• Fibrosis
• Mesenchymal stem cells
• Pneumonitis
• Radiation-induced lung injury
• Radiotherapy
• Therapy

• Humans
• Lung Injury/etiology
• Lung Injury/therapy
• Radiation Injuries/therapy
• Radiation Injuries/etiology
• Radiation Pneumonitis/etiology
• Radiation Pneumonitis/therapy
• Animals
• Genetic Therapy/methods

• 3-dimensional conformal radiation therapy
• intensity-modulated radiation therapy
• lobectomy
• non–small cell lung cancer
• postoperative radiation
• resection
• stage III
• stage IIIA-N2
• surgery

• Aged
• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Carcinoma, Non-Small-Cell Lung/surgery
• Cohort Studies
• Humans
• Lung Neoplasms/radiotherapy
• Lung Neoplasms/surgery
• Male
• Margins of Excision
• Neoplasm Staging
• Prospective Studies
• Radiotherapy, Intensity-Modulated/methods
• Retrospective Studies
• Treatment Outcome

Patient: Male, 43-year-old

Final Diagnosis: Lung cancer

Symptoms: —

Medication:—

Clinical Procedure: —

Specialty: Oncology • Radiology

To explore the maximum tolerated dose (MTD) and evaluate the safety of dose escalation using hypofractionated simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) concurrent with chemotherapy for unresectable stage III non-small cell lung cancer (NSCLC).

Four escalating radiation dose levels were used. This study included 25 patients with previously untreated NSCLC who received six concurrent weekly chemotherapy cycles comprising cisplatin and docetaxel. Dose-limiting toxicity (DLT) was defined as any acute toxicity that interrupted radiotherapy for more than 1 week. MTD was defined as the highest dose level that didn’t induce DLT or grade 5 toxicity in two patients.

All 25 patients received the prescribed escalating radiation dose from the start dose up to LEVEL 4. Two patients experienced DLT at dose LEVEL 4. One patient died because of upper gastrointestinal hemorrhage within 6 months after radiotherapy, whereas another patient among the additional five patients died because of grade 5 radiation pneumonitis within 2 months after radiotherapy. Dose LEVEL 3 was defined as MTD. The 1- and 2-year local controls were 82.8 and 67.8%, respectively. The median progression-free survival was 15.4 months, whereas the median overall survival was 27.3 months.

Dose escalation was safely achieved up to LEVEL 3 [the planning gross target volume (PTVG) 60.5 Gy/22 Fx, 2.75 Gy/Fx; the planning clinical target volume (PTVC) 49.5 Gy/22 Fx] using SIB-IMRT concurrently with chemotherapy for unresectable stage III NSCLC, and the acute toxicities were generally well tolerated. Further prospective studies on long-term outcomes and late toxicities are warranted.

Retrospective registration, ChiCTR1900027290(08/11/2019).

The online version contains supplementary material available at 10.1186/s12885-021-09099-3.

Various radiotherapy treatment methods are available for patients with stage III non-small-cell lung cancer (NSCLC). A multidisciplinary tumor board review is recommended to determine the best treatment strategy. In fit patients with inoperable tumors, concurrent chemoradiotherapy (cCRT) is preferred over sequential CRT (sCRT), due to better survival. Nonetheless, the use of cCRT in stage III NSCLC varies significantly, with concerns about treatment toxicity being a contributory factor. Many reports describing the relationship between overall survival, toxicity, and dosimetry in patients with locally advanced NSCLC are based on clinical trials, with strict criteria for patient selection, including good performance status, pulmonary function, etc. These trials have not always mandated the use of IMRT/VMAT. We therefore performed an institutional analysis to study the relationship between dosimetric parameters and overall survival and toxicity in patients with stage III NSCLC treated with IMRT/VMAT-based techniques in routine clinical practice.

Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection. We performed an institutional analysis to study the relationship between dosimetric parameters, toxicity, and OS in inoperable patients with stage III NSCLC treated with (hybrid) IMRT/VMAT-based techniques in routine clinical practice. Eligible patients had undergone treatment with radical intent using cCRT, sCRT, or RT alone, planned to a total dose ≥ 50 Gy delivered in ≥15 fractions. All analyses were performed for two patient groups, (1) cCRT (n = 64) and (2) sCRT/RT (n = 65). The toxicity rate differences between the two groups were not significant, and OS was 29 and 17 months, respectively. For sCRT/RT, no dosimetric factors were associated with OS, whereas for cCRT, PTV-volume, esophagus V50 Gy, and contralateral lung V5 Gy were associated. cCRT OS was significantly lower in patients with esophagitis ≥ G2. The overall rate of ≥G3 pneumonitis was low (3%), and the rate of high-grade esophagitis the OS in this real-world patient population was comparable to those reported in clinical trials. Based on this hypothesis-generating data, more aggressive esophageal sparing merits consideration. Institutional auditing and benchmarking of the planning strategy, dosimetry, and outcome have an important role to play in the continuous quality improvement process.

