Clin Lung Cancer 2017 Mar
Canadian Phase III Randomized Trial of Stereotactic Body Radiotherapy Versus Conventionally Hypofractionated Radiotherapy for Stage I, Medically Inoperable Non-Small-Cell Lung Cancer - Rationale and Protocol Design for the Ontario Clinical Oncology Group (OCOG)-LUSTRE Trial.
Related Questions
What dose constraints do you use when treating ultra-central lung tumors with a hypofractionated/ultra-hypofractionated approach using 8-10 fractions?
Typically, ultra-central lung tumors mean that they abut/invade critical central structures such as the bronchial tree, tracheal, esophagus, major vessels, etc. For these critical structures, particularly for the esophagus, bronchial tree and tracheal, ablative dose could cause severe chronic toxici...
How would you approach a mediastinal-only presentation of squamous cell carcinoma of the lung s/p lymph node biopsy consistent with lung origin, with PET positive for only mediastinal disease?
First, I would confirm no prior cancer diagnosis, review in detail with a multidisciplinary tumor board, and try to rule out the non-lung primary site. If no primary can be found, and PET demonstrates limited disease only in the mediastinum/hilum, then I would just treat the disease that you can see...
What dose constraints do you use for 60 Gy in 15-20 fraction lung treatments that are adjacent to the hilum?
The LUSTRE trial, which is a Canadian RCT comparing SABR (60/8, 48/4) vs. 60/15 provides some max point constraints to address this for 15#. Swaminath, Clin Lung Cancer. 2017 Mar;18(2):250-254. Spinal Canal 36 GyEsophagus 48 GyBrachial Plexus 50 GyHeart 66 GyGreat Vessels 66 GyTrachea/PBT 66 GySkin ...
What dose constraint do you use for the proximal bronchial tree for when treating NSCLC to 60 Gy/8 fx?
The Canadian LUSTRE trial (which randomizes patients to 48/4 or 60/8 versus 60/15) accepts a dose limit of 64 Gy max, and 60 Gy to 5 cc to the PBT for a 60/8 fractionation schedule. Typically we aim to keep the dose relatively less heterogeneous within the target so as not to draw any significant ho...
What is your preferred dose and fractionation schedule for a patient with a stage III non-small cell lung cancer, whose comorbidities preclude chemotherapy, but has good enough performance status to warrant an attempt at longer-term local control?
This is a very good question. I'd say the answer to this one is evolving! Typically the patients who cannot tolerate either sequential or concurrent chemotherapy for locally-advanced NSCLC are quite frail and/or have comorbidities that are significant. The results using radiation alone for Stage III...