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Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer
When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationa...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Nature Publishing Group UK
2020
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735212/ https://www.ncbi.nlm.nih.gov/pubmed/33293671 http://dx.doi.org/10.1038/s41416-020-01070-6 |
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author | Conibear, John |
author_facet | Conibear, John |
author_sort | Conibear, John |
collection | PubMed |
description | When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks. |
format | Online Article Text |
id | pubmed-7735212 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Nature Publishing Group UK |
record_format | MEDLINE/PubMed |
spelling | pubmed-77352122020-12-17 Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer Conibear, John Br J Cancer Mini Review When treating patients with unresectable stage III non-small-cell lung cancer (NSCLC), those with a good performance status and disease measured within a radical treatment volume should be considered for definitive concurrent chemoradiotherapy (cCRT). This guidance is based on key scientific rationale from two large Phase 3 randomised studies and meta-analyses demonstrating the superiority of cCRT over sequential (sCRT). However, the efficacy of cCRT comes at the cost of increased acute toxicity versus sequential treatment. Currently, there are several documented approaches that are addressing this drawback, which this paper outlines. At the point of diagnosis, a multidisciplinary team (MDT) approach can enable accurate assessment of patients, to determine the optimal treatment strategy to minimise risks. In addition, reviewing the Advisory Committee on Radiation Oncology Practice (ACROP) guidelines can provide clinical oncologists with additional recommendations for outlining target volume and organ-at-risk delineation for standard clinical scenarios in definitive cCRT (and adjuvant radiotherapy). Furthermore, modern advances in radiotherapy treatment planning software and treatment delivery mean that radiation oncologists can safely treat substantially larger lung tumours with higher radiotherapy doses, with greater accuracy, whilst minimising the radiotherapy dose to the surrounding healthy tissues. The combination of these advances in cCRT may assist in creating comprehensive strategies to allow patients to receive potentially curative benefits from treatments such as immunotherapy, as well as minimising treatment-related risks. Nature Publishing Group UK 2020-12-08 2020-12-01 /pmc/articles/PMC7735212/ /pubmed/33293671 http://dx.doi.org/10.1038/s41416-020-01070-6 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Mini Review Conibear, John Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer |
title | Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer |
title_full | Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer |
title_fullStr | Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer |
title_full_unstemmed | Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer |
title_short | Rationale for concurrent chemoradiotherapy for patients with stage III non-small-cell lung cancer |
title_sort | rationale for concurrent chemoradiotherapy for patients with stage iii non-small-cell lung cancer |
topic | Mini Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735212/ https://www.ncbi.nlm.nih.gov/pubmed/33293671 http://dx.doi.org/10.1038/s41416-020-01070-6 |
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