Showing papers by "David Bell published in 2023"
TL;DR: In this article , the Trans Tasman Radiation Oncology Group compared single- versus multifraction stereotactic ablative body radiotherapy (SABR) in 90 patients with 133 oligometastases to the lung and found no differences in safety, efficacy, systemic immunogenicity or survival between arms, with single-fraction SABR picked as the winner on the basis of cost-effectiveness.
Abstract: Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported. In a randomized phase II clinical trial, the Trans Tasman Radiation Oncology Group compared single- versus multifraction stereotactic ablative body radiotherapy (SABR) in 90 patients with 133 oligometastases to the lung. The study found no differences in safety, efficacy, systemic immunogenicity, or survival between arms, with single-fraction SABR picked as the winner on the basis of cost-effectiveness. In this article, we report the final updated survival outcome analysis. The protocol mandated no concurrent or post-therapy systemic therapy until progression. Modified disease-free survival (mDFS) was defined as any progression not addressable by local therapy, or death. At a median follow-up of 5.4 years, the 3- and 5-year estimates for overall survival (OS) were 70% (95% CI, 59 to 78) and 51% (95% CI, 39 to 61). There were no significant differences between the multi- and single-fraction arms for OS (hazard ratio [HR], 1.1 [95% CI, 0.6 to 2.0]; P = .81). The 3- and 5-year estimates for disease-free survival were 24% (95% CI, 16 to 33) and 20% (95% CI, 13 to 29), with no differences between arms (HR, 1.0 [95% CI, 0.6 to 1.6]; P = .92). The 3- and 5-year estimates for mDFS were 39% (95% CI, 29 to 49) and 34% (95% CI, 24 to 44), with no differences between arms (HR, 1.0 [95% CI, 0.6 to 1.8]; P = .90). In this patient population, where patients receive SABR in lieu of systemic therapy, one-in-three patients are alive without disease in the long term. There were no differences in outcomes by fractionation schedule.
2 citations
TL;DR: The first prospective trial of functional lung avoidance (FLA) radiation therapy using four-dimensional Gallium 68 Ventilation-Perfusion PET/CT (68Ga-4D-V/QPET/CT) was reported in this article .
Abstract: Introduction Functional lung avoidance (FLA) radiation therapy aims to spare regions of functional lung to reduce toxicity. We report the results of the first prospective trial of FLA using Four-Dimensional Gallium 68 Ventilation-Perfusion PET/CT (68Ga-4D-V/Q PET/CT). Methods Inclusion criteria required a diagnosis of stage III Non-Small Cell Lung cancer (NSCLC) and ability to undergo radical intent chemoradiation therapy. Functional volumes were generated using planning 68Ga-4D-V/Q PET/CT. These volumes were used to generate a clinical FLA plan to 60Gy in 30 fractions. The primary tumor was boosted to 69Gy. A comparison anatomical plan was generated for each patient. Feasibility was met if FLA plans (compared to anatomical plans) allowed (A) reduction in mean functional lung dose (fMLD) of ≥2% and reduction in the functional lung volume receiving 20 Gy (fV20Gy) of ≥4%; and (B) Mean heart dose ≤30 Gy and relative heart volume receiving 50 Gy <25%. Results 19 patients were recruited, one withdrew consent. Eighteen patients underwent chemoradiation with FLA. Of the 18 patients, 15 met criteria for feasibility. All patients completed the entire course of chemoradiotherapy. Using FLA resulted in an average reduction of the functional mean lung dose of 12.4% (SD ± 12.8%) and mean relative reduction of the fV20 of 22.9% (SD ± 11.9%). At 12 months, Kaplan-Meier estimates for Overall Survival were 83% (95% CI: 56-94%) and estimates for Progression Free Survival were 50% (95% CI: 26-70%). Quality-of-Life scores were stable over all timepoints. Conclusion Using 68Ga-4D-V/Q PET/CT to image and avoid functional lung is feasible.
TL;DR: In this paper , the authors compared conventional radiation therapy with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer.
Abstract: The TROG 09.02 CHISEL trial compared conventional radiation therapy (CRT) with stereotactic body radiation therapy (SBRT) in patients with inoperable early-stage non-small cell lung cancer. Patients randomized to SBRT had less local failure and improved overall survival. This analysis reports differences in pulmonary function tests (PFTs) and the 6-minute walk test (SMWT) between patients who received SBRT and those who received CRT.We analyzed the PFTs and SMWTs of all patients recruited to the CHISEL [trial. During this trial, patients underwent serial PFTs. Linear regression models were used to compare parameters between SBRT and CRT at 3 and 12 months after treatment.One hundred and one patients were enrolled; 33 patients were treated with CRT, 61 were treated with SBRT, and 7 did not receive treatment. Primary tumor size was similar between arms: SBRT 25 mm (standard deviation [SD], 9) and CRT 28 mm (SD, 9). On regression analysis, at 3 and 12 months, there was no evidence of a difference between arms in PFT decline or distance walked in the SMWT. Planning target volume size was significantly larger in the CRT arm, 142.79 cc (SD, 61.14), compared with the SBRT group, 46.15 cc (SD, 23.39). The mean biologically effective dose received by the target was significantly larger in the SBRT group, 125.92 Gy (SD, 21.58), compared with CRT, 65.49 Gy (SD, 6.32). Mean dose to the lungs minus the gross target volume incorporating motion was 8.9 Gy (SD, 2.34) in the CRT group and 4.37 Gy (SD, 1.42) in the SBRT group.Despite the considerably higher biologically effective doses delivered to the tumor in SBRT, there was no difference in decline in respiratory function observed between the 2 groups.
TL;DR: In this paper , the authors assessed the potential reductions of dose to the functional lung when radiation therapy plans were adapted to avoid functional lung at the mid-treatment timepoint using volumetric arc radiotherapy (VMAT).