[an error occurred while processing this directive]|[an error occurred while processing this directive]
局部晚期非小细胞肺癌放疗剂量提升研究进展
王大权, 毕楠, 王绿化
国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院放疗科 100021
Research progress on radiation dose escalation for locally advanced non-small cell lung cancer
Wang Daquan, Bi Nan, Wang Lvhua
Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100021,China
Abstract：RTOG0617 trial has indicated that no benefit can be obtained in the overall survival of locally advanced non-small cell lung cancer patients by improving the prescribed dose, which promotes the adjustments to the strategies of dose escalation. Currently, multiple studies have been designed to explore more effective approaches to boost dose, such as dose boosts based on increased 18FDG-uptake regions, simultaneous integrated boost intensity-modulated radiotherapy and modulation of dose fractions, which have achieved a series of progress. The widespread application of PET-CT and intensity-modulated radiotherapy offers broad space for the dose escalation and optimization.
Wang Daquan,Bi Nan,Wang Lvhua. Research progress on radiation dose escalation for locally advanced non-small cell lung cancer[J]. Chinese Journal of Radiation Oncology, 2019, 28(10): 788-791.
[1] Bradley J,Graham MV,Winter K,et al. Toxicity and outcome results of RTOG 9311:a phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma[J]. Int J Radiat Oncol Biol Phys,2005,61(2):318-328. DOI:10.1016/j.ijrobp.2004.06.260. [2] Kong FM,Ten Haken RK,Schipper MJ,et al. High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer:long-term results of a radiation dose escalation study[J]. Int J Radiat Oncol Biol Phys,2005,63(2):324-333. DOI:10.1016/j.ijrobp.2005.02.010. [3] Socinski MA,Rosenman JG,Halle J,et al. Dose-escalating conformal thoracic radiation therapy with induction and concurrent carboplatin/paclitaxel in unresectable stage ⅢA/B nonsmall cell lung carcinoma:a modified phase Ⅰ/Ⅱ trial[J]. Cancer,2001,92(5):1213-1223. DOI:10.1002/1097-0142(20010901)92:5. [4] Bradley JD,Bae K,Graham MV,et al. Primary analysis of the phase Ⅱ component of a phase Ⅰ/Ⅱ dose intensification study using three-dimensional conformal radiation therapy and concurrent chemotherapy for patients with inoperable non-small-cell lung cancer:RTOG 0117[J]. J Clin Oncol,2010,28(14):2475-2480. DOI:10.1200/JCO.2009.27.1205. [5] Socinski MA,Blackstock AW,Bogart JA,et al. Randomized phase Ⅱ trial of induction chemotherapy followed by concurrent chemotherapy and dose-escalated thoracic conformal radiotherapy (74 Gy) in stage Ⅲ non-small-cell lung cancer:CALGB 30105[J]. J Clin Oncol,2008,26(15):2457-2463. DOI:10.1200/JCO.2007.14.7371. [6] Brower JV,Amini A,Chen S,et al. Improved survival with dose-escalated radiotherapy in stage Ⅲ non-small-cell lung cancer:analysis of the national cancer database[J]. Ann Oncol,2016,27(10):1887-1894. DOI:10.1093/annonc/mdw276. [7] Machtay M,Bae K,Movsas B,et al. Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation:an analysis of the Radiation Therapy Oncology Group[J]. Int J Radiat Oncol Biol Phys,2012,82(1):425-434. DOI:10.1016/j.ijrobp.2010.09.004. [8] Hudson A,Chan C,Woolf D,et al. Is heterogeneity in stage 3 non-small cell lung cancer obscuring the potential benefits of dose-escalated concurrent chemo-radiotherapy in clinical trials?