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Title
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Volumetric response analysis during chemoradiation as predictive tool for optimizing treatment strategy in locally advanced unresectable NSCLC
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Author
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Abstract
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| Purpose: To study the feasibility of measuring volumetric changes in the primary tumor on megavoltage-computed tomography (MVCT) during chemoradiation and to examine the correlation with local response. Patients and methods: Fifteen consecutive patients with stage III, inoperable, locally advanced non-small cell lung cancer (NSCLC) were treated in a prospective dose escalation study protocol of concurrent chemoradiation. They were monitored for acute toxicity and evaluated with daily MVCT imaging. The volumetric changes were fitted to a negative exponential resulting in a regression coefficient (RC). Local response evaluation was done with positron emission tomography using the radio-labeled glucose analogue F18 fluorodeoxyglucose (FDG-PET). Results: The mean volume decrease (+/- standard deviation) was 73% (+/- 18%). With a mean treatment time of 42 days this treatment schedule resulted in a mean decrease of 1.74%/day. Of the 13 evaluable patients seven developed a metabolic complete remission (MCR). The mean RC of the patients with MCR is 0.050 versus a mean RC of 0.023 in non-responders (p=0.0074). Using a proposed cut-off value for the RC of 0.0380% of the non-responders will be detected correctly while misclassifying 16.4% of patients who will eventually achieve an MCR. The total cumulative percentage of esophageal grade 3 or more toxicity was 46.7%. Conclusion: The RC derived from volumetric analysis of daily MVCT is prognostic and predictive for local response in patients treated with chemoradiation for a locally advanced NSCLC. Because this treatment schedule is toxic in nearly half of the patient population, MVCT is a tool in the implementation of patient-individualized treatment strategies. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 91 (2009) 438-442 |
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Language
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English
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Source (journal)
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Radiotherapy and oncology. - Amsterdam
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Publication
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Amsterdam
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2009
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ISSN
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0167-8140
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DOI
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10.1016/J.RADONC.2009.03.015
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Volume/pages
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91
:3
(2009)
, p. 438-442
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ISI
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000266749200025
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Full text (Publisher's DOI)
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