TY - JOUR
T1 - Adaptive Lung Radiation Therapy in the Era of Immunotherapy
T2 - A Single-Center Retrospective Study
AU - Portal, Daniella
AU - Lu, Shou En
AU - Piperdi, Huzaifa
AU - Jabbour, Salma K.
AU - Reyhan, Meral
N1 - Publisher Copyright: © 2023 The Authors
PY - 2024/1
Y1 - 2024/1
N2 - Purpose: Treatment for locally advanced non-small cell lung cancer consists of concurrent chemoradiation followed by immunotherapy. Though this combination has been shown to have a benefit in both progression-free survival and overall survival, treatment is often limited by the development of pneumonitis. One way to mitigate toxicity is through adaptive radiation therapy, which does not currently have a standardized implementation in clinical practice. Methods and Materials: A single-center retrospective review of patients with locally advanced stage III or oligometastatic stage IV non-small cell lung cancer who were treated with chemoradiation with concurrent or subsequent immunotherapy from 2015 to 2020 was performed. Patients were stratified based on having 1 or more offline adapted plan. The aim of this study was to evaluate the association between dose-volume histogram values and common toxicities experienced during this treatment, including pneumonitis and esophagitis. Results: Twenty-five patients were included in the final analysis: 10 with adapted plans (AP), and 15 with nonadapted plans (NAP). Mean age at onset was 74 years. The most common histology was adenocarcinoma (N = 13). Five patients experienced pneumonitis: 2 in AP and 3 in NAP. Mann-Whitney U test of gross tumor volume sizes between AP (346.2 ± 269.7 cm3) and NAP (153.1 ± 99.6 cm3) was significant (P = .019). Multiple linear regression analysis with adjustment for covariates of pneumonitis versus plan adaptation (P = .106) and esophagitis versus plan adaptation (P = .59) did not demonstrate a significant difference in toxicity between the adapted and nonadaptive patients. Conclusions: Despite similar toxicities in both groups, the gross tumor volume size in the AP was more than double compared with NAP, suggesting that adaptive techniques provide a method for patients with larger target volumes to be treated without an observed difference in pneumonitis rates. These results suggest adaptive radiation therapy may have a role in mitigating toxicity experience from chemoradiation and immunotherapy and warrants further investigation.
AB - Purpose: Treatment for locally advanced non-small cell lung cancer consists of concurrent chemoradiation followed by immunotherapy. Though this combination has been shown to have a benefit in both progression-free survival and overall survival, treatment is often limited by the development of pneumonitis. One way to mitigate toxicity is through adaptive radiation therapy, which does not currently have a standardized implementation in clinical practice. Methods and Materials: A single-center retrospective review of patients with locally advanced stage III or oligometastatic stage IV non-small cell lung cancer who were treated with chemoradiation with concurrent or subsequent immunotherapy from 2015 to 2020 was performed. Patients were stratified based on having 1 or more offline adapted plan. The aim of this study was to evaluate the association between dose-volume histogram values and common toxicities experienced during this treatment, including pneumonitis and esophagitis. Results: Twenty-five patients were included in the final analysis: 10 with adapted plans (AP), and 15 with nonadapted plans (NAP). Mean age at onset was 74 years. The most common histology was adenocarcinoma (N = 13). Five patients experienced pneumonitis: 2 in AP and 3 in NAP. Mann-Whitney U test of gross tumor volume sizes between AP (346.2 ± 269.7 cm3) and NAP (153.1 ± 99.6 cm3) was significant (P = .019). Multiple linear regression analysis with adjustment for covariates of pneumonitis versus plan adaptation (P = .106) and esophagitis versus plan adaptation (P = .59) did not demonstrate a significant difference in toxicity between the adapted and nonadaptive patients. Conclusions: Despite similar toxicities in both groups, the gross tumor volume size in the AP was more than double compared with NAP, suggesting that adaptive techniques provide a method for patients with larger target volumes to be treated without an observed difference in pneumonitis rates. These results suggest adaptive radiation therapy may have a role in mitigating toxicity experience from chemoradiation and immunotherapy and warrants further investigation.
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U2 - 10.1016/j.adro.2023.101315
DO - 10.1016/j.adro.2023.101315
M3 - Article
SN - 2452-1094
VL - 9
JO - Advances in Radiation Oncology
JF - Advances in Radiation Oncology
IS - 1
M1 - 101315
ER -