This webinar is pending approval from CAMPEP for 1 MPCEC hour and approved by ASRT for 1 category A credit.
Globally, unresectable stage III non-small cell lung cancer (NSCLC) accounts for 30% of NSCLC diagnoses. (1)
For this subset of patients, the current standard treatment consists of concurrent chemo-radiotherapy followed by consolidation with Durvalumab in patients with PD-L1≥1%, with remarkable advantages in terms of progression-free (PFS) and overall survival (OS) as reported in the practice-changing PACIFIC trial and validated in several real-world experiences. (2-4)
Nonetheless, despite the undeniable impact of consolidative immunotherapy, intrathoracic and local failures remain a major issue for unresectable stage III disease, leading clinicians to hypothesize new strategies to improve local control with radiotherapy.
The RTOG 0617 trial failed to demonstrate a potential benefit of radiotherapy dose escalation up to 74 Gy reporting no advantage in terms of local control (LC) and higher incidence of toxicity, compared to conventional 60 Gy arm. (5)
The constant technological progress and the consequent improvement in terms of accuracy for both RT planning and delivery have led clinicians to consider hypofractionation as a means to improve LC rates, and a recent metanalysis by Mauguen et al. reported an OS advantage when ≥2 Gy/fx are applied, either with sequential or concurrent chemotherapy. (6-8)
Consequently, based on the consolidated role of SBRT in the management of early-stage NSCLC, our scientific community is witnessing a growing interest in the use of stereotactic radiotherapy also for locally advanced disease.
The attractiveness of SBRT in this setting relies on a double advantage: from one perspective, very high doses are delivered in a short time with a lower exposure of nearby healthy structures, such as proximal bronchial tree, oesophagus, heart etc; secondly, SBRT may play a role of immuno-booster enhancing the effect of maintenance Durvalumab. (9)
Still, some caveats remain, as locally advanced disease usually involves mediastinal lymph nodes, and the use of SBRT in central and ultra-central disease is potentially related to a higher risk of severe toxicity.
In this webinar, we will explore the available literature data reporting the outcomes of moderate hypofractionation and extreme hypofractionation applied in the setting of locally advanced non-small cell lung cancer.
The educational aims of the webinar are the following:
1- provide an overview about the current state-of-the-art of radiotherapy for locally advanced non-small cell lung cancer
2- discuss and evaluate the role of moderate hypofractionation either in the sequential or concurrent chemoradiation setting
3- assess the potential role of extreme hypofractionation in this challenging scenario.
Presenter: Francesco Cuccia, M.D.
Consultant Radiation Oncologist, UOC Radioterapia Oncologica, ARNAS Civico Hospital, Palermo, Italy
Francesco Cuccia is a Consultant Radiation Oncologist at the Radiation Oncology Unit of the ARNAS Civico Hospital in Palermo. Since the residency period, he developed a long training with Helical TomoTherapy with a special focus on the implementation of stereotactic radiotherapy for lung malignancies, prostate cancer and oligometastatic disease.
In 2021-2023 he was involved in the Italian Study Group for Oligometastatic Disease on behalf of the Italian Association of Radiation Oncology (AIRO).
Since 2023, he is a Full Member of the ESTRO SBRT Focus Group and at a national level, of the Italian Study Group for Thoracic Oncology on behalf of AIRO.
In 2024, he has been involved in the development of ESTRO guidelines for spine SBRT and is currently working on other ESTRO-ISRS projects.
Moderator: Todd Carpenter, M.D.
Associate Director of Clinical Operations, Radiation Oncology, NYU Langone Hospital- Long Island, New York, USA
Dr. Todd J. Carpenter is a radiation oncologist in New York. He received his medical degree from the State University of New York Downstate Medical Center College of Medicine and completed his residency at Icahn School of Medicine at Mount Sinai, Radiation Oncology in 2015.
Dr. Carpenter is an internationally recognized user of the CyberKnife® System and is extensively involved in research furthering the application of stereotactic and image-guided radiotherapy and has published several articles.
References
1. Giaj-Levra N, Borghetti P, Bruni A, Ciammella P, Cuccia F, Fozza A, Franceschini D, Scotti V, Vagge S, Alongi F. Current radiotherapy techniques in NSCLC: challenges and potential solutions. Expert Rev Anticancer Ther. 2020 May;20(5):387-402. doi: 10.1080/14737140.2020.1760094.
