Although there were no significant differences in OS and LRFS between the QD and BID groups, there was a trend toward improved local control in the BID group. The two‐year OS rate was 43.3% and 48.8% for QD and BID therapy, respectively. Further attempts to improve response through hyperfractionation or accelerated Although this schedule proved to be effective for the treatment of MSCC, 10–27% of MSCC patients have an additional loss of motor function after 30 Gy in 10 fractions (1, 2, 3, 4). The study was under protocols approved by the institutional review boards of the Shandong Cancer Prevention and Treatment Research ethics committee. A total dose of 30 Gy given in 10 fractions (overall treatment time 2 weeks) is considered the standard schedule in most centers worldwide. †The mean irradiation dose that the lung, heart and esophagus received, respectively; ‡The volume of the lung that received the 5 Gy and 20 Gy irradiation doses, respectively; §The volume of the heart that received the 30 Gy irradiation dose; ¶The volume of the esophagus that received the 45 Gy irradiation dose; ††The maximum irradiation dose that the spinal cord received. A meta‐analysis of thoracic radiotherapy for small‐cell lung cancer, Does thoracic irradiation improve survival and local control in limited‐stage small‐cell carcinoma of the lung? Our study was based on a small sample size and potential confounding factors existed, such as patient, tumor, and radiation treatment characteristics. Different treatment traditions have developed, and a variety of current fractionation schedules, ranging from 10 Gy per one fraction to 60 Gy per 30 fractions, are used in clinical practice . , once daily (QD); , twice daily (BID). It is possible that MSCC patients could benefit from an escalation of the radiation dose to >30 Gy in 10 fractions (10 × 3 Gy… MCC is a radiosensitive cancer and fractionated radiotherapy (FRT), typically delivered at 30 Gy over 10 fractions, is often effective for MCC metastases. Patients were randomized to receive minimum total doses of 60.0, 64.8, and 69.6 Gy. Side effect assessment was graded using the National Cancer Institute Common Toxicity Criteria (version 3.0) during the RT and chemotherapy periods. The RTOG 0617 study, which concluded that 74 Gy radiation given in 2 Gy fractions with concurrent chemotherapy was not superior to 60 Gy plus concurrent chemotherapy for patients with stage III non‐small‐cell lung cancer, supported these findings.18. All of the patients received four to six cycles of platinum plus etoposide. High-risk 78 Gy in 39 fractions (SV 45-54 Gy) Prostate and SV as dose constraints allow 28 mos of hormone ablation, starting 2 mos before treatment Organ Confined Disease. have recently published data of nearly 6000 patients with different prostate cancer risk groups, all treated with external beam radiotherapy either with standard fractionation (1.8 - 2.0 Gy per fraction; 40% of the patients) or hypofractionation (2.5 - 6.7 Gy per fraction; 60% of the patients). Statistically significant differences were found in the rates of both grade 2 or higher esophagitis (P = 0.036) and pneumonitis (P = 0.043) between QD and BID groups, respectively. Of note, multiple studies have confirmed the equivalence of various dose fractionation schemes for whole‐brain radiotherapy, including 5 fractions of 4 Gy, 10 fractions of 3 Gy, 15 fractions of 2.5 Gy, and 20 fractions of 2 Gy without statistically significant differences in overall survival or symptom control noted among the regimens. Preventive (adjuvant) doses are typically around 45–60 Gy in 1.8–2 Gy fractions (for breast, head, and neck cancers). Learn about our remote access options, Departments of Radiation Oncology, Shandong Cancer Hospital & Institute, Shandong Academy of Medical Sciences, Jinan, China, Department of Thoraic Surgery, Shandong Cancer Hospital & Institute, Jinan, China, Department of Radiation Oncology, Shandong Cancer Hospital & Institute, Jinan, China. All patients had FDG-PET performed at 40 Gy midtreatment, with radiation therapy delivered in 30 daily fractions. For each plan, according to different situations, the gantry angles were set to reduce the radiation volume to normal tissues as much as possible. One hundred and twenty‐one (85%) patients received etoposide and cisplatin; of the remainder, 12 (8%) received etoposide and carboplatin, and 10 (7%) each received irinotecan and cisplatin or irinotecan and carboplatin. In the BID group, the dose was 45 Gy at 1.5 Gy per twice‐daily fraction. conducted a randomized trial that demonstrated a BID regimen of 45 Gy in 30 fractions over three weeks that was superior to 45 Gy in 25 daily fractions; as a result of their study, clinical use of accelerated hyper‐fractionated RT in LD‐SCLC has become more prevalent.11 The NCCTG 95‐20‐53 trial, which