[J]. Lung Cancer,2018,118:139-147. DOI:10.1016/j.lungcan.2018.02.006. [9] Hong JC,Salama JK. Dose escalation for unresectable locally advanced non-small cell lung cancer:end of the line?[J]. Transl Lung Cancer Res,2016,5(1):126-133. DOI:10.3978/j.issn.2218-6751.2016.01.07. [10] Aerts HJ,Bosmans G,van Baardwijk AA,et al. Stability of 18F-deoxyglucose uptake locations within tumor during radiotherapy for NSCLC:a prospective study[J]. Int J Radiat Oncol Biol Phys,2008,71(5):1402-1407. DOI:10.1016/j.ijrobp.2007.11.049. [11] Aerts HJ,van Baardwijk AA,Petit SF,et al. Identification of residual metabolic-active areas within individual NSCLC tumours using a pre-radiotherapy (18) Fluorodeoxyglucose-PET-CT scan[J]. Radiother Oncol,2009,91(3):386-392. DOI:10.1016/j.radonc.2009.03.006. [12] Mahasittiwat P,Yuan S,Xie C,et al. Metabolic Tumor Volume on PET Reduced More than Gross Tumor Volume on CT during Radiotherapy in Patients with Non-Small Cell Lung Cancer Treated with 3DCRT or SBRT[J]. J Radiat Oncol,2013,2(2):191-202. DOI:10.1007/s13566-013-0091-x. [13] van Elmpt W,De Ruysscher D,van der Salm A,et al. The PET-boost randomised phase Ⅱ dose-escalation trial in non-small cell lung cancer[J]. Radiother Oncol,2012,104(1):67-71. DOI:10.1016/j.radonc.2012.03.005. [14] Moller DS,Khalil AA,Knap MM,et al. A planning study of radiotherapy dose escalation of PET-active tumour volumes in non-small cell lung cancer patients[J]. Acta Oncol,2011,50(6):883-888. DOI:10.3109/0284186X.2011.581694. [15] Kong FM,Ten Haken RK,Schipper M,et al. Effect of midtreatment PET-CT-adapted radiation therapy with concurrent chemotherapy in patients with locally advanced non-small cell lung cancer:a phase 2 clinical trial[J]. JAMA Oncol,2017,3(10):1358-1365. DOI:10.1001/jamaoncol.2017.0982. [16] van Elmpt W,Ollers M,Dingemans AM,et al. Response assessment using 18F-FDG PET early in the course of radiotherapy correlates with survival in advanced-stage non-small cell lung cancer[J]. J Nucl Med,2012,53(10):1514-1520. DOI:10.2967/jnumed.111.102566. [17] Zeng J,Rengan R. Dose Escalation optimization in patients with locally advanced non-small cell lung cancer:the right dose,in the right location,to the right patient,at the right time[J]. JAMA Oncol,2017,3(10):1365-1367. DOI:10.1001/jamaoncol.2017.1344. [18] Kepka L,Maciejewski B,Withers RH. Does incidental irradiation with doses below 50 gy effectively reduce isolated nodal failures in non-small-cell lung cancer:dose-response relationship[J]. Int J Radiat Oncol Biol Phys,2009,73(5):1391-1396. DOI:10.1016/j.ijrobp.2008.07.070. [19] Yang W,Zeng B,Qiu Y,et al. A dosimetric comparison of dose escalation with simultaneous integrated boost for locally advanced non-small cell lung cancer[J]. Biomed Res Int,2017,2017:9736362. DOI:10.1155/2017/9736362. [20] Ji K,Zhao LJ,Liu WS,et al. Simultaneous integrated boost intensity-modulated radiotherapy for treatment of locally advanced non-small-cell lung cancer:a retrospective clinical study[J]. Br J Radiol,2014,87(1035):20130562. DOI:10.1259/bjr.20130562. [21] Fondevilla-Soler A,Lopez-Guerra JL,Dzugashvili M,et al. Outcome and toxicity of intensity modulated radiotherapy with simultaneous integrated boost in locally advanced non-small cell lung cancer patients[J]. Clin Transl Oncol,2017,19(12):1469-1477. DOI:10.1007/s12094-017-1689-z. [22] Xu Y,Zheng X,Bai X,et al. