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Accelerated Hypofractionated Chemoradiation Followed by Stereotactic Ablative Radiotherapy Boost for Locally
Trudy C Wu1, Elaine Luterstein2, Beth K Neilsen1
1Department of Radiation Oncology, University of California, Los Angeles.
JAMA Oncology
|January 11, 2024
Summary
Concurrent chemoradiation with an adaptive stereotactic ablative radiotherapy (SABR) boost is safe and effective for locally advanced non-small cell lung cancer (NSCLC). This approach improved local control and overall survival in patients with unresectable NSCLC.
Area of Science:
- Radiation Oncology
- Medical Oncology
- Thoracic Oncology
Background:
- Intrathoracic progression is a common failure pattern in unresectable non-small cell lung cancer (NSCLC) treated with chemoradiation and immunotherapy.
- Hypofractionated concurrent chemoradiation with a stereotactic ablative radiotherapy (SABR) boost is being investigated to improve outcomes.
Purpose of the Study:
- To determine the maximum tolerated dose (MTD) of hypofractionated concurrent chemoradiation with an adaptive SABR boost.
- To evaluate the safety and efficacy of this treatment regimen in patients with locally advanced, unresectable NSCLC.
Main Methods:
- An early-phase, single-institution, dose-escalation, nonrandomized controlled trial was conducted.
- Patients received concurrent weekly carboplatin/paclitaxel with escalating doses of SABR boost (25, 30, or 35 Gy) to residual disease after initial chemoradiation.
- The MTD was defined by dose-limiting toxic effects within 90 days.
Main Results:
- The protocol-specified MTD was not exceeded in 28 patients with stage II or III NSCLC.
- Incidences of grade 3 or higher nonhematologic toxic effects were 11% acute and 7% late.
- Two-year local control rates were 74.1% (low), 85.7% (intermediate), and 100.0% (high) dose cohorts.
- Two-year overall survival rates were 30.0% (low), 76.2% (intermediate), and 55.6% (high) dose cohorts.
Conclusions:
- Concurrent chemoradiation with an adaptive SABR boost to 70 Gy in 15 fractions is a safe and effective regimen for locally advanced, unresectable NSCLC.
- The intermediate-dose boost (30 Gy) showed promising results with no grade 3 toxic effects and high overall survival.
- This approach warrants further investigation in larger trials.
