Higher biologically effective dose is associated with improved survival in patients with squamous cell carcinoma of the lung treated with stereotactic body radiation therapy

Stereotactic body radiation therapy (SBRT) has emerged as the standard of care in the treatment of medically inoperable early-stage non-small cell lung cancer (NSCLC).[1] When compared to conventionally fractionated radiotherapy, SBRT offers improved local control, the convenience of treatment completion in 1-5 fractions, less toxicity, and improved quality of life.[2,3] Historical studies established a dose-response relationship when employing this approach, with a biological equivalent dose (BED10)> 94-105 Gy being associated with improved local control.[4 –6] The Radiation Therapy Oncology Group (RTOG) 0236, a prospective, multi-institutional trial, showed that patients treated with 60 Gy in 3 fractions (54 Gy/3 with heterogeneity correction, BED10 = 151.2 Gy) had excellent local control.[7] Of note, central tumors were excluded from that study owi ng to high rates of toxicity observed with that fractionation in the foundational experience from Indiana University.[8] Subsequently, RTOG 0813 established the maximum tolerated dose of 60 Gy/5 fractions (BED10 = 132) for central tumors.[9] In practice, clinicians take into account tumor location, size, and histology, among other patient characteristics, when making dose and fractionation determinations.
Source: Radiotherapy and Oncology - Category: Radiology Authors: Tags: Original Article Source Type: research