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The following is a summary of “Primary Results of NRG-RTOG1106/ECOG-ACRIN 6697: A Randomized Phase II Trial of Individualized Adaptive (chemo)Radiotherapy Using Midtreatment 18F-Fluorodeoxyglucose Position Emission Tomography/Computed Tomography in Stage III Non–Small Cell Lung Cancer” published in the October 2024 issue of Oncology by Kong et al.
Previous research, including NRG-RTOG0617, showed a negative impact of uniformly high-dose radiation in patients with stage III non-small cell lung cancer (NSCLC).
Researchers conducted a prospective study determining if midtreatment 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) could guide individualized radiotherapy dose escalation to improve patient outcomes in stage III NSCLC.
They randomly assigned patients eligible for concurrent chemoradiation (1:2) to either a standard radiation arm (60 Gy/30 fractions) or an adaptive treatment arm, guided by midtreatment 18F-FDG-PET/CT. Adaptive-arm patients received an individualized, intensified radiation boost to residual metabolically active areas. The primary outcome was 2-year freedom from local-regional progression (FFLP), assessed using a one-sided Z-test (P=.15).
The results showed 138 patients, 127 were eligible. Patients in the adaptive arm received a mean radiation dose of 71 Gy in 30 fractions, with a mean lung dose of 17.9 Gy. No significant difference in centrally reviewed 2-year FFLP between the standard arm (59.5%) and adaptive arm (54.6%) (P=.66). No significant differences were observed in protocol-specified grade 3 toxicities, survival, or PFS (P>.4). In the adaptive arm, median SUVpeak and metabolic tumor volume (MTV) decreased by 49% and 54% from pre-RT to mid-RT PET, but ΔSUVpeak and ΔMTV were not associated with FFLP (HR, 0.997; P=.395 and .461).
They concluded that midtreatment PET-adapted radiotherapy dose escalation was safe and feasible but did not improve patient outcomes.
Source: ascopubs.org/doi/10.1200/JCO.24.00022
