Increased radiation with SABR boost seems to enhance local control but with reduced overall survival at highest dose
By Elana Gotkine HealthDay Reporter
TUESDAY, Jan. 16, 2024 (HealthDay News) — Chemoradiation with an adaptive stereotactic ablative radiotherapy (SABR) boost is safe and effective for patients with locally advanced, unresectable nonâsmall cell lung cancer (NSCLC), according to a study published online Jan. 11 in JAMA Oncology.
Trudy C. Wu, M.D., from the University of California in Los Angeles, and colleagues examined the maximum tolerated dose (MTD) and use of hypofractionated concurrent chemoradiation with an adaptive SABR boost among patients with clinical stage II or III NSCLC. All patients first received 4 Gy x 10 fractions followed by an adaptive SABR boost consisting of an additional 25 Gy (low), 30 Gy (intermediate), or 35 Gy (high) with concurrent weekly carboplatin/paclitaxel. Data were evaluated from 28 patients (24 with stage III disease) enrolled across the low-, intermediate-, and high-dose cohorts (10, nine, and nine, respectively).
The researchers found that the protocol-specified MTD was not exceeded in the study. Nonhematologic acute and late grade 3 or higher effects had incidences of 11 and 7 percent, respectively. In the intermediate-dose boost cohort, there were no grade 3 toxic effects. In the high-dose cohort, there were two deaths. For the low-, intermediate-, and high-dose cohorts, two-year local control was 74.1, 85.7, and 100.0 percent, respectively, and two-year overall survival was 30.0, 76.2, and 55.6 percent, respectively.
“The present findings suggest that increasing the BED [biologic effective dose] through hypofractionation may enhance LC [local control], but this approach is limited by grade 5 toxic effects beyond a certain BED, which was 70 Gy in 15 fractions in this study,” the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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