Less is more in radiotherapy target volume planning: lessons from the PET-plan trial.,The Lancet Oncology

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Less is more in radiotherapy target volume planning: lessons from the PET-plan trial.
The Lancet Oncology ( IF 41.6 ) Pub Date : 2020-03-12 , DOI: 10.1016/s1470-2045(20)30108-x
Corinne Faivre-Finn ₁

Affiliation

In The Lancet Oncology, Ursula Nestle and colleagues report a randomised, controlled trial of image-based radiotherapy target volumes for patients with stage II–III non-small-cell lung cancer. Patients suitable for concurrent chemoradiotherapy were randomly assigned to a target volume informed by ¹⁸F-fluorodeoxyglucose ( ¹⁸F-FDG) PET and CT plus elective nodal irradiation or by ¹⁸F-FDG-PET alone without elective nodal irradiation. In both groups, the dose of radiation was escalated (60–74 Gy, 2 Gy per fraction) and prescribed for each individual patient on the basis of predefined normal tissue constraints (the concept of isotoxic radiotherapy). The study used a non-inferiority design with a primary endpoint of time to locoregional progression from randomisation. It can be concluded from this study that target volume reduction based on ¹⁸F-FDG PET alone was not inferior to traditional large volume radiotherapy with elective nodal irradiation with regard to locoregional control, with a suggestion of improvement in locoregional control; allowed further escalation of the radiation dose; and was not associated with a substantial reduction or increase in toxicity. However, given the design and results of the study, it is not possible to draw conclusions on the superiority of the target volume reduction strategy with regard to locoregional control or survival; the impact of the isotoxic dose escalation; or the association between study endpoints and dose-volume histograms (particularly heart dose). In view of the result of this study, target volume reduction based on ¹⁸F-FDG PET alone could be considered standard of care. International guidelines already recommend the omission of elective nodal irradiation guided by ¹⁸F-FDG PET/CT in locally advanced non-small-cell lung cancer, making this study practice confirming. ^,

中文翻译：

放疗目标量计划中的少即是多：PET计划试验提供的经验教训。

Ursula Nestle及其同事在《柳叶刀肿瘤》杂志上报告了一项针对II-III期非小细胞肺癌患者的基于图像的放射治疗目标量的随机对照试验。适用于同时放化疗的患者被随机分配至¹⁸ F-氟脱氧葡萄糖（¹⁸ F-FDG）PET和CT加上选择性淋巴结照射或¹⁸单独使用F-FDG-PET，无选择性节点照射。在两组中，放射剂量均逐步提高（60-74 Gy，每部分2 Gy），并根据预定义的正常组织约束（等毒放疗的概念）为每位患者开出处方。该研究采用了非劣效性设计，其主要终点是从随机化到局部进展的时间。从这项研究可以得出结论，基于¹⁸就局部区域控制而言，仅F-FDG PET并不逊色于传统的大剂量放疗和择期淋巴结照射，这提示局部区域控制有所改善。允许进一步增加辐射剂量；并且与毒性的大幅降低或增加无关。但是，鉴于研究的设计和结果，不可能就目标体积减少战略在局部控制或生存方面的优势得出结论。等毒性剂量增加的影响；或研究终点与剂量-体积直方图（尤其是心脏剂量）之间的关联。根据这项研究的结果，基于¹⁸单独使用F-FDG PET可以被视为护理标准。国际指南已经建议在局部晚期非小细胞肺癌中省略¹⁸ F-FDG PET / CT引导的选择性淋巴结照射，这一研究实践得到了证实。^，

更新日期：2020-03-31

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