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ICORG 06-35: a prospective evaluation of PET-CT scan in patients with non-operable or non-resectable non-small cell lung cancer treated by radical 3-dimensional conformal radiation therapy: a phase II study

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Abstract

Background

Radiotherapy (RT) is a key treatment modality in the curative treatment of patients with non-small cell lung cancer (NSCLC). Incorrect definition of the gross, or clinical, target volume is a common source of error which can lead to a reduced probability of tumour control.

Objective

This was a pilot and a phase II study. The pilot evaluated the technical feasibility of integrating positron emission tomography–computed tomography (PET-CT) fusion. The primary outcome of the phase II study was to evaluate the safety of PET-CT scan–based RT by evaluating the rate of loco-regional recurrence outside the PET-CT planning target volume (PTV) but within conventional 3-D PTV.

Methods

Patients underwent standard post-treatment follow-up, including repeated three monthly CT scans of the thorax. In case of loco-regional recurrence, three categories were considered, with only extra-PET scan PTV and intra-CT scan PTV recurrences considered as a failure. Our hypothesis was that the rate of these events would be < 10%.

Results

Twelve patients were recruited; the study closed early due to poor recruitment. The primary endpoint of the pilot was met; it was feasible to deliver a PET-CT-based plan to ≥ 60% of patients. Two patients had intra-PET scan PTV recurrences, six had extra-PET scan PTV and extra-CT, and three patients had both. Another patient had extra-PET scan PTV and extra-CT as well as extra-PET scan PTV and intra-CT scan PTV recurrence.

Conclusion/advances in knowledge

PET-based planning has the potential to reduce radiation treatment volumes because of the avoidance of mediastinal lymph nodes that are PET negative.

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Funding

The Health Research Board

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Authors and Affiliations

  1. St Luke’s Radiation Oncology Network, Radiation Oncology, Dublin, Ireland

    Karla A. Lee, Guhan Rangaswamy, Naomi A. Lavan & Pierre Thirion

  2. The Royal Marsden NHS Foundation Trust, Fulham Rd, London, SW3 6JJ, UK

    Karla A. Lee

  3. Clinical Trials, St Luke’s Radiation Oncology Network, Dublin, Ireland

    Mary Dunne

  4. Department of Diagnostic Imaging St. Luke’s Hospital and Department of Nuclear Medicine, Blackrock Clinic, Dublin, Ireland

    Conor D. Collins

  5. Radiation Oncology, Galway University Hospital, Galway, Ireland

    Cormac Small

  6. Cancer Trials Ireland, Dublin, Ireland

    Pierre Thirion

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  1. Karla A. Lee
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Correspondence to Karla A. Lee.

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Lee, K.A., Rangaswamy, G., Lavan, N.A. et al. ICORG 06-35: a prospective evaluation of PET-CT scan in patients with non-operable or non-resectable non-small cell lung cancer treated by radical 3-dimensional conformal radiation therapy: a phase II study. Ir J Med Sci 188, 1155–1161 (2019). https://doi.org/10.1007/s11845-019-02019-2

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  • DOI: https://doi.org/10.1007/s11845-019-02019-2

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