Dose escalation optimization in patients with locally advanced non–small-cell lung cancer: The right dose, in the right location, to the right patient, at the right time
Mené sur 42 patients atteints d'un cancer du poumon non à petites cellules de stade localement avancé (âge médian : 63 ans), cet essai de phase II évalue, du point de vue du contrôle local de la tumeur et dans le cadre d'une chimioradiothérapie concomitante, l'efficacité d'une radiothérapie adaptative utilisant à mi-traitement une tomographie numérique par émission de positrons à base de fluorodésoxyglucose (18F) pour révaluer la dose de rayonnements à administrer et mieux cibler la zone tumorale
Results from RTOG 0617, comparing conventionally fractionated 60 Gy vs 74 Gy with concurrent chemotherapy in patients with unresectable non–small-cell lung cancer (NSCLC), informed us that uniform dose escalation over the entire tumor volume in an unselected population to 74 Gy led to inferior survival compared with 60 Gy.1 The exact cause of inferior survival in the higher-dose arm is unclear; however, local failure remains a considerable problem in radiation therapy (RT) for locally advanced NSCLC, with local failure rates of 31% to 39% at 2 years reported in RTOG 0617, consistent with other studies. Kong et al2 attempt to address this problem with the phase 2 trial reported in this issue of JAMA Oncology.
JAMA Oncology , commentaire en libre accès, 2016