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced non-small cell lung cancer in Chinese population:a retrospective study[J]. Oncotarget,2017,8(30):49084-49092. DOI:10.18632/oncotarget.17094. [23] Swanick CW,Lin SH,Sutton J,et al. Use of simultaneous radiation boost achieves high control rates in patients with non-small-cell lung cancer who are not candidates for surgery or conventional chemoradiation[J]. Clin Lung Cancer,2015,16(2):156-163. DOI:10.1016/j.cllc.2014.10.005. [24] Zhang W,Liu C,Lin H,et al. Prospective study of special stage Ⅱ(T2b-3N0M0) non-small-cell lung cancer treated with hypofractionated-simultaneous integrated boost-intensity modulated radiation therapy[J]. J Cancer Res Ther,2015,11(2):381-387. DOI:10.4103/0973-1482.157332. [25] Cox JD,Azarnia N,Byhardt RW,et al. A randomized phase Ⅰ/Ⅱ trial of hyperfractionated radiation therapy with total doses of 60.0 Gy to 79.2 Gy:possible survival benefit with greater than or equal to 69.6 Gy in favorable patients with Radiation Therapy Oncology Group stage Ⅲ non-small-cell lung carcinoma:report of Radiation Therapy Oncology Group 83-11[J]. J Clin Oncol,1990,8(9):1543-1555. DOI:10.1200/JCO.1990.8.9.1543. [26] Lee JS,Scott C,Komaki R,et al. Concurrent chemoradiation therapy with oral etoposide and cisplatin for locally advanced inoperable non-small-cell lung cancer:radiation therapy oncology group protocol 91-06[J]. J Clin Oncol,1996,14(4):1055-1064. DOI:10.1200/JCO.1996.14.4.1055. [27] Curran WJJr,Paulus R,Langer CJ,et al. Sequential vs.concurrent chemoradiation for stage Ⅲ non-small cell lung cancer:randomized phase Ⅲ trial RTOG9410[J]. J Natl Cancer Inst,2011,103(19):1452-1460. DOI:10.1093/jnci/djr325. [28] Cannon DM,Mehta MP,Adkison JB,et al. Dose-limiting toxicity after hypofractionated dose-escalated radiotherapy in non-small-cell lung cancer[J]. J Clin Oncol,2013,31(34):4343-4348. DOI:10.1200/JCO.2013.51.5353. [29] Agolli L,Valeriani M,Bracci S,et al. Hypofractionated image-guided radiation therapy (3Gy/fraction) in patients affected by inoperable advanced-stage non-small cell lung cancer after long-term follow-up[J]. Anticancer Res,2015,35(10):5693-5700. DOI:10.1016/S0167-8140(15)41167-3. [30] Urbanic JJ,Wang X,Bogart JA,et al. Phase 1 study of accelerated hypofractionated radiation therapy with concurrent chemotherapy for Stage Ⅲ non-small cell lung cancer:CALGB 31102(Alliance)[J]. Int J Radiat Oncol Biol Phys,2018,101(1):177-185. DOI:10.1016/j.ijrobp.2018.01.046. [31] Kaster TS,Yaremko B,Palma DA,et al. Radical-intent hypofractionated radiotherapy for locally advanced non-small-cell lung cancer:a systematic review of the literature[J]. Clin Lung Cancer,2015,16(2):71-79. DOI:10.1016/j.cllc.2014.08.002. [32] Donato V,Arcangeli S,Monaco A,et al. Moderately escalated hypofractionated (chemo) radiotherapy delivered with helical intensity-modulated technique in Stage Ⅲ unresectable non-small cell lung cancer[J]. Front Oncol,2013,3:286. DOI:10.3389/fonc.2013.00286.
2019, Vol. 28 