• NSCLC
• dosimetric parameters
• overall survival
• toxicity

To assist in the selection of a suitable combination of an irradiation technique and jaw condition in intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc radiotherapy (VMAT) for lung cancer treatment plans.

Thirty patients with lung cancer who underwent radiotherapy were enrolled retrospectively. They were categorized as having central lung cancer, peripheral lung cancer with mediastinal lymph node metastasis (peripheral E lung cancer), and peripheral lung cancer without mediastinal lymph node metastasis (peripheral N lung cancer). Four treatment plans were designed for each patient: fixed jaw and adaptive jaw IMRT technique (FJ‐IMRT and JA‐IMRT), and fixed jaw and jaw tracking VMAT technique (FJ‐VMAT and JT‐VMAT). The dose parameters of the four group plans were compared and analyzed.

Compared to FJ‐IMRT, JA‐IMRT significantly reduced the mean dose (D_mean) and volume percentage of 5 Gy (V_5Gy) of the total lung in central and peripheral N lung cancer. Similarly, compared to FJ‐VMAT, JT‐VMAT provided better protection to most organs at risk (OARs), particularly for total lung and heart. In comparison with IMRT, VMAT significantly improved the conformity index (CI) of the planning target volume for the three lung cancer classifications, and it reduced the dose of almost all OARs except V_5Gy and D_mean of the total lung. Moreover, the mean monitor units of the VMAT groups were far lower than the IMRT groups.

Based on the dosimetric findings and considering clinical data published on lung and heart side effects, we propose recommendations on the preferred treatment technique based on tumor location and pulmonary function. For central lung cancer with normal pulmonary function, we advise JT‐VMAT techniques. Conversely, for central lung cancer with poor pulmonary function, we recommend JA‐IMRT techniques. We advocate JA‐IMRT for peripheral E lung cancer. For peripheral N lung cancer, JT‐VMAT techniques are strongly recommended.

• IMRT
• VMAT
• adaptive jaw
• jaw tracking
• lung cancer

• Carcinoma, Non-Small-Cell Lung/radiotherapy
• Humans
• Immunotherapy
• Lung Neoplasms/radiotherapy

• Cancer
• Dosimetry
• Dosimétrie
• IMRT
• Lung
• Poumon
• RC3D
• Radiothérapie conformationnelle en trois dimensions
• Toxicity
• Toxicité

• Disparities
• lung cancer
• race
• socioeconomic status

• Chemoradiotherapy
• ECOG 2
• Efficacy
• Locally advanced
• Non-small-cell lung cancer
• Toxicity

• RILI
• RILT
• adverse effects
• fibrosis
• lung
• pneumonitis
• radiotherapy

• HATs
• NSCLC
• hMOF
• prognosis
• radiosensitivity

• non-small cell lung cancer (NSCLC)
• overall survival
• radiotherapy
• treatments

This study is to report clinical outcomes of salvage concurrent chemo-radiation therapy (CCRT) in treating patients with loco-regional recurrence (LRR) following initial complete resection of non-small cell lung cancer.

Between February 2004 and December 2016, 127 patients underwent salvage CCRT for LRR. The median radiation therapy (RT) dose was 66 Gy and clinical target volume was to cover recurrent lesion with margin without elective inclusion of regional lymphatics. Majority of patients (94.5%) received weekly platinum-based doublet chemotherapy during RT course.

The median follow-up time from the start of CCRT was 25 months. The median survival duration was 49 months, and overall survival (OS) rates at 2 and 5 years were 72.9% and 43.9%. The 2- and 5-year rates of in-field failure-free survival, distant metastasis free survival, and progression free survival were 82.4% and 73.8%, 50.4% and 39.9%, and 34.6% and 22.3%, respectively. Grade ≥ 3 radiation-related esophagitis and pneumonitis occurred in 14 (11.0%) and six patients (4.7%), respectively. On both univariate and multivariate analysis, higher biologically equivalent dose (BED₁₀) (≥ 79.2 Gy₁₀ vs. < 79.2 Gy₁₀; hazard ratio [HR], 0.431), smaller CTV (≤ 80 cm³ vs. > 80 cm³; HR, 0.403), and longer disease-free interval (> 1 year vs. ≤ 1 year; HR, 0.489) were significantly favorable factors for OS.

