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Dosage Regimen Designs: Nomograms and Tabulations01:23

Dosage Regimen Designs: Nomograms and Tabulations

Nomograms and tabulations are vital tools used by clinicians to design accurate and individualized dosage regimens. These instruments provide a straightforward method for adjusting dosages based on individual patient characteristics, including age, weight, and physiological condition. The foundation of a drug's nomogram is population pharmacokinetic data collected and analyzed using specific models. This data simplifies complex equations, presenting them diagrammatically or tabularly for easy...

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What is the Optimal Dose and Fractionation Schedule for Inoperable Node-Negative Large (≥ 5 cm) Non-Small Cell Lung

Ye Jin Yoo1, Si Yeol Song2, Young Seob Shin2

  • 1Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea; Department of Radiation Oncology, Kyunghee University Hospital at Gangdong, Seoul, Republic of Korea.

Clinical Lung Cancer
|August 21, 2025
PubMed
Summary

Stereotactic body radiation therapy (SBRT) and hypofractionated radiation therapy (HFRT) offer superior local control for inoperable non-small cell lung cancer (NSCLC) ≥5 cm compared to conventionally fractionated radiation therapy (CRT). HFRT is preferred for central tumors, while SBRT suits peripheral tumors.

Keywords:
Conventionally fractionated radiotherapyHypofractionated radiotherapyLarge tumorsNon-small cell lung carcinomasStereotactic body radiotherapy

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Area of Science:

  • Radiation Oncology
  • Thoracic Oncology
  • Medical Physics

Background:

  • Optimal radiotherapy for inoperable, node-negative non-small cell lung cancer (NSCLC) measuring ≥5 cm is not well-defined.
  • This study evaluates stereotactic body radiation therapy (SBRT), hypofractionated radiation therapy (HFRT), and conventionally fractionated radiation therapy (CRT) in this patient group.

Purpose of the Study:

  • To compare the clinical outcomes of SBRT, HFRT, and CRT for inoperable node-negative NSCLC ≥5 cm.
  • To assess freedom from local progression (FFLP), overall survival (OS), and treatment-related toxicities across different radiotherapy strategies.

Main Methods:

  • Retrospective analysis of 137 patients with node-negative NSCLC ≥5 cm treated between 2011 and 2023.
  • Patients received SBRT (n=37), HFRT (n=56), or CRT (n=44). SBRT was not used for central tumors due to toxicity concerns.
  • Outcomes including FFLP, OS, and toxicity (Grade ≥2 and ≥3) were evaluated.

Main Results:

  • Median follow-up was 23.0 months. Two-year FFLP rates were 87.7% for SBRT, 69.0% for HFRT, and 57.5% for CRT (P=.021).
  • Hypofractionated regimens (SBRT+HFRT) showed higher FFLP than CRT (P=.010). OS did not differ significantly (P=.92).
  • Grade ≥2 toxicities were higher with SBRT (37.8%) versus HFRT (14.3%) and CRT (13.6%) (P=.028), primarily chest wall pain. Grade ≥3 toxicities were similar.

Conclusions:

  • SBRT and HFRT provide effective local control for node-negative NSCLC ≥5 cm.
  • HFRT is a suitable option for central tumors, while SBRT may be considered for peripheral tumors in select patients.
  • Hypofractionation strategies demonstrate improved local control in this challenging NSCLC cohort.