Locally Advanced Non Small Cell Lung Cancer: The Case for Radiation Dose De-escalation in the Management of the Mediastinum

Locally Advanced Non Small Cell Lung Cancer: The Case for Radiation Dose De-escalation in the Management of the Mediastinum Viacheslav Soyfer1* and Benjamin W. Corn2 1Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel 2Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel Outcomes for patients with locally-advanced Non Small Cell Lung Cancer (NSCLC) remain poor. In the context of definitive (as opposed to neoadjuvant) treatment, radiation oncologists have traditionally embraced dose escalation as a means to improve control of the primary tumor as well as draining nodal regions for this clinical problem. Yet we wonder: is it optimal—or even rational—to treat the primary and the mediastinal nodes to the same dose in these patients? Enthusiasm for dose escalation was fueled by RTOG 73-01, a randomized trial that systematically explored incremental increases of dose which were correlated with improved intra-thoracic disease control in nearly linear fashion (1). Although the trial has acquired landmark status, it may not be germane for today's patients since radiation alone was used. It is conceivable that in the absence of chemotherapy, higher doses of radiation were needed. However, even when 60 Gy was delivered, a survival advantage did not emerge. At this juncture, standard management is predicated on a multi-modality approach. The same cooperative group endeavored to push the dose envelope even further w...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research

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Source: Cirugia Espanola - Category: Surgery Source Type: research
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Source: Health Physics - Category: Radiology Tags: NOTES Source Type: research
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Source: Health Physics - Category: Radiology Tags: CORRESPONDENCE Source Type: research
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Source: Health Physics - Category: Radiology Tags: PAPERS Source Type: research
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Source: Revista Paulista de Pediatria - Category: Pediatrics Source Type: research
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Source: Revista Paulista de Pediatria - Category: Pediatrics Source Type: research
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Source: Pathology Research and Practice - Category: Pathology Source Type: research
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Source: Journal of Pediatric Orthopaedics B - Category: Orthopaedics Tags: Bone Tumours Source Type: research
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Source: Nursing Clinics of North America - Category: Nursing Authors: Source Type: research
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