Clinical outcome of image-guided adaptive radiotherapy in the treatment of lung cancer patients

Marie Tvilum*, Azza A. Khalil, Ditte S. Møller, Lone Hoffmann, Marianne M. Knap

*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

19 Citations (Scopus)

Abstract

BACKGROUND: Adaptive strategy with daily online tumour match is a treatment option when treating locally advanced lung cancer patients with curative intended radiotherapy (RT).

MATERIAL AND METHODS: Fifty-two consecutive lung cancer patients treated with soft tissue match, adaptive RT and small planning target volumes (PTV) margins were analysed. A control group of 52 consecutive patients treated with bone match, no adaptive strategy and larger margins was included. Patients were followed with computed tomography (CT) scans every third month. CT-images showing loco-regional recurrences were identified. The recurrence gross tumour volume was delineated and registered with the original radiation treatment plan to identify site of failure. All patients were toxicity-scored using CTCAE 4.03 grading scale. Data were analysed using the Kaplan-Meier analysis.

RESULTS: The median follow-up time was 16 months (3-35). Within a year, 35% of the patients in the adaptive group (ART-group) and 53% in the control group (No-ART-group) experienced loco-regional failure, showing improved loco-regional control in the ART group (p = 0.05). One patient in the ART-group and four patients in the No-ART-group showed marginal failure. Median overall progression-free survival time for the ART-group was 10 months (95% CI 8-12), and 8 months (95% CI 6-9) for the No-ART-group. Severe pneumonitis (grade 3-5) decreased from 22% in the No-ART-group to 18% in the ART-group (non-significant, p = 0.6). No significant difference in severe dysphagia was found between the two groups.

CONCLUSION: In the first small cohort of patients investigated, implementation of soft-tissue tumour match and adaptive strategies for locally advanced lung cancer patients increased the loco-regional control rate without increasing treatment-related toxicity.

Original languageEnglish
JournalActa Oncologica
Volume54
Issue9
Pages (from-to)1430-1437
Number of pages8
ISSN0284-186X
DOIs
Publication statusPublished - 2015

Keywords

  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma/diagnostic imaging
  • Case-Control Studies
  • Denmark/epidemiology
  • Female
  • Follow-Up Studies
  • Humans
  • Lung Neoplasms/diagnostic imaging
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Neoplasm Recurrence, Local/diagnostic imaging
  • Radiation Pneumonitis/epidemiology
  • Radiotherapy, Image-Guided
  • Radiotherapy, Intensity-Modulated

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