SBRT combined with concurrent chemoradiation in stage III NSCLC: Feasibility study of the phase I Hybrid trial.

Abstract

PURPOSE

To assess the technical and clinical feasibility of the phase I Hybrid trial (NCT01933568), combining SBRT of the primary tumor (PT) and fractionated radiotherapy (FRT) to the lymph nodes (LN).

MATERIALS AND METHODS

Ten patients with stage III NSCLC with a peripheral PT < 5 cm were prospectively selected. The EQD2 corrected normal tissue dose parameters of the FRT plan of 24×2.75 Gy to PT and 24×2.42 Gy to LN (IMRT) was compared with 3×18 Gy on the PT and 24×2.42 Gy on the LN (VMAT) using a Wilcoxon signed-rank test. To anticipate differential motion between PT and LN, worst-case scenarios for OAR were calculated. Electronic portal imaging device (EPID) dosimetry analysis was performed to rule out dosimetric errors during delivery.

RESULTS

The Hybrid plans revealed a significant decrease of esophagus EUD n = 0.13, lung V5 and V20 and a significant increase in Dmax of the PRV of the mediastinal envelope. Plans were robust against differential motion of 5 mm between PT and LN in 8 patients and failed in 2 patients due to spinal cord constraints. Average pass rates were ≥87% for EPID dosimetry.

CONCLUSIONS

SBRT and FRT could be combined within the given OAR constraints. Safety will be assessed in the Hybrid trial.

More about this publication

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
  • Volume 142
  • Pages 224-229
  • Publication date 01-01-2020

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