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Review
. 2014 Apr;6(4):336-47.
doi: 10.3978/j.issn.2072-1439.2014.01.23.

Radiation dose effect in locally advanced non-small cell lung cancer

Feng-Ming Spring Kong  1 , Jing Zhao  1 , Jingbo Wang  1 , Corrine Faivre-Finn  1
Affiliations
Review

Radiation dose effect in locally advanced non-small cell lung cancer

Feng-Ming Spring Kong et al. J Thorac Dis. 2014 Apr.

Abstract

Radiation is the foundation of treatment for locally advanced non-small cell lung cancer (NSCLC), and as such, optimal radiation dose is essential for successful treatment. This article will briefly review biological considerations of radiation dose and their effect in the context of three-dimensional conformal radiation therapy (3D-CRT) including intensity modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT) for NSCLC. It will focus on literature review and discussions regarding radiation dose effect in locally advanced NSCLC including potential severe and lethal toxicities of high dose radiation given with concurrent chemotherapy. Potential new approaches for delivering safe and effective doses by individualizing treatment based on functional imaging are being applied in studies such as the PET boost trial and RTOG1106. The RTOG concept of delivering high dose radiation to the more resistant tumors with the use of isotoxic dose prescription and adaptive planning will also be discussed in detail.

Keywords: Non-small cell lung cancer (NSCLC); concurrent chemotherapy; radiation dose.

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Figures

Figure 1
Figure 1
Tumor control probability and biological effective dose. The dose response relationship is sigmoidal in one of the early dose escalation studies of non-small cell lung cancer (NSCLC) performed in University of Michigan.
Figure 2
Figure 2
Local tumor control increases with higher dose radiation. Radiation dose is associated with long-term tumor control. Dose response relationship is steeper for longer follow-up.
Figure 3
Figure 3
Correlation between local regional tumor control and overall survival in locally advanced non-small cell lung cancer (NSCLC). Data presented are reported individual results from 10 phase III trials comparing sequential chemoradiation with concurrent chemoradiation.
Figure 4
Figure 4
Radiation dose and survival in non-small cell lung cancer (NSCLC) in patients treated with or without concurrent chemotherapy. High dose group has better overall survival in both Chemo+ and Chemo- groups.
See this image and copyright information in PMC

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