Navigation Links
Higher-dose RT results in inferior survival in patients with stage III lung cancer
Date:5/29/2013

In a randomized phase III clinical trial conducted by the Radiation Therapy Oncology Group (RTOG), high-dose (HD), compared with standard-dose (SD), radiotherapy (RT) with concurrent chemotherapy (CT) did not improve overall survival of patients with stage III non-small-cell lung cancer (NSCLC).

Philadelphia, PAOf all the patients in the US with lung cancer, the country's leading cause of cancer death, 75 to 80 percent of them have NSCLC, with 30 to 40 percent of those being considered locally advanced (stage IIIA or IIIB). Although RT plus CT has been the standard of care for locally advanced NSCLC, more research has focused on the incorporation of appropriate CT drugs than on revisiting the 60-Gy RT dose established over 30 years ago. Concern over local tumor progression rates near 85 percent following treatment for stage III NSCLC with CT plus conventional RT doses and research results showing increased median survival time associated with a 74-Gy RT dose led to the development of RTOG 0617, which sought to identify the optimal RT dose for the treatment of patients with locally advanced NSCLC. The trial additionally tested the hypothesis that the addition of cetuximab, a drug that targets the epidermal growth factor receptor (EGFR) pathway and has radiation-sensitizing properties, to chemoradiation would lead to improved survival.

The trial randomized 464 patients with pathologically diagnosed unresectable stage IIIA or IIIB NSCLC to SD (60 Gy) or HD (74 Gy) arms. All patients received concurrent CT of weekly paclitaxel and carboplatin, as well as additional cycles of consolidation CT following combined CT and RT.

The trial's final results on radiation dose will be presented Tuesday, June 4 at the American Society of Clinical Oncology 2013 Annual Meeting by Principal Investigator (PI) Jeffrey D. Bradley, M.D., a professor in radiation oncology, and chief of thoracic service at Washington University School of Medicine in St. Louis, Mo. Median follow-up time of the trial's 419 evaluable patients was 17.2 months, with a median survival time of 28.7 vs. 19.5 months and 18-month overall survival rates of 66.9% vs. 53.9% for the SD and HD arms, respectively. Local failure rates at 18 months similarly favored the SD over the HD arms. "In the setting of concurrent chemotherapy with daily radiation therapy for stage III lung cancer, these results definitively confirm that 60 Gray is superior to 74 Gray, with a clear detriment associated with the higher radiation dose," concludes Bradley. Although participants were stratified according to the RT technique used (three-dimensional vs. intensity- modulated RT [IMRT]), analysis of survival, patterns of failure, and physician-reported toxicity did not identify one technique to be better or worse than the other, according to Bradley.

Bradley points to two emerging research directions that benefit from the knowledge gained by the RTOG 0617 trial. "With the identification of a number of genetic driver mutations, targeted therapy is clearly the next phase of treatment for NSCLC," states Bradley. RTOG 1306 is an example of a phase II study evaluating newly developed agents that block EGFR or anaplastic lymphoma kinase (ALK) mutations. "Patients will receive either a targeted agent for a few months followed by chemoradiation or chemoradiation alone, which represents the standard arm in RTOG 0617," he explains.

A second research direction addresses how to improve RT in the setting of concurrent CT with the efficacy of the lower RT dose now confirmed. According to Bradley, efforts will focus on evaluating the use of adaptive RT, which involves changing the radiation treatment plan delivered to a patient during a course of RT. In RTOG 1106 protocol, for example, a patient on the experimental arm undergoes a PET scan after 20 RT treatments, and the RT plan is then refocused on the remaining tumor volume, with a higher dose per fraction given for the remaining 10 treatments."

"These results stand as an excellent example of the importance of rigorously testing new radiotherapy strategies and of RTOG's essential role in conducting clinical trials to provide the evidence to guide clinical care," says Walter J. Curran, Jr. M.D., RTOG Group Chair and Executive Director of the Winship Cancer Institute of Emory University in Atlanta.


'/>"/>

Contact: Shawn Farley
PR@acr.org
703-648-8936
American College of Radiology
Source:Eurekalert

Related medicine news :

1. Cayman Enterprise City’s Overseas Trips to Silicon Valley and Toronto Producing Results
2. Narconon Releases Early Study of Delaware Prison Program, Demonstrating Crime Reduction Consistent with More Recent Narconon Results
3. Integrated stroke care system results in fewer deaths, discharges to long-term care facilities
4. Diversity Focus Announces Results from the 2013 Creative Corridor Community Survey
5. Statins May Hamper Workout Results
6. Diversity Focus Announces Results from 2013 Creative Corridor Survey at News Conference on Thursday, May 23rd at 10:30 a.m.
7. Abutment-Free Sophono Systems Produce Comparable Study Results to Cochlear’s Baha Products, With Fewer Complications
8. Narconon Releases Report on its Very First Narconon Program, the First of 23 Reviews or Evaluations of Results up to 2009
9. Sous Vide Circulating Bath Systems Enable Chefs to Achieve Perfect Results
10. Cellphone Calls During Blood Pressure Readings May Skew Results
11. Injectable Fillers - How to Avoid Nurse Injectors and Get Natural Results
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:10/13/2017)... ... ... Lori R. Somekh, founder of the Law Office of Somekh & ... and special needs planning attorneys. “Membership in ElderCounsel helps our office remain up to ... with elder law attorneys nationwide,” said Somekh. , ElderCounsel was founded ...
(Date:10/13/2017)... ... October 13, 2017 , ... Global Healthcare Management’s 4th Annual Kids Fun ... NJ. This free event, sponsored by Global Healthcare Management’s CEO, Jon Letko, is ... is geared towards children of all ages; it is a non-competitive, non-timed event, which ...
(Date:10/13/2017)... ... October 13, 2017 , ... “America On The Brink”: the ... “America On The Brink” is the creation of published author, William Nowers. Captain ... As a WWII veteran, he spent thirty years in the Navy. Following his ...
(Date:10/12/2017)... , ... October 12, 2017 , ... IsoComforter, Inc. ( ... announced today the introduction of an innovative new design of the shoulder pad. ... you get maximum comfort while controlling your pain while using cold therapy. By utilizing ...
(Date:10/12/2017)... ... ... HMP , a leader in healthcare events and education, today announced that ... for ‘Best B-to-B Healthcare Website.’ Winners were announced during the Eddie & Ozzie Awards ... recognizes editorial and design excellence across a range of sectors. This year’s program included ...
Breaking Medicine News(10 mins):
(Date:10/7/2017)... , Oct. 6, 2017   Provista, ... more than $100 billion in purchasing power, today announced ... and information. The Newsroom is the online ... industry trends, infographics, expert bios, news releases, slideshows and ... access to a wealth of resources at their fingertips, ...
(Date:10/4/2017)... South Korea , Oct. 4, 2017  South ... its next-generation CPR training aide "cprCUBE" on Kickstarter. The ... chest compression during cardiac arrests with better efficiency compared ... It also offers real-time feedback on efficacy of the ... The crowdfunding campaign has a goal to raise $5,000. ...
(Date:10/4/2017)... Mass. , Oct. 4, 2017 ... of single-use, self-contained, illuminating medical devices, today announced ... National Health Surveillance Agency (or Agência Nacional de ... The first single-use, cordless surgical retractor with integrated ... provides optimal access, illumination and exposure of a ...
Breaking Medicine Technology: