18F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost)

¹⁸F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial

Research output: Contribution to journal › Journal article › Research › peer-review

Standard

¹⁸F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost) : Results from a randomised clinical trial. / Cooke, Saskia A.; de Ruysscher, Dirk; Reymen, Bart; Lambrecht, Maarten; Fredberg Persson, Gitte; Faivre-Finn, Corinne; Dieleman, Edith M. T.; Lewensohn, Rolf; van Diessen, Judi N. A.; Sikorska, Karolina; Lalezari, Ferry; Vogel, Wouter; van Elmpt, Wouter; Damen, Eugène M. F.; Sonke, Jan-Jakob; Belderbos, José S. A.

In: Radiotherapy and Oncology, Vol. 181, 109492, 2023.

Research output: Contribution to journal › Journal article › Research › peer-review

Harvard

Cooke, SA, de Ruysscher, D, Reymen, B, Lambrecht, M, Fredberg Persson, G, Faivre-Finn, C, Dieleman, EMT, Lewensohn, R, van Diessen, JNA, Sikorska, K, Lalezari, F, Vogel, W, van Elmpt, W, Damen, EMF, Sonke, J-J & Belderbos, JSA 2023, '¹⁸F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial', Radiotherapy and Oncology, vol. 181, 109492. https://doi.org/10.1016/j.radonc.2023.109492

APA

Cooke, S. A., de Ruysscher, D., Reymen, B., Lambrecht, M., Fredberg Persson, G., Faivre-Finn, C., Dieleman, E. M. T., Lewensohn, R., van Diessen, J. N. A., Sikorska, K., Lalezari, F., Vogel, W., van Elmpt, W., Damen, E. M. F., Sonke, J-J., & Belderbos, J. S. A. (2023). ¹⁸F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial. Radiotherapy and Oncology, 181, [109492]. https://doi.org/10.1016/j.radonc.2023.109492

Vancouver

Cooke SA, de Ruysscher D, Reymen B, Lambrecht M, Fredberg Persson G, Faivre-Finn C et al. ¹⁸F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial. Radiotherapy and Oncology. 2023;181. 109492. https://doi.org/10.1016/j.radonc.2023.109492

Author

Cooke, Saskia A. ; de Ruysscher, Dirk ; Reymen, Bart ; Lambrecht, Maarten ; Fredberg Persson, Gitte ; Faivre-Finn, Corinne ; Dieleman, Edith M. T. ; Lewensohn, Rolf ; van Diessen, Judi N. A. ; Sikorska, Karolina ; Lalezari, Ferry ; Vogel, Wouter ; van Elmpt, Wouter ; Damen, Eugène M. F. ; Sonke, Jan-Jakob ; Belderbos, José S. A. / ¹⁸F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost) : Results from a randomised clinical trial. In: Radiotherapy and Oncology. 2023 ; Vol. 181.

Bibtex

@article{3ba956e3595a49d48540437316a2046b,

title = "18F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial",

abstract = "Background and purpose: We aimed to assess if radiation dose escalation to either the whole primary tumour, or to an 18F-FDG-PET defined subvolume within the primary tumour known to be at high risk of local relapse, could improve local control in patients with locally advanced non-small-cell lung cancer. Materials and methods: Patients with inoperable, stage II-III NSCLC were randomised (1:1) to receive dose-escalated radiotherapy to the whole primary tumour or a PET-defined subvolume, in 24 fractions. The primary endpoint was freedom from local failure (FFLF), assessed by central review of CT-imaging. A phase II {\textquoteleft}pick-the-winner{\textquoteright} design (alpha = 0.05; beta = 0.80) was applied to detect a 15 % increase in FFLF at 1-year. ClinicalTrials.gov:NCT01024829. Results: 150 patients were enrolled. 54 patients were randomised to the whole tumour group and 53 to the PET-subvolume group. The trial was closed early due to slow accrual. Median dose/fraction to the boosted volume was 3.30 Gy in the whole tumour group, and 3.50 Gy in the PET-subvolume group. The 1-year FFLF rate was 97 % (95 %CI 91–100) in whole tumour group, and 91 % (95 %CI 82–100) in the PET-subvolume group. Acute grade ≥ 3 adverse events occurred in 23 (43 %) and 20 (38 %) patients, and late grade ≥ 3 in 12 (22 %) and 17 (32 %), respectively. Grade 5 events occurred in 19 (18 %) patients in total, of which before disease progression in 4 (7 %) in the whole tumour group, and 5 (9 %) in the PET-subvolume group. Conclusion: Both strategies met the primary objective to improve local control with 1-year rates. However, both strategies led to unexpected high rates of grade 5 toxicity. Dose differentiation, improved patient selection and better sparing of central structures are proposed to improve dose-escalation strategies.",

keywords = "18F-FDG-PET, Dose escalation, Hypofractionation, Locally advanced non-small cell lung cancer, Radiotherapy",

author = "Cooke, {Saskia A.} and {de Ruysscher}, Dirk and Bart Reymen and Maarten Lambrecht and {Fredberg Persson}, Gitte and Corinne Faivre-Finn and Dieleman, {Edith M. T.} and Rolf Lewensohn and {van Diessen}, {Judi N. A.} and Karolina Sikorska and Ferry Lalezari and Wouter Vogel and {van Elmpt}, Wouter and Damen, {Eug{\`e}ne M. F.} and Jan-Jakob Sonke and Belderbos, {Jos{\'e} S. A.}",

note = "Publisher Copyright: {\textcopyright} 2023 Elsevier B.V.",

year = "2023",

doi = "10.1016/j.radonc.2023.109492",

language = "English",

volume = "181",

journal = "Radiotherapy & Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

RIS

TY - JOUR

T1 - 18F-FDG-PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost)

T2 - Results from a randomised clinical trial

AU - Cooke, Saskia A.

