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Alexander Thieme



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    OA12 - Profiling the Multidisciplinary Management of Stage III NSCLC (ID 144)

    • Event: WCLC 2019
    • Type: Oral Session
    • Track: Treatment of Locoregional Disease - NSCLC
    • Presentations: 1
    • Now Available
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      OA12.05 - Imaging-Guided Target Volume Reduction in Radiotherapy of Lung Cancer: The Prospective Randomized Multinational PET-Plan Trial (Now Available) (ID 2558)

      15:45 - 17:15  |  Author(s): Alexander Thieme

      • Abstract
      • Presentation
      • Slides

      Background

      Advanced medical imaging offers a chance for target volume reduction in modern radiotherapy, which may lead to more effective local treatments with reduced toxicity and offer the protection of draining lymph nodes and large vessels, possibly of importance for the upcoming combination of radiotherapy and immunotherapy. Locally advanced non-small cell lung cancer (NSCLC) with improvable local control and high toxicity is an excellent model to investigate this topic.

      Method

      In the prospective randomised controlled PET-Plan trial (NCT00697333), patients with inoperable stage II/III NSCLC and an indication for radiochemotherapy were randomized at a 1:1 ratio. In conventional arm A target volumes were informed by FDG-PET and CT plus elective nodal irradiation and in experimental arm B they were solely informed by FDG-PET. In both arms, quality assured isotoxically dose-escalated IMRT or 3D-CRT (60 - 74Gy, 2Gy per fraction) was planned and applied to the respective target volumes along with simultaneous platinum-based chemotherapy. The primary objective was time to locoregional progression (LRP) in terms of non-inferiority of experimental arm B.

      Result

      311 patients were recruited, 205 patients included in the intent to treat (ITT) (A: n=99, B: n=106) and 172 patients in the per protocol (PP) analysis (A: n=84, B: n=88). Median FU time in the PP set was 16 months. Non-inferiority of experimental arm B was confirmed for the pre-specified non-inferiority margin. The risk of LRP was lower in the experimental arm B (2y-LRP 0.20 vs. 0.39; HR=0·57; 95% CI: 0·30–1·06; p=0·039) with no difference between study arms concerning survival (2y-OS 0.57 vs. 0.54), out-field recurrence and toxicity.

      Conclusion

      In radiochemotherapy for locally advanced NSCLC PET-Imaging based reduction of radiotherapy target volumes is feasible and may improve local control without increasing toxicity. However, in this trial there was no impact on survival. The procedures established in this clinical trial provide a radiotherapy standard for future NSCLC-trials including immunotherapy and may furthermore inspire trials on imaging based target volume reduction for other types of tumours.

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