Lung Cancer

SSRN Electronic Journal ◽

10.2139/ssrn.2648576 ◽

2015 ◽

Author(s):

Minsun Kim ◽

Mark H Phillips

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Feasibility Study ◽

Cell Lung Cancer ◽

Small Cell ◽

Adaptive Radiotherapy ◽

Small Cell Lung

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Long‐term outcomes of high‐dose (74 GyE ) proton beam therapy with concurrent chemotherapy for stage III nonsmall‐cell lung cancer

Thoracic Cancer ◽

10.1111/1759-7714.13896 ◽

2021 ◽

Author(s):

Kayoko Ohnishi ◽

Hitoshi Ishikawa ◽

Kensuke Nakazawa ◽

Toshihiro Shiozawa ◽

Yutaro Mori ◽

...

Keyword(s):

Lung Cancer ◽

Proton Beam ◽

Cell Lung Cancer ◽

Nonsmall Cell Lung Cancer ◽

Proton Beam Therapy ◽

Concurrent Chemotherapy ◽

Stage Iii ◽

High Dose ◽

Long Term Outcomes

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Complete metabolic response in patients with advanced nonsmall cell lung cancer with prolonged response to immune checkpoint inhibitor therapy

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-002262 ◽

2021 ◽

Vol 9 (3) ◽

pp. e002262

Author(s):

Justin Ferdinandus ◽

Martin Metzenmacher ◽

Lukas Kessler ◽

Lale Umutlu ◽

Clemens Aigner ◽

...

Keyword(s):

Lung Cancer ◽

Cell Lung Cancer ◽

Metabolic Response ◽

Standard Of Care ◽

Nonsmall Cell Lung Cancer ◽

Published Data ◽

Complete Metabolic Response ◽

Positron Emission ◽

Checkpoint Inhibitor Therapy

IntroductionImmunotherapy is the new standard of care in advanced nonsmall cell lung cancer (NSCLC). Recently published data show that treatment discontinuation after 12 months of nivolumab treatment is associated with shorter survival. Therefore, the ideal duration of immunotherapy remains unclear, and finding markers of beneficial outcomes is of great importance. Here, we determine the proportion of complete metabolic responses (CMR) in patients who have not progressed after 24 months of immunotherapy.MethodsThis is a retrospective analysis of 45 patients with positron emission tomography using 2-[18F]fluoro-2-deoxy-D-glucose imaging for assessment of residual metabolic activity after at least 24 months. CMR was defined as uptake in tumor lesions below background levels, using mediastinum as a reference. ResultsOut of 45 patients, 29 patients had a CMR (64%). CMR was observed more frequently in non-first-line patients. Patients with CMR were younger (median 65.7 vs 75.5, p=0.03). Fourteen patients with CMR have discontinued therapy and have not progressed until time of analysis; however, median follow-up was only 5.6 (range 0.8–17.0) months.ConclusionAfter a minimum of 24 months of palliative immunotherapy for NSCLC, CMR occurred in almost two thirds of patients. Potentially, achievement of CMR might identify patients, for whom palliative immunotherapy may be safely discontinued.

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