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Author Notes:

Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute of Emory University, Atlanta, GA 30322 USA. Raj S Rajpara, Email: : kristin.higgins@emory.edu

RSR carried out the data collection, analysis of results and drafted the manuscript.

ES assisted in conception of the study, acquisition of data, and reviewing the manuscript critically.

TF assisted in interpretation of data, reviewing the manuscript, and revising the manuscript critically for important intellectual content.

LJS and JJB contributed by reviewing the manuscript and revising it critically for important intellectual content.

WJC contributed by analyzing and interpreting the results and reviewing the manuscript critically for important intellectual content.

KAH assisted in conception of the project, analysis and interpretation of results, drafting the manuscript, and reviewing it critically for important intellectual content.

All authors read and approved the final manuscript.

Competing interests: E.S. is entitled to royalties derived from Velocity Medical Solutions’ sale of products. The terms of this agreement have been reviewed and approved by Emory University in accordance with its conflict of interest policies.

T.F. is entitled to royalties derived from Velocity Medical Solutions’ sale of products and serves as a scientific advisor to Velocity Medical Solutions and owns equity in the company. The terms of this agreement have been reviewed and approved by Emory University in accordance with its conflict of interest policies.

There are no other conflicts of interest to report.

Subjects:

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Oncology
  • Radiology, Nuclear Medicine & Medical Imaging
  • ONCOLOGY
  • RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
  • Lung cancer
  • Locally advanced
  • Locoregional failure
  • PET/CT
  • Radiation
  • Chemotherapy
  • STANDARDIZED UPTAKE VALUE
  • PHASE-III
  • CONCURRENT CHEMOTHERAPY
  • FDG-PET
  • TRIAL
  • RADIOTHERAPY
  • INDUCTION
  • SURVIVAL
  • THERAPY
  • DISEASE

Locoregional tumor failure after definitive radiation for patients with stage III non-small cell lung cancer

Journal Title:

Radiation Oncology

Volume:

Volume 9, Number 1

Publisher:

, Pages 187-187

Type of Work:

Article | Final Publisher PDF

Abstract:

Background: Locoregional tumor failure (LRF) after definitive chemoradiation for patients with stage III NSCLC remains unacceptably high. This analysis sought to further define where LRF occurs relative to radiation dose received and pre-treatment PET scan-defined maximum standard uptake value (SUVmax). Methods: This was a retrospective study analyzing patients with stage III NSCLC treated with definitive radiation between 2006 and 2011. LRF was defined as failure within the ipsilateral lung, hilum or mediastinum. The CT simulation scan with the radiation dose distribution was registered to the CT or PET/CT documenting LRF. The region of LRF was contoured, and the dose to 95% of the volume (D95) of LRF was extracted. The pre-treatment SUVmax was also extracted for the anatomic region of LRF. Results: Sixty-one patients were identified. Median follow-up time was 19.1 months (range 2.37-76.33). Seventy four percent of patients were treated with 3-D conformal technique (3DCRT), 15% were treated with Intensity Modulated Radiotherapy (IMRT), and 11% were treated with a combination of 3DCRT and IMRT. Median prescribed radiation dose for all patients was 66 Gy (39.6-74). Concurrent chemotherapy was delivered in 90% of patients. Twenty-two patients (36%) developed a LRF, with a total of 39 anatomic regions of LRF identified. Median time to LRF was 11.4 months (3.5-44.6). Failures were distributed as follows: 36% were in-field failures, 27% were out-of-field failures, 18% were in-field and out-of-field failures, and 18% were in-field and marginal (recurrences within the field edge) failures. There were no isolated marginal failures. Of the patients that developed a LRF, 73% developed a LRF with an in-field component. Sixty-two percent of LRFs were nodal. The median pre-treatment SUVmax for the anatomic region of LRF for patients with an in-field failure was 13. The median D95 of in-field LRF was 63 Gy. Conclusions: LRF after definitive chemoradiation are comprised primarily of in-field failures, though out-of field failures are not insignificant. Marginal failures are rare, indicating field margins are appropriate. Although radiation dose escalation to standard radiation fields has not yielded success, using PET parameters to define high-risk regions remains worthy of further investigation.

Copyright information:

© 2014 Rajpara et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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