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Radical Radiotherapy in the Management of Locally Advanced Non-Small-Cell Lung Cancer

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Tumors of the Chest

17.10 Conclusions

Radiotherapy has played a part in the management of locally advanced NSCLC for decades. It has provided an option of radical treatment in patients who present with inoperable disease. Recent advances in radiotherapy techniques and the combined modality treatment with chemotherapy have improved the outcome for these patients. Future developments for more accurate staging of disease with both anatomical and functional imaging, improved radiotherapy conformity with IMRT and image-guided radiotherapy, and the use of novel chemotherapeutic agents and biological agents in conjunction with radiotherapy, will further improve the outcome for NSCLC.

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References

  1. Jemal A, Thomas A, Murray T, et al. Cancer statistics, 2002. CA Cancer J Clin 2002; 52:23.

    Article  PubMed  Google Scholar 

  2. Pfister DG, Johnson DH, Azzoli CG, et al. American Society of Clinical Oncology treatment of unresectable non-small-cell lung cancer guideline: update 2003. J Clin Oncol 2004; 22:330.

    Article  PubMed  Google Scholar 

  3. Morita K, Fuwa N, Suzuki Y, et al. Radical radiotherapy for medically inoperable non-small cell lung cancer in clinical stage I: a retrospective analysis of 149 patients. Radiother Oncol 1997; 42:31.

    Article  PubMed  CAS  Google Scholar 

  4. Jeremic B, Shibamoto Y, Acimovic L, et al. Hyperfractionated radiotherapy alone for clinical stage I nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1997; 38:521.

    Article  PubMed  CAS  Google Scholar 

  5. Krol AD, Aussems P, Noordijk EM, et al. Local irradiation alone for peripheral stage I lung cancer: could we omit the elective regional nodal irradiation? Int J Radiat Oncol Biol Phys 1996; 34:297.

    Article  PubMed  CAS  Google Scholar 

  6. Slotman BJ, Antonisse IE, Njo KH. Limited field irradiation in early stage (T1-2N0) non-small cell lung cancer. Radiother Oncol 1996; 41:41.

    PubMed  CAS  Google Scholar 

  7. Graham PH, Gebski VJ, Langlands AO. Radical radiother apy for early nonsmall cell lung cancer. Int J Radiat Oncol Biol Phys 1995; 31:261.

    Article  PubMed  CAS  Google Scholar 

  8. Kaskowitz L, Graham MV, Emami B, et al. Radiation therapy alone for stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 1993; 27:517.

    PubMed  CAS  Google Scholar 

  9. Dosoretz DE, Katin MJ, Blitzer PH, et al. Radiation therapy in the management of medically inoperable carcinoma of the lung: results and implications for future treatment strategies. Int J Radiat Oncol Biol Phys 1992; 24:3.

    PubMed  CAS  Google Scholar 

  10. Landberg T, Chavaudra J, Dobbs HJ. ICRU Report 62. Prescribing, recording and reporting photon beam therapy (supplement to ICRU Report 50). International Commission on Radiotherapy Units and Measurements, Bethesda, MD, 1999.

    Google Scholar 

  11. Senan S, Burgers S, Samson MJ, et al. Can elective nodal irradiation be omitted in stage III non-small-cell lung cancer? Analysis of recurrences in a phase II study of induction chemotherapy and involved-field radiotherapy. Int J Radiat Oncol Biol Phys 2002; 54:999.

    Article  PubMed  Google Scholar 

  12. Rosenzweig KE, Sim SE, Mychalczak B, et al. Elective nodal irradiation in the treatment of non-small-cell lung cancer with three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 2001; 50:681.

    Article  PubMed  CAS  Google Scholar 

  13. Sibley GS. Radiotherapy for patients with medically inoperable Stage I nonsmall cell lung carcinoma: smaller volumes and higher doses — a review. Cancer 1998; 82:433.

    Article  PubMed  CAS  Google Scholar 

  14. van Sornsen de Koste JR, Lagerwaard FJ, Nijssen-Visser MR, et al. Tumor location cannot predict the mobility of lung tumors: a 3D analysis of data generated from multiple CT scans. Int J Radiat Oncol Biol Phys 2003; 56:348.

    Article  PubMed  Google Scholar 

  15. Sixel KE, Ruschin M, Tirona R, et al. Digital fluoroscopy to quantify lung tumor motion: potential for patient-specific planning target volumes. Int J Radiat Oncol Biol Phys 2003; 57:717.

