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Purpose <p>In definitive radiotherapy/radiochemotherapy (RT/RCT) for localized non-small cell lung cancer (NSCLC), the introduction of positron-emission tomography (PET)-CT-based staging/RT planning and dynamic RT techniques (intensity-modulated radiotherapy, IMRT/volumetric modulated arc therapy, VMAT) were important innovations.</p> Methods <p>We performed a&#xa0;retrospective study and compared clinical outcomes (1)&#xa0;in patients with PET-CT-based staging (<i>n</i> = 170) vs. conventional staging (<i>n</i> = 103) and (2)&#xa0;in patients with dynamic RT techniques (IMRT/VMAT; <i>n</i> = 99) vs. three-dimensional conformal radiotherapy (3D-CRT; <i>n</i> = 64).</p> Results <p>We found improved survival with PET-CT vs. conventional staging. PET-CT patients vs. conventionally staged patients had higher applied RT doses, higher RT completion rates, and a&#xa0;higher rate of patients who received RCT vs. RT only. Additionally, we found higher rates of leukopenia and lung infections in PET-CT patients. When comparing RT techniques (IMRT/VMAT vs. 3D-CRT), there were no differences in survival. IMRT/VMAT patients had higher RT doses and higher rates of intensified concomitant chemotherapy (cisplatin/vinorelbine vs. low-dose cisplatin). IMRT/VMAT was associated with a&#xa0;reduction in pneumonitis and dermatitis.</p> Conclusion <p>In summary, refined RT/RCT strategies with PET-CT and IMRT/VMAT enable the intensification of multimodal treatment. Reduction of toxicities with IMRT/VMAT widens the therapeutic window. The coincidence of intensified treatment, improved outcomes, and higher toxicity rates in PET-CT-staged patients emphasizes the need for a&#xa0;detailed risk–benefit assessment during planning and application of treatment modalities.</p>

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Treatment of non-small cell lung cancer: advances following the introduction of PET-CT and IMRT/VMAT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月6日

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  • Julian Muster,
  • Niklas Josua Alt,
  • Marcus Edelmann,
  • Mahalia Zoe Anczykowski,
  • Carla Marie Zwerenz,
  • Markus Anton Schirmer,
  • Tobias Raphael Overbeck,
  • Friederike Braulke,
  • Manuel Guhlich,
  • Rami El Shafie,
  • Stefan Rieken,
  • Martin Leu,
  • Leif Hendrik Dröge

摘要

Purpose

In definitive radiotherapy/radiochemotherapy (RT/RCT) for localized non-small cell lung cancer (NSCLC), the introduction of positron-emission tomography (PET)-CT-based staging/RT planning and dynamic RT techniques (intensity-modulated radiotherapy, IMRT/volumetric modulated arc therapy, VMAT) were important innovations.

Methods

We performed a retrospective study and compared clinical outcomes (1) in patients with PET-CT-based staging (n = 170) vs. conventional staging (n = 103) and (2) in patients with dynamic RT techniques (IMRT/VMAT; n = 99) vs. three-dimensional conformal radiotherapy (3D-CRT; n = 64).

Results

We found improved survival with PET-CT vs. conventional staging. PET-CT patients vs. conventionally staged patients had higher applied RT doses, higher RT completion rates, and a higher rate of patients who received RCT vs. RT only. Additionally, we found higher rates of leukopenia and lung infections in PET-CT patients. When comparing RT techniques (IMRT/VMAT vs. 3D-CRT), there were no differences in survival. IMRT/VMAT patients had higher RT doses and higher rates of intensified concomitant chemotherapy (cisplatin/vinorelbine vs. low-dose cisplatin). IMRT/VMAT was associated with a reduction in pneumonitis and dermatitis.

Conclusion

In summary, refined RT/RCT strategies with PET-CT and IMRT/VMAT enable the intensification of multimodal treatment. Reduction of toxicities with IMRT/VMAT widens the therapeutic window. The coincidence of intensified treatment, improved outcomes, and higher toxicity rates in PET-CT-staged patients emphasizes the need for a detailed risk–benefit assessment during planning and application of treatment modalities.