Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Mar 6.
doi: 10.1007/s00066-025-02377-0. Online ahead of print.

Treatment of non-small cell lung cancer: advances following the introduction of PET-CT and IMRT/VMAT

Julian Muster  1   2 , Niklas Josua Alt  1   2 , Marcus Edelmann  1   2 , Mahalia Zoe Anczykowski  1   2 , Carla Marie Zwerenz  1   2 , Markus Anton Schirmer  1   2 , Tobias Raphael Overbeck  2   3 , Friederike Braulke  2 , Manuel Guhlich  1   2 , Rami El Shafie  1   2 , Stefan Rieken  1   2 , Martin Leu  1   2 , Leif Hendrik Dröge  4   5
Affiliations

Treatment of non-small cell lung cancer: advances following the introduction of PET-CT and IMRT/VMAT

Julian Muster et al. Strahlenther Onkol. .

Abstract

Purpose: In definitive radiotherapy/radiochemotherapy (RT/RCT) for localized non-small cell lung cancer (NSCLC), the introduction of positron-emission tomography (PET)-CT-based staging/RT planning and dynamic RT techniques (intensity-modulated radiotherapy, IMRT/volumetric modulated arc therapy, VMAT) were important innovations.

Methods: We performed a retrospective study and compared clinical outcomes (1) in patients with PET-CT-based staging (n = 170) vs. conventional staging (n = 103) and (2) in patients with dynamic RT techniques (IMRT/VMAT; n = 99) vs. three-dimensional conformal radiotherapy (3D-CRT; n = 64).

Results: We found improved survival with PET-CT vs. conventional staging. PET-CT patients vs. conventionally staged patients had higher applied RT doses, higher RT completion rates, and a higher rate of patients who received RCT vs. RT only. Additionally, we found higher rates of leukopenia and lung infections in PET-CT patients. When comparing RT techniques (IMRT/VMAT vs. 3D-CRT), there were no differences in survival. IMRT/VMAT patients had higher RT doses and higher rates of intensified concomitant chemotherapy (cisplatin/vinorelbine vs. low-dose cisplatin). IMRT/VMAT was associated with a reduction in pneumonitis and dermatitis.

Conclusion: In summary, refined RT/RCT strategies with PET-CT and IMRT/VMAT enable the intensification of multimodal treatment. Reduction of toxicities with IMRT/VMAT widens the therapeutic window. The coincidence of intensified treatment, improved outcomes, and higher toxicity rates in PET-CT-staged patients emphasizes the need for a detailed risk-benefit assessment during planning and application of treatment modalities.

Keywords: 3D-conformal radiotherapy; Intensity-modulated radiotherapy; Non-small cell lung cancer; Positron emission tomography-computed tomography; Radiochemotherapy; Radiotherapy; Volumetric modulated arc therapy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflict of interest: J. Muster, N.J. Alt, M. Edelmann, M.Z. Anczykowski, C.M. Zwerenz, M.A. Schirmer, T.R. Overbeck, F. Braulke, M. Guhlich, R.E. Shafie, S. Rieken, M. Leu, and L.H. Dröge declare that they have no competing interests. Ethical standards: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Ethics Committee of the University Medical Center of Göttingen (protocol code 6/4/21; date of approval: 04/27/2021). Due to the retrospective nature of the study, additional informed consent was not necessary.

References

    1. Zentrum für Krebsregisterdaten (2023) Krebs in Deutschland für 2019/2020. https://www.krebsdaten.de/Krebs/DE/Content/Publikationen/Krebs_in_Deutsc... . Accessed 30 Jan 2024
    1. Meldgaard P, Kristensen M, Conte S et al (2023) Improved overall survival for stage III NSCLC patients treated with curative-intended therapy from 2010 to 2018—a cohort study in Denmark. Acta Oncol 62(12):1672–1679. https://doi.org/10.1080/0284186X.2023.2254474 - DOI - PubMed
    1. Gkika E, Grosu AL, Nestle U (2023) The use of 18F-FDG PET/CT for radiotherapy treatment planning in non-small cell lung cancer: a mini-review. Precis Cancer Med 6:7. https://doi.org/10.21037/pcm-22-38 - DOI
    1. Le Roy T, Wallet J, Barthoulot M et al (2023) IMRT in the treatment of locally advanced or inoperable NSCLC in the pre-durvalumab era: clinical outcomes and pattern of relapses, experience from the Oscar Lambret Center. Front Oncol 13:1236361. https://doi.org/10.3389/fonc.2023.1236361 - DOI - PubMed - PMC
    1. Chun SG, Hu C, Choy H et al (2017) Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: a secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial. J Clin Oncol 35(1):56–62. https://doi.org/10.1200/JCO.2016.69.1378 - DOI - PubMed

LinkOut - more resources