    Article  PubMed  Google Scholar 

  16. Tredaniel J, Hennequin C, Zalcman G, et al. Prolonged survival after high-dose rate endobronchial radiation for malignant airway obstruction. Chest 1994; 105:767.

    PubMed  CAS  Google Scholar 

  17. Gollins SW, Burt PA, Barber PV, et al. Long-term survival and symptom palliation in small primary bronchial carcinomas following treatment with intraluminal radiotherapy alone. Clin Oncol (R Coll Radiol) 1996; 8:239.

    CAS  Google Scholar 

  18. Buccheri G, Ferrigno D. Prognostic factors. Hematol Oncol Clin North Am 2004; 18:187.

    Article  PubMed  Google Scholar 

  19. Perez CA, Bauer M, Edelstein S, et al. Impact of tumor control on survival in carcinoma of the lung treated with irradiation. Int J Radiat Oncol Biol Phys 1986; 12:539.

    PubMed  CAS  Google Scholar 

  20. Slawson RG, Salazar OM, Poussin-Rosillo H, et al. Once-a-week vs conventional daily radiation treatment for lung cancer: final report. Int J Radiat Oncol Biol Phys 1988; 15:61.

    PubMed  CAS  Google Scholar 

  21. 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 Clin Oncol 1990; 8:1543.

    PubMed  CAS  Google Scholar 

  22. Kwa SL, Lebesque JV, Theuws JC et al. Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998; 42:1.

    Article  PubMed  CAS  Google Scholar 

  23. Hernando ML, Marks LB, Bentel GC, et al. Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer. Int J Radiat Oncol Biol Phys 2001; 51:650.

    Article  PubMed  CAS  Google Scholar 

  24. Kim YH, Fayos JV. Radiation tolerance of the cervical spinal cord. Radiology 1981; 139:473.

    PubMed  CAS  Google Scholar 

  25. Bradley J, Thorstad WL, Mutic S, et al. Impact of FDG-PET on radiation therapy volume delineation in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004; 59:78.

    Article  PubMed  Google Scholar 

  26. Werner-Wasik M, Yu X, Marks LB, et al. Normal-tissue toxicities of thoracic radiation therapy: esophagus, lung, and spinal cord as organs at risk. Hematol Oncol Clin North Am 2004; 18:131.

    Article  PubMed  Google Scholar 

  27. Silverberg E, Boring CC, Squires TS. Cancer statistics, 1990. CA Cancer J Clin 1990; 40:9

    PubMed  CAS  Google Scholar 

  28. PORT Meta-analysis Trialists Group. Postoperative radiotherapy for non-small cell lung cancer. The Cochrane Database of Systematic Reviews 2003: Art.No.:CD002142. DOI: 10.1002/14651858.CD002142.

    Google Scholar 

  29. Okawara G, Ung YC, Markman BR, et al. Postoperative radiotherapy in stage II or IIIA completely resected non-small cell lung cancer: a systematic review and practice guideline. Lung Cancer 2004; 44:1.

    Article  PubMed  Google Scholar 

  30. Emami B. Three-dimensional conformal radiation therapy in bronchogenic carcinoma. Semin Radiat Oncol 1996; 6:92.

    Article  PubMed  Google Scholar 

  31. Martel MK, Ten Haken RK, Hazuka MB, et al. Estimation of tumor control probability model parameters from 3-D dose distributions of non-small cell lung cancer patients. Lung Cancer 1999; 24:31.

    Article  PubMed  CAS  Google Scholar 

  32. Rengan R, Rosenzweig KE, Venkatraman E, et al. Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004; 60:741.

    Article  PubMed  Google Scholar 

  33. Belderbos JS, De Jaeger K, Heemsbergen WD, et al. First results of a phase I/II dose escalation trial in non-small cell lung cancer using three-dimensional conformal radiotherapy. Radiother Oncol 2003; 66:119.

    Article  PubMed  Google Scholar 

  34. Saunders M, Dische S, Barrett A, et al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet 1997; 350:161.

    Article  PubMed  CAS  Google Scholar 

  35. Saunders MI, Rojas A, Lyn BE, et al. Experience with dose escalation using CHARTWEL (continuous hyperfractionated accelerated radiotherapy weekend less) in non-small-cell lung cancer. Br J Cancer 1998; 78:1323.

    PubMed  CAS  Google Scholar 

  36. Dische S, Saunders MI. The CHART regimen and morbidity. Acta Oncol 1999; 38:147.

    Article  PubMed  CAS  Google Scholar 

  37. Langendijk H, de Jong J, Tjwa M, et al. External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study. Radiother Oncol 2001; 58:257.

