The treatment of unresectable, locally advanced non-small cell lung cancer (NSCLC) has seen significant advancements in recent years, particularly with the integration of modern technology and techniques in radiation therapy. These advancements have led to improved dosimetry, meaning that radiation can be delivered more precisely to the tumor while sparing surrounding healthy tissue. Here’s a brief overview of the technical advancements mentioned:

  1. Clinical Setup and Image Acquisition: Innovations such as cone-beam CT (CBCT) and 4D-CT scans have improved the accuracy of tumor localization. These imaging techniques allow for better visualization of the tumor and surrounding anatomy, which is crucial for precise treatment planning.
  2. Radiation Planning: Treatment planning systems have become more sophisticated, with algorithms that can account for tumor motion and heterogeneity. Intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) are advanced planning techniques that enable high precision in dose delivery.
  3. Quality Assurance (QA): QA in radiation therapy has become more rigorous and automated. Advanced software and hardware tools ensure that the radiation dose delivered matches the planned dose and that the equipment functions correctly.
  4. Motion Management: Respiratory gating and tumor tracking are techniques used to manage tumor motion due to breathing. These technologies allow for synchronization of radiation delivery with the patient’s breathing cycle or real-time tumor tracking, reducing the risk of missing the target.
  5. Delivery: The actual radiation delivery has been enhanced through linear accelerators equipped with onboard imaging and real-time monitoring systems. These systems allow adjustments during treatment to account for any changes in the patient’s position or tumor size.

RTOG 0617 trial compared standard-dose (SD; 60 Gy) versus high-dose (HD; 74 Gy) radiation with concurrent chemotherapy and determined the efficacy of cetuximab for stage III non-small-cell lung cancer (NSCLC). Despite these technical advancements, the challenge of improving patient outcomes regarding progression-free survival (PFS) and local control remains. The median PFS of 16.9 months after chemoradiation with doses ranging from 60 to 66 Gy, followed by adjuvant durvalumab (an immune checkpoint inhibitor), indicates that there is still room for improvement. The local recurrence rates reported from the Radiation Therapy Oncology Group (RTOG) 0617 trial also highlight the need for better local control strategies.To address these challenges, ongoing research is focusing on several areas:

  • Optimization of Radiation Dose and Fractionation: Studies are exploring different radiation dosing schedules and fractionation to improve outcomes.
  • Combination Therapies: Combining radiation with other treatments, such as immunotherapy (e.g., durvalumab) and targeted therapies, is an active area of research.
  • Biomarkers for Personalized Treatment: Identifying biomarkers that predict response to therapy could lead to more personalized treatment approaches.
    Adaptive Radiation Therapy: This approach involves adjusting the treatment plan in response to tumor size, shape, or position changes during treatment.
  • Enhanced Radiobiological Understanding: A deeper understanding of the radiobiological effects on cancer cells and the tumor microenvironment may lead to more effective treatment strategies.
    Continued research and clinical trials are essential to translate these technical advancements into improved survival and quality of life for patients with locally advanced NSCLC.

Source: <a href=”https://www.redjournal.org/article/S0360-3016(24)00371-7/fulltext?rss=yes”>Link</a>