Clara Chan

Intensity-Modulated Radiotherapy for Lung Cancer: Current Status and Future Developments

Radiotherapy plays an important role in the management of lung cancer, with over 50% of patients receiving this modality at some point during their treatment. Intensity-modulated radiotherapy (IMRT) is a technique that adds fluence modulation to beam shaping, which improves radiotherapy dose conformity around the tumor and spares surrounding normal structures. Treatment with IMRT is becoming more widely available for the treatment of lung cancer, despite the paucity of high level evidence supporting the routine use of this more resource intense and complex technique. In this review article, we have summarized data from planning and clinical studies, discussed challenges in implementing IMRT, and made recommendations on the minimum requirements for safe delivery of IMRT.

Is heterogeneity in stage 3 non-small cell lung cancer obscuring the potential benefits of dose-escalated concurrent chemo-radiotherapy in clinical trials?

The current standard of care for the management of inoperable stage 3 non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (cCRT) using radiotherapy dose-fractionation and chemotherapy regimens that were established 3 decades ago. In an attempt to improve the chances of long-term control from cCRT, dose-escalation of the radiotherapy dose was assessed in the RTOG 0617 randomised control study comparing the standard 60 Gy in 30 fractions with a high-dose arm receiving 74 Gy in 37 fractions. Following the publication of this trial the thoracic oncology community were surprised to learn that there was worse survival in the dose-escalated arm and that for now the standard of care must remain with the lower dose. In this article we review the RTOG 0617 paper with subsequent analyses and studies to explore why the use of dose-escalated cCRT in stage 3 NSCLC has not shown the benefits that were expected. The overarching theme of this opinion piece is how heterogeneity between stage 3 NSCLC cases in terms of patient, tumour, and clinical factors may obscure the potential benefits of dose-escalation by causing imbalances in the arms of studies such as RTOG 0617. We also examine recent advances in the staging, management, and technological delivery of radiotherapy in NSCLC and how these may be employed to optimise cCRT trials in the future and ensure that any potential benefits of dose-escalation can be detected.

The use of volunteers to implement electronic patient reported outcomes in lung cancer outpatient clinics

Highlights • 104 eligible lung cancer patients were approached, 86 (83%) consented to take part.• At 1st attempt 69% of patients completed the ePRO questionnaire without assistance.• Assistance was defined as verbal/physical help to complete the ePRO questionnaire.• Most patients requiring help had a companion that could have provided assistance.• More patients preferred electronic than paper questionnaires.

PO-0663: Lung V5 does not predict for lung toxicity after fixed-beam intensity modulated radiotherapy (IMRT) for lung cancer

Results: Seventy-one consecutive patients were prospectively included in the study. Baseline patient, tumour and treatment characteristics are presented in Table 1. Preliminary analysis of the first 34 patients with baseline SPECT/CT scans showed no association with radiation pneumonitis for conventional MLD, whereas there was an association with symptomatic radiation pneumonitis for MLD to FL 40%. MLDf was larger than MLDc in 13 out of 34 patients with a difference of around 5 Gy. All 13 patients developed symptomatic RP. Analysis of functional DVH parameters for the whole patient cohort is underway.