The current study has demonstrated that high dose salvage CCRT focused to the involved lesion only was highly effective and safe. In particular, higher BED₁₀, smaller CTV, and longer disease-free interval were favorable factors for improved survival.

• Loco-regional recurrence
• Non-small cell lung carcinoma
• Salvage concurrent chemo-radiation therapy

• Non-small cell lung cancer (NSCLC)
• intensity-modulated radiation therapy (IMRT)
• proton therapy
• three-dimensional conformal radiotherapy (3DCRT)
• toxicities

• cost–benefit analysis
• lung neoplasms
• radiotherapy

• Non–small cell lung cancer
• chemotherapy
• combined modality
• radiotherapy
• stage III
• surgery

• Ad-interim FDG-PET
• Adaptive radiotherapy
• Chemo-radiotherapy
• Lung cancer
• Non-Small Cell Lung Cancer
• Tumour response

Lung cancer is the leading cause of cancer death worldwide. Majority of newly diagnosed lung cancers are non-small cell lung cancer (NSCLC), of which up to half are considered locally advanced at the time of diagnosis. Patients with locally advanced stage III NSCLC consists of a heterogeneous population, making management for these patients complex. Surgery has long been the preferred local treatment for patients with resectable disease. For select patients, multi-modality therapy involving systemic and radiation therapies in addition to surgery improves treatment outcomes compared to surgery alone. For patients with unresectable disease, concurrent chemoradiation is the preferred treatment. More recently, research into different chemotherapy agents, targeted therapies, radiation fractionation schedules, intensity-modulated radiotherapy, and proton therapy have shown promise to improve treatment outcomes and quality of life. The array of treatment approaches for locally advanced NSCLC is large and constantly evolving. An updated review of past and current literature for the roles of surgery, chemotherapeutic agents, radiation therapy, and targeted therapy for stage III NSCLC patients are presented.

• Non-small cell lung cancer
• Chemoradiotherapy
• Multi-modality
• Targeted therapy
• Dose-escalation

Lung cancer is the leading cause of cancer mortality, and radiotherapy plays a key role in both curative and palliative treatments for this disease. Recent advances include stereotactic ablative radiotherapy (SABR), which is now established as a curative-intent treatment option for patients with peripheral early-stage NSCLC who are medically inoperable, or at high risk for surgical complications. Improved delivery techniques have facilitated studies evaluating the role of SABR in oligometastatic NSCLC, and encouraged the use of high-technology radiotherapy in some palliative settings. Although outcomes in locally advanced NSCLC remain disappointing for many patients, future progress may come about from an improved understanding of disease biology and the development of radiotherapy approaches that further reduce normal tissue irradiation. At the moment, the benefits, if any, of radiotherapy technologies such as proton beam therapy remain unproven. This paper provides a critical review of selected aspects of modern radiotherapy for lung cancer, highlights the current limitations in our understanding and treatment approaches, and discuss future treatment strategies for NSCLC.

• Intensity-modulated radiotherapy
• Non-small cell lung cancer
• Proton therapy
• Radiotherapy
• Stereotactic ablative radiotherapy

• Carcinoma, Non-Small-Cell Lung/pathology
• Carcinoma, Non-Small-Cell Lung/therapy
• Chemoradiotherapy
• ErbB Receptors/genetics
• Humans
• Lung Neoplasms/pathology
• Lung Neoplasms/therapy
• Mutation/genetics
• Neoplasm Recurrence, Local/pathology

• chemotherapy
• endostatin
• extended therapy
• nsclc

• Adult
• Aged
• Antineoplastic Combined Chemotherapy Protocols/therapeutic use
• Camptothecin/administration & dosage
• Camptothecin/analogs & derivatives
• Carcinoma, Non-Small-Cell Lung/drug therapy
• Carcinoma, Non-Small-Cell Lung/pathology
• Cisplatin/administration & dosage
• Deoxycytidine/administration & dosage
• Deoxycytidine/analogs & derivatives
• Endostatins/administration & dosage
• Female
• Humans
• Irinotecan
• Lung Neoplasms/drug therapy
• Lung Neoplasms/pathology
• Male
• Middle Aged
• Organoplatinum Compounds/administration & dosage
• Pemetrexed/administration & dosage
• Retrospective Studies
• Survival Rate
• Treatment Outcome
• Gemcitabine