    Article  PubMed  CAS  Google Scholar 

  38. Steel G. Basic Clinical Radiobiology, 3rd edn. Hodder Arnold, London, 2002.

    Google Scholar 

  39. Shibamoto Y, Jeremic B. Biologic premises of combined radiation therapy and chemotherapy in lung cancer. Hematol Oncol Clin North Am 2004; 18:29.

    Article  PubMed  Google Scholar 

  40. LeChevalier TAR, Lacombe-Terrier M-J, et al. Radiotherapy alone versus combined chemotherapy and radiotherapy in nonresectable non-small-cell lung cancer: first analysis of a randomised trial in 353 patients. J Natl Cancer Inst 1991; 83:417.

    CAS  Google Scholar 

  41. Dillman RO, Herndon J, Seagren SL, et al. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of cancer and leukemia group B (CALGB) 8433 trial. J Natl Cancer Inst 1996; 88:1210.

    PubMed  CAS  Google Scholar 

  42. Sause W, Kolesar P, Taylor S, et al. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group. Chest 2000; 117:358.

    Article  PubMed  CAS  Google Scholar 

  43. NSCLCCG. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ 1995; 311:899.

    Google Scholar 

  44. Rowell N, O’Rourke N. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev 2004:CD002140.

    Google Scholar 

  45. Curran WJ, Scott CB, Langer CJ, et al. Long-term benefit is observed in a phase III comparison of sequential vs concurrent chemoradiation for patients with unresected stage III NSCLC: RTOG 9410. Proc Am Soc Clin Oncol 2003:621.

    Google Scholar 

  46. Zatloukal P, Petruzelka L, Zemanova M, et al. Concurrent versus sequential chemoradiotherapy with cisplatin and vinorelbine in locally advanced non-small cell lung cancer: a randomized study. Lung Cancer 2004; 46:87.

    Article  PubMed  Google Scholar 

  47. Fournel P, Perol M, Robinet G, et al. A randomized phase III trial of sequential chemo-radiotherapy versus concurrent chemo-radiotherapy in locally advanced non small cell lung cancer (nsclc) (glot-gfpc Npc 95-01 Study). Proc Am Soc Clin Oncol 2001; 22:621.

    Google Scholar 

  48. Albain KS, Crowley JJ, Turrisi AT 3rd, et al. Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group phase II study, SWOG 9019. J Clin Oncol 2002; 20:3454.

    Article  PubMed  CAS  Google Scholar 

  49. Gandara DR, Chansky K, Albain KS, et al. Consolidation docetaxel after concurrent chemoradiotherapy in stage IIIB non-small-cell lung cancer: phase II Southwest Oncology Group Study S9504. J Clin Oncol 2003; 21:2004.

    Article  PubMed  CAS  Google Scholar 

  50. Kutlu CA, Pastorino U, Maisey M, et al. Early experience with PET scanning in thoracic tumours. J Cardiovasc Surg (Torino) 2001; 42:403.

    CAS  Google Scholar 

  51. Prauer HW, Weber WA, Romer W, et al. Controlled prospective study of positron emission tomography using the glucose analogue [18f]fluorodeoxyglucose in the evaluation of pulmonary nodules. Br J Surg 1998; 85:1506.

    Article  PubMed  CAS  Google Scholar 

  52. Wong JW, Sharpe MB, Jaffray DA, et al. The use of active breathing control (ABC) to reduce margin for breathing motion. Int J Radiat Oncol Biol Phys 1999; 44:911.

    Article  PubMed  CAS  Google Scholar 

  53. Mah D, Hanley J, Rosenzweig KE et al. Technical aspects of the deep inspiration breath-hold technique in the treatment of thoracic cancer. Int J Radiat Oncol Biol Phys 2000; 48:1175.

    Article  PubMed  CAS  Google Scholar 

  54. Keall PJ, Kini VR, Vedam SS, et al. Motion adaptive x-ray therapy: a feasibility study. Phys Med Biol 2001; 46:1.

    Article  PubMed  CAS  Google Scholar 

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Newbold, K., Nutting, C.M. (2006). Radical Radiotherapy in the Management of Locally Advanced Non-Small-Cell Lung Cancer. In: Syrigos, K.N., Nutting, C.M., Roussos, C. (eds) Tumors of the Chest. Springer, Berlin, Heidelberg . https://doi.org/10.1007/3-540-31040-1_17

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  • DOI: https://doi.org/10.1007/3-540-31040-1_17

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