Is moderately hypofractionated RT using 60 Gy/20fx with concurrent chemotherapy appropriate for unresectable stage III NSCLC?
Based on results from Zhang et al., PMID 38631536. Would we select patients based on planned lung V20 to avoid excess toxicity? Any further considerations in patients planned for consolidative immunotherapy?
Answer from: Radiation Oncologist at Academic Institution
No perfect answers, as usual. We (CALGB) did a prospective multi-institutional Phase I trial asking the question, what is the MTD for hypofx treatment with concurrent chemo for stage 3 disease? We came to an MTD of 60 Gy in 24 fx (2.5 gy/fx). Urbanic et al., PMID 29487024. Inclusion was your typical...
Answer from: Radiation Oncologist at Community Practice
This data shows fascinating outcomes, but I am not surprised at the "ho hum" reaction from most radiation oncologists. The reasons for this:
American radiation oncologists are loathe to trust data from other countries, China, in particular. As an example, there is a PMRT study for triple-negative e...
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Radiation Oncologist at Cleveland Clinic Excellent answer and covering a lot of bases! I re...
Answer from: Radiation Oncologist at Academic Institution
Hi everyone. LTL FTP and sorry for the lengthy post. I concur with Dr. @Urbanic and the Alliance Group that 60 Gy/24 fractions with chemo is acceptable. I would avoid 60 Gy/20 fractions outside of a clinical trial. A long time ago (? galaxy far away), I opened an investigator-initiated tri...
Answer from: Radiation Oncologist at Academic Institution
We have used this approach, but in a personalized way, accelerating the fractionation according to the ability to meet or beat conventional normal tissue dose constraints.Our experience is summarized here: Hui et al., PMID 38065707. This was mostly in the era before adjuvant immune checkpoint i...
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Radiation Oncologist at Beaumont Health System In addition to the studies mentioned by Dr. @Loo, ...
Radiation Oncologist at Wake Forest School of Medicine I may be missing it in the publications above but ...
Radiation Oncologist at Stanford University School of Medicine We didn't use dose to the PBT as a fraction-determ...
Answer from: Radiation Oncologist at Academic Institution
I trust readers of this thread appreciate that it is too simplistic to think through this conundrum with conversations limited to daily dose/fxn so they can just "go for it". Radiation therapy entails a 3-dimensional prescription that should always consider the volume of normal tissues that can get ...
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Radiation Oncologist at UC San Diego School of Medicine I basically agree with you @Drew, but this is basi...
Radiation Oncologist at UCLA | VA Greater Los Angeles Healthcare System The caveat I shared stems from observing gross mis...
Radiation Oncologist at UC San Diego School of Medicine Totally onboard with that. Makes a ton of sense