included six cycles of EP, with cycles four and five including concurrent chemotherapy and TRT (30 Gy/20 BID fractions, a 2‐week break, and further 30 Gy/20 BID fractions), resulted in a favorable five‐year survival rate of 24%; however, the locoregional failure remained a problem and grade 3 or grade 3+ toxicity were as high as 97%.10 In the RTOG 0239 study, patients with LD‐SCLC were given thoracic radiation to 61.2 Gy over five weeks (daily 1.8 Gy fractions on days 1–22, then BID 1.8 Gy fractions on days 23–33), and the rates of grade 3 esophagitis and local regional failure were 18% and 20%, respectively; the two‐year OS rate of 36.6% did not reach the projected goal.12 The 2014 National Comprehensive Cancer Network (NCCN) recommended the standard doses for QD and BID TRT as 60–70 Gy in 30–35 fractions and 45 Gy in 30 fractions, respectively. found that the rates of acute esophagitis increased in SCLC patients treated with BID TRT and our results also supported this view.13 The main toxicity problem of the present study was grade 3 esophagitis, affecting 6% versus 19% (QD vs. BID). Our provincial dose constraint guidelines were used . and you may need to create a new Wiley Online Library account. Seventy‐seven patients (40 receiving QD and 37 receiving BID radiation) were administered PCI within four weeks of completion of all chemotherapy. h�bbd``b`N�W��?�`il� �m "N|l %f0��$�DAD"� Ipe �4 !V2 HL����Ȱd#i���� �� P If you do not receive an email within 10 minutes, your email address may not be registered, Statistically significant differences were found in the rates of both grade 2 or higher esophagitis (P = 0.036) and pneumonitis (P = 0.043) between the QD and BID groups, respectively. The most common chemotherapy regimen consisted of etoposide (100 mg/m2 intravenously on days 1–5) and cisplatin (25 mg/m2 intravenously on days 1–3) (EP) and was administered every three weeks. Incidence of progression‐free survival by radiotherapy fractionation pattern. Follow‐up after treatment completion was every three months over the first two years and every six months thereafter. Dan Han and Shaoyu Hao contributed equally. Preventive (adjuvant) doses are typically around 45–60 Gy in 1.8–2 Gy fractions (for breast, head, and neck cancers.) Statistical calculations were performed using SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). The median OS of all patients was 30.4 months: 29.5 months for QD, and 31.4 months for BID therapy ( Figure 1). 68 0 obj <>/Encrypt 46 0 R/Filter/FlateDecode/ID[<0A85329A487FE64C87767BE9F9D671BF><18E3276A56B9EF48B9787F8A5C326D1C>]/Index[45 36]/Info 44 0 R/Length 98/Prev 72461/Root 47 0 R/Size 81/Type/XRef/W[1 2 1]>>stream Use the link below to share a full-text version of this article with your friends and colleagues. Pneumonitis was more common in the QD group, and esophagitis was more common in the BID group. Between June 2008 and December 2013, 143 patients confirmed by pathology or cytology with stage I–III SCLC at the Shandong Cancer Hospital & Institute were retrospectively analyzed. The median age was 55 (range, 35–74) and 58 years (range, 45 to 71) for patients receiving QD and BID therapy, respectively. Over a median follow-up period of 7 months, incidence of grade ≥2 RP was 36% (including grade 3 RP: 5% and grade 5 RP: 3%). Although there were no significant differences in OS and LRFS between the QD and BID groups, there was a trend toward improved local control in the BID group. In some cases, two fractions per day are used near the end of a course of treatment. The differences in chemotherapy cycle numbers at the time of RT (P = 0.244) were not statistically significant between the two groups. In the present study we compared toxicities, disease control, and survival in patients treated with either once daily (QD) or twice‐daily (BID) RT with platinum‐based chemotherapy at our institution. Meaning Pain response rates were higher for high-dose, single ... (12 Gy for ≥4-cm lesions or 16 Gy for <4-cm lesions) or MFRT to 30 Gy in 10 fractions. 10–12 This has led to the adoption of the dose regimen of 60–65 Gy delivered in 1.8–2.0 Gy fractions as standard in the therapy of better prognosis patients with high-grade malignant glioma. Elective treatment of clinically uninvolved lymphatic regions was not carried out. After acceptable risks of acute and late effects were found, 74.4 Gy and 79.2 Gy … The median overall survival (OS) of all patients was 30.4 months: 29.5 months for QD therapy, and 31.4 months for BID therapy. Materials and methods: A typical glioblastoma plan (8-cm tumor, 60 Gy/30 fractions) was constructed using the Pinnacle™ radiation planning system. Differences between the two groups in patient characteristics, toxicity or treatment response were assessed using the t‐test for numerical data and the Fisher exact test