Strategies of dose escalation in the treatment of locally advanced non-small cell lung cancer: Image guidance and beyond

Alexander Chi*, Nam Phong Nguyen, James S. Welsh, William Tse, Manish Monga, Olusola Oduntan, Mohammed Almubarak, John Rogers, Scot C. Remick, David R Gius

*Corresponding author for this work

Research output: Contribution to journalReview article

8 Scopus citations

Abstract

Radiation dose in the setting of chemo-radiation for locally advanced non-small cell lung cancer (NSCLC) has been historically limited by the risk of normal tissue toxicity and this has been hypothesized to correlate with the poor results in regard to local tumor recurrences. Dose escalation, as a means to improve local control, with concurrent chemotherapy has been shown to be feasible with three-dimensional conformal radiotherapy in early phase studies with good clinical outcome. However, the potential superiority of moderate dose escalation to 74 Gy has not been shown in phase III randomized studies. In this review, the limitations in target volume definition in previous studies; and the factors that may be critical to safe dose escalation in the treatment of locally advanced NSCLC, such as respiratory motion management, image guidance, intensity modulation, FDG-positron emission tomography incorporation in the treatment planning process, and adaptive radiotherapy, are discussed. These factors, along with novel treatment approaches that have emerged in recent years, are proposed to warrant further investigation in future trials in a more comprehensive and integrated fashion.

Original languageEnglish (US)
Article number156
JournalFrontiers in Oncology
Volume4 JUN
DOIs
StatePublished - Jan 1 2014

Keywords

  • Adaptive radiotherapy
  • Image guidance
  • Intensity-modulated radiotherapy
  • Nsclc
  • Proton therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Chi, A., Nguyen, N. P., Welsh, J. S., Tse, W., Monga, M., Oduntan, O., Almubarak, M., Rogers, J., Remick, S. C., & Gius, D. R. (2014). Strategies of dose escalation in the treatment of locally advanced non-small cell lung cancer: Image guidance and beyond. Frontiers in Oncology, 4 JUN, [156]. https://doi.org/10.3389/fonc.2014.00156