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Functional lung avoidance for individualized radiotherapy (FLAIR): study protocol for a randomized, double-blind
Douglas A Hoover, Dante Pi Capaldi, Khadija Sheikh
1Department of Radiation Oncology, London Regional Cancer Program, 790 Commissioners Rd, E, London, Ontario N6A 4L6, Canada. brian.yaremko@lhsc.on.ca.
BMC Cancer
|December 16, 2014
Summary
This study tested avoiding functional lung during radiotherapy for non-small cell lung cancer (NSCLC). Avoiding functional lung may reduce pulmonary toxicity and improve quality of life for NSCLC patients receiving chemoradiotherapy.
Area of Science:
- Oncology
- Radiotherapy
- Pulmonary Medicine
Background:
- Radiotherapy for locally advanced non-small cell lung cancer (NSCLC) can cause significant pulmonary toxicity.
- Current radiotherapy planning does not account for regional lung function differences, particularly in smokers.
- Avoiding functional lung during radiotherapy is hypothesized to reduce toxicity, but has not been prospectively tested.
Purpose of the Study:
- To evaluate the impact of avoiding functional lung on pulmonary toxicity and quality of life in patients with locally advanced NSCLC.
- To compare standard radiotherapy planning with a plan that avoids functional lung.
Main Methods:
- A prospective randomized, double-blind trial involving 64 patients with Stage III NSCLC receiving concurrent chemoradiotherapy (CRT).
- Patients underwent functional lung imaging (hyperpolarized 3He MRI) to identify normally ventilated lung regions.
- Two radiotherapy plans were created: standard (no functional lung consideration) and avoidance (optimized to minimize dose to functional lung).
- Patients were randomized 1:1 to receive either the standard or avoidance plan.
Main Results:
- Primary endpoint: pulmonary quality of life (QOL) at 3 months post-treatment using the functional assessment of cancer therapy-lung cancer subscale.
- Secondary endpoints include QOL at other time points, toxicity, overall survival, progression-free survival, and quality-adjusted survival.
Conclusions:
- This randomized trial will provide comprehensive data on the efficacy of functional lung avoidance in reducing pulmonary toxicity and improving QOL for NSCLC patients undergoing CRT.