or Chi‐square test for categorical data. None of the patients died of treatment‐related causes. The primary end point was overall survival. This schedule, known as a concomitant boost regimen or hyperfractionation, is used on tumors that regenerate more quickly when they are … No significant differences were observed in the comparisons between the parameters of the total lung, ipsilateral lung, contralateral lung, the maximum irradiation dose to the spinal cord, V30 and mean dose to the heart, or V45 and mean esophagus dose (all P > 0.05). In IRCCS, the dose prescriptions as followed: high grade glioma 60 Gy in 30 fractions (2 Gy per fraction), multiple brain metastases 30 Gy in 10 fractions (3 Gy per fraction), while in stereotactic intracranial treatment, dose prescription was 27 Gy in 3 fractions (9 Gy per fraction). Organ sparing comparison was done with mean doses to rectum and bladder. In the QD group, the prescribed dose was 60 Gy in 30 fractions at 2 Gy QD to the PTV. The toxicities of the 143 patients are presented in detail in Table 4. The full text of this article hosted at iucr.org is unavailable due to technical difficulties. Of these, 62 (80%) received a regimen of 25 Gy in 10 fractions to the entire brain; the remainder received a regimen of 30 Gy in 10 fractions. Despite the addition of TRT to chemotherapy, local treatment failures occur in approximately one third of LD‐SCLC patients treated with the currently accepted optimal therapy.19 As a dose‐response relationship exists in treating LD‐SCLC, local control and subsequent survival are associated with dose‐fractionation parameters.8 The INT 0096 protocol supported this view and reported that BID TRT reduced the rate of local failure, with rates of 52% and 36% in the QD and BID groups, respectively (P = 0.06). • Microscopic disease (ex: positive margin): 60-66 Gy • Elective coverage (ex: uninvolved but at-risk lymph nodes): 45-54 Gy. There were no statistically significant differences in patient characteristics between the two groups. Although no statistically significant difference was observed in LRFS between the QD and BID groups, there was a trend toward improved local control for the BID group in the present study. Thoracic radiotherapy was performed using a Varian linear accelerator (Varian Medical Systems, Palo Alto, CA, USA). The Nordic trial, which randomly assigned patients with newly diagnosed GBM who were aged 60 years and older to receive TMZ monotherapy, hypofractionated radiotherapy of 34 Gy in 10 fractions, or standard radiotherapy of 60 Gy in 30 fractions, demonstrated that hypofractionated radiotherapy produced survival rates that were similar to those in patients receiving standard … Age, sex, Brinkman index, and blood test results did not significantly differ between patients with grade ≥2 RP and grade ≤1 RP. The BED can be used to compare the efficacy of various dose‐fractionation regimens in providing tumor control and survival.9 Compared with the BID group, QD RT resulted in a higher BED of 54.7 Gy to the tumor. The National Cancer Institute of Canada Clinical Trials Group, Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited‐disease small‐cell lung cancer, Comparison of once and twice daily radiotherapy for limited stage small‐cell lung cancer, Once‐daily radiotherapy to > or = 59.4 Gy versus twice‐daily radiotherapy to > or = 45.0 Gy with concurrent chemotherapy for limited‐stage small‐cell lung cancer: A comparative analysis of toxicities and outcomes, Standard‐dose versus high‐dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non‐small‐cell lung cancer (RTOG 0617): A randomised, two‐by‐two factorial phase 3 study, Twice‐daily compared with once‐daily thoracic radiotherapy in limited small‐cell lung cancer treated concurrently with cisplatin and etoposide. Gy↔uGy 1 Gy = 1000000 uGy » Centigray Conversions: cGy↔rd 1 cGy = 1 rd cGy↔mrd 1 cGy = 1000 mrd cGy↔J/kg 1 J/kg = 100 cGy cGy↔J/g 1 J/g = 100000 cGy cGy↔J/cg 1 J/cg = 10000000 cGy cGy↔J/mg 1 J/mg = 100000000 cGy cGy↔Gy 1 Gy = 100 cGy cGy↔Mgy 1 Mgy = 100000000 cGy Grade 3 esophagitis occurred in 6% of patients receiving QD and 19% of those receiving BID therapy. Three scenarios were applied consisting of different sets of planning aims: 85 and 60 Gy for the HR-CTV and the intermediate-risk CTV (IR-CTV) D90 (minimal dose received by 90% of the volume) in scenario 1, 90 and 60 Gy, respectively, for scenarios 2 and 3. Treatment response was estimated using CT or PET‐CT after treatment, according to Response Evaluation Criteria in Solid Tumors (version 1.0). Working off-campus? There were no significant differences in the response rates between the groups. The gross tumor volume (GTV) referred to the restaging chest CT obtained after induction chemotherapy, including the residual primary tumor and all clinically involved lymphatic regions. 