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Feng-Ming (Spring) Kong
Author of
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OA02 - Updates in Locally Advanced NSCLC (ID 125)
- Event: WCLC 2020
- Type: Oral
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/29/2021, 09:15 - 10:15, Scientific Program Auditorium
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OA02.04 - Randomized Phase Ⅱ Trial (RTOG1106) on Midtreatment PET/CT Guided Adaptive Radiotherapy in Locally Advanced Non-Small Cell Lung Cancer (ID 3790)
09:15 - 10:15 | Presenting Author(s): Feng-Ming (Spring) Kong
- Abstract
- Presentation
Introduction
Dose-intensified radiation has been shown to improve tumor control and survival in Stage I NSCLC, and in Stage III NSCLC radiation-alone studies. However, NRG-RTOG 0617 showed that with concurrent chemo-RT, higher-dose RT paradoxically worsened survival. Here we present the results of a multicenter trial led by NRG Oncology and American College of Radiology Network (ACRIN), which aimed to determine whether adaptive isotoxic radiation dose escalation to mid-treatment FDG-PET provides superior local tumor control compared to a standard uniform dose of 60 Gy in patients with stage III NSCLC.
Methods
Patients with stage III NSCLC medically fit for concurrent chemoradiation were randomized by a 1:2 ratio to standard (60Gy) arm and adaptive therapy arm (dose individualized to 20 Gy MLD and adapted to residual tumor on the mid-treatment FDG-PET/CT). All patients had FDG-PET performed around 40 Gy mid-treatment and RT was delivered in 30 daily fractions. The adaptive arm consisted of an initial plan of 2.2 Gy/Fx for 21 Fx followed by an adaptive RT boost to mid-treatment FDG-PET target using a variable prescription of 2.2-3.8 Gy/Fx for the final 9 Fx. The primary endpoint of this report was 2-year Local-Regional tumor Progression Free (LRPF), with inclusion of overall and in-field LRPF, assessed independently and blindly by ACRIN radiologists.
Results
Of 138 patients enrolled between February 2012 and March 2017, 127 were eligible and analyzable, with 43 and 84 patients in the standard and adaptive arms, with a minimum follow-up of 3.7 and 3.4 years for surviving patients, respectively. The baseline characteristics, including age, gender, race, performance status, tumor size, histology, and stage, were balanced between the two arms. The median prescription dose for the adaptive arm was 71 Gy (Q1-Q3 68-76 Gy) vs. 60 Gy in the standard arm (P<0.01). The overall RT protocol compliance rates were Acceptable in 92.9% and 95.8%, Per Protocol in 50.0% and 32.4%, of standard and adaptive RT arms, respectively. There were no significant differences in lung, esophagus and heart toxicities, though the adaptive arm had numerically higher mean doses of these organs at risk. The 2-year overall LRPF rates were 59.5% (95% CI: 37.9, 75.7) on the standard arm, and 54.6% (95% CI: 39.9, 67.0) on the adaptive arm. The median LRPF time was 27.5 months (95% CI: 14.3, not reached) on the standard arm and 28.4 months (95% CI: 19.1, not reached) on the adaptive arm. There were no significant differences in overall survival, progression free survival or lung cancer specific survival between the two arms. Correlative analyses, including radiation sensitivity genotyping, doses to lymphocytes and in-field LRPF, are planned and results will be presented.
Conclusion
This is the first randomized trial that demonstrated the feasibility and safety of performing biologically adaptive RT escalation in a multicenter setting in patients with stage III NSCLC. This preliminary analysis did not show an improvement in overall local regional tumor control. The in-field local regional tumor control results are awaited.
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