AU - de Ruysscher, Dirk

AU - Reymen, Bart

AU - Lambrecht, Maarten

AU - Fredberg Persson, Gitte

AU - Faivre-Finn, Corinne

AU - Dieleman, Edith M. T.

AU - Lewensohn, Rolf

AU - van Diessen, Judi N. A.

AU - Sikorska, Karolina

AU - Lalezari, Ferry

AU - Vogel, Wouter

AU - van Elmpt, Wouter

AU - Damen, Eugène M. F.

AU - Sonke, Jan-Jakob

AU - Belderbos, José S. A.

PY - 2023

Y1 - 2023

N2 - Background and purpose: We aimed to assess if radiation dose escalation to either the whole primary tumour, or to an 18F-FDG-PET defined subvolume within the primary tumour known to be at high risk of local relapse, could improve local control in patients with locally advanced non-small-cell lung cancer. Materials and methods: Patients with inoperable, stage II-III NSCLC were randomised (1:1) to receive dose-escalated radiotherapy to the whole primary tumour or a PET-defined subvolume, in 24 fractions. The primary endpoint was freedom from local failure (FFLF), assessed by central review of CT-imaging. A phase II ‘pick-the-winner’ design (alpha = 0.05; beta = 0.80) was applied to detect a 15 % increase in FFLF at 1-year. ClinicalTrials.gov:NCT01024829. Results: 150 patients were enrolled. 54 patients were randomised to the whole tumour group and 53 to the PET-subvolume group. The trial was closed early due to slow accrual. Median dose/fraction to the boosted volume was 3.30 Gy in the whole tumour group, and 3.50 Gy in the PET-subvolume group. The 1-year FFLF rate was 97 % (95 %CI 91–100) in whole tumour group, and 91 % (95 %CI 82–100) in the PET-subvolume group. Acute grade ≥ 3 adverse events occurred in 23 (43 %) and 20 (38 %) patients, and late grade ≥ 3 in 12 (22 %) and 17 (32 %), respectively. Grade 5 events occurred in 19 (18 %) patients in total, of which before disease progression in 4 (7 %) in the whole tumour group, and 5 (9 %) in the PET-subvolume group. Conclusion: Both strategies met the primary objective to improve local control with 1-year rates. However, both strategies led to unexpected high rates of grade 5 toxicity. Dose differentiation, improved patient selection and better sparing of central structures are proposed to improve dose-escalation strategies.

AB - Background and purpose: We aimed to assess if radiation dose escalation to either the whole primary tumour, or to an 18F-FDG-PET defined subvolume within the primary tumour known to be at high risk of local relapse, could improve local control in patients with locally advanced non-small-cell lung cancer. Materials and methods: Patients with inoperable, stage II-III NSCLC were randomised (1:1) to receive dose-escalated radiotherapy to the whole primary tumour or a PET-defined subvolume, in 24 fractions. The primary endpoint was freedom from local failure (FFLF), assessed by central review of CT-imaging. A phase II ‘pick-the-winner’ design (alpha = 0.05; beta = 0.80) was applied to detect a 15 % increase in FFLF at 1-year. ClinicalTrials.gov:NCT01024829. Results: 150 patients were enrolled. 54 patients were randomised to the whole tumour group and 53 to the PET-subvolume group. The trial was closed early due to slow accrual. Median dose/fraction to the boosted volume was 3.30 Gy in the whole tumour group, and 3.50 Gy in the PET-subvolume group. The 1-year FFLF rate was 97 % (95 %CI 91–100) in whole tumour group, and 91 % (95 %CI 82–100) in the PET-subvolume group. Acute grade ≥ 3 adverse events occurred in 23 (43 %) and 20 (38 %) patients, and late grade ≥ 3 in 12 (22 %) and 17 (32 %), respectively. Grade 5 events occurred in 19 (18 %) patients in total, of which before disease progression in 4 (7 %) in the whole tumour group, and 5 (9 %) in the PET-subvolume group. Conclusion: Both strategies met the primary objective to improve local control with 1-year rates. However, both strategies led to unexpected high rates of grade 5 toxicity. Dose differentiation, improved patient selection and better sparing of central structures are proposed to improve dose-escalation strategies.

KW - 18F-FDG-PET

KW - Dose escalation

KW - Hypofractionation

KW - Locally advanced non-small cell lung cancer

KW - Radiotherapy

U2 - 10.1016/j.radonc.2023.109492

DO - 10.1016/j.radonc.2023.109492

M3 - Journal article

C2 - 36706958

AN - SCOPUS:85147888863

VL - 181

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

SN - 0167-8140

M1 - 109492

ER -

ID: 357332854