60 Gy in 30 fractions over 6 weeks with cisplatin and etoposide (Grade A) 66 Gy in 33 fractions over 6.5 weeks with cisplatin and etoposide (Grade A) Sequential: 55 Gy in 20 fractions over 4 weeks (Grade A) 60 Gy in 30 fractions over 6 weeks (Grade B) 66 Gy in 33 fractions over 6.5 weeks (Grade B) 54 Gy in 36 fractions treating thrice daily over 12 consecutive days (CHART) (Grade B) Cellular immunity plays a particularly important role in MCC survival. 0 When enlarged lymph nodes (greater than 1.0 cm in short axis measurement on CT, or demonstrated positive on the fludeoxyglucose‐positron emission tomography [FDG‐PET]/CT scan) resolved after induction chemotherapy, the previously involved lymph node regions were still included in the radiation target by reviewing the prechemotherapy CT scan. This is in keeping with a study by Gazula et al., which showed higher rates of pneumonitis among LD‐SCLC patients treated with a median dose of 61.2 Gy (range 50–66.6) in 1.8–2.0 Gy QD fractions, compared with patients treated with 45 Gy in 1.5 Gy BID fractions.16 However, Watkins et al. This study was designed to compare toxicities, disease control, and survival outcomes for limited disease small‐cell lung cancer (LD‐SCLC) treated with once daily (QD) versus twice daily (BID) radiotherapy. Learn more. Three months after treatment, late toxicities were evaluated according to the Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer late radiation morbidity scoring schema. Chemotherapy and radiotherapy were combined simultaneously. Data from a total of 143 LD‐SCLC patients treated at the Shandong Cancer Hospital & Institute were retrospectively analyzed. The five‐year OS rate was 13.3% for QD, and 19.6% for BID therapy. No authors report any conflict of interest. In the BID group, the prescribed dose was 45 Gy in 30 fractions at 1.5 Gy BID to the PTV. , once daily (QD); , twice daily (BID). Transient effects of eyelash loss and erythema occur at 30 Gy to 40 Gy with ... or equal to 45 Gy in 25 fractions developing a dry eye syndrome compared with 100% for doses above or equal to 57 Gy in 30 fractions. The biological equivalent dose (BED) was calculated using the linear quadratic formula: BED = (nd)[1 + d/(α/β)] − (0.693t/αTpot), where n = the total number of fractions delivered; d = the dose per fraction (Gy); α/β = 10 for acute effects and tumor control and three for chronic effects; α = 0.3 Gy−1; t = total days in which RT was delivered; and Tpot = potential doubling time (5.6 days).9, 10 The BED using an α/β ratio of 10 was 54.7 and 43.1 Gy for the QD and BID regimens, respectively. The CALGB trial 8433, which randomized patients to conventional radiation therapy (60 Gy in 30 fractions) or 2 cycles of cisplatin and vinblastine followed by conventional radiation therapy, demonstrated an improvement in median survival to 13.7 months (compared with 9.6 months for conventional radiation therapy alone) and 5-year overall survival of 17% (compared to 6%). Two-year overall survival was 56%, 67%, and 50% accordingly. Further, there appeared to be a significant dose- response relationship between 30 and 60 Gy Materials and methods: Prescription doses ranged from 60 Gy to planning target volume (PTV) and 66.25 Gy for clinical target volume prostate (CTV-P) over 25-30 fractions. The Arm 1 dose prescription was 60 Gy in 30 fractions at five fractions per week. From January 1978 to January 1988, 859 patients with T3-T4, NO-3, MO were randomly allocated to receive either: Group A--60Co 60, 60 Gy in 30 fractions; Group B--60Co, 70.4 Gy in 64 fractions; Group C--60Co, 60 Gy in 30 fractions plus chemotherapy (5 Fu, 250 mg/m2/IV every 2 days). There were no significant differences between the groups in the incidence of grade 2 or higher hematologic toxicity. Dearnaley et al 21 compared 60 Gy in 20 fractions over 4 weeks (the same regimen as the current trial) and 57 Gy in 19 fractions over 3.8 weeks, with 74 Gy in 38 fractions over 7.6 weeks in predominantly intermediate-risk patients who also all received 6 months of androgen deprivation therapy before and during RT. did not detect a statistically significant difference in acute toxicities in LD‐SCLC patients treated with concurrent chemotherapy and QD versus BID RT.17, Thoracic radiation affects patient outcome by decreasing the tumor burden within the chest, resulting in enhanced local control and survival. Radiation doses to circulating cells (DCC) were analyzed using MatLab™. 60–64 Gy in 30–32 fractions over 6–6.5 weeks (Grade B) There is robust evidence that radiotherapy with a radiosensitiser using carbogen and nicotinamide or … Radiation protection. The planning aims were to cover at least 95% of the PTV volume by the prescription dose (V 100% > 95%) and to cover at least 99% of the PTV volume by 54 Gy (V 90% > 99%).