2. Filippi AR, Bar J, Chouaid C, Christoph DC, Field JK, Fietkau R, Garassino MC, Garrido P, Haakensen VD, Kao S, Markman B, McDonald F, Mornex F, Moskovitz M, Peters S, Sibille A, Siva S, van den Heuvel M, Vercauter P, Anand S, Chander P, Licour M, de Lima AR, Qiao Y, Girard N. Real-world outcomes with durvalumab after chemoradiotherapy in patients with unresectable stage III NSCLC: interim analysis of overall survival from PACIFIC-R. ESMO Open. 2024 Jun;9(6):103464. doi: 10.1016/j.esmoop.2024.103464.
3. Bruni A, Scotti V, Borghetti P, Vagge S, Cozzi S, D’Angelo E, Giaj Levra N, Fozza A, Taraborrelli M, Piperno G, Vanoni V, Sepulcri M, Trovò M, Nardone V, Lattanzi E, Bou Selman S, Bertolini F, Franceschini D, Agustoni F, Jereczek-Fossa BA, Magrini SM, Livi L, Lohr F, Filippi AR. A Real-World, Multicenter, Observational Retrospective Study of Durvalumab After Concomitant or Sequential Chemoradiation for Unresectable Stage III Non-Small Cell Lung Cancer. Front Oncol. 2021 Sep 28;11:744956. doi: 10.3389/fonc.2021.744956. Erratum in: Front Oncol. 2021 Nov 16;11:802949. doi: 10.3389/fonc.2021.802949.
4. Park JE, Hong KS, Choi SH, Lee SY, Shin KC, Jang JG, Kwon YS, Park SH, Choi KJ, Jung CY, Eom JS, Kim S, Seol HY, Kim J, Kim I, Park JH, Kim TH, Ahn JH. Durvalumab Consolidation After Chemoradiotherapy in Elderly Patients With Unresectable Stage III NSCLC: A Real-World Multicenter Study. Clin Lung Cancer. 2024 Jun;25(4):354-364. doi: 10.1016/j.cllc.2024.02.006
5. Bradley JD, Hu C, Komaki RR, Masters GA, Blumenschein GR, Schild SE, Bogart JA, Forster KM, Magliocco AM, Kavadi VS, Narayan S, Iyengar P, Robinson CG, Wynn RB, Koprowski CD, Olson MR, Meng J, Paulus R, Curran WJ Jr, Choy H. Long-Term Results of NRG Oncology RTOG 0617: Standard- Versus High-Dose Chemoradiotherapy With or Without Cetuximab for Unresectable Stage III Non-Small-Cell Lung Cancer. J Clin Oncol. 2020 Mar 1;38(7):706-714. doi: 10.1200/JCO.19.01162.
6. Mauguen A, Le Pechoux C, Saunders MI, et al. Hyperfractionated or accelerated radiotherapy in lung cancer: An individual patient data meta-analysis. J Clin Oncol 2012;30:2788-2797.
7. Patibandla A, Featherstone C, Maclaren V, Lumsden G, Harrow S, Jones R, Chalmers AJ, McLoone P, Hicks J. Hypofractionated Accelerated Concurrent Chemoradiotherapy in Inoperable Stage III Non-small Cell Lung Cancer: SOCCAR. A Large Single-Centre Experience. Clin Oncol (R Coll Radiol). 2020 Oct;32(10):e211. doi: 10.1016/j.clon.2020.06.006.
8. Maguire J, Khan I, McMenemin R, O’Rourke N, McNee S, Kelly V, Peedell C, Snee M. SOCCAR: A randomised phase II trial comparing sequential versus concurrent chemotherapy and radical hypofractionated radiotherapy in patients with inoperable stage III Non-Small Cell Lung Cancer and good performance status. Eur J Cancer. 2014 Nov;50(17):2939-49. doi: 10.1016/j.ejca.2014.07.009.
9. Miljanic M, Montalvo S, Aliru M, Song T, Leon-Camarena M, Innella K, Vujovic D, Komaki R, Iyengar P. The Evolving Interplay of SBRT and the Immune System, along with Future Directions in the Field. Cancers (Basel). 2022 Sep 19;14(18):4530. doi: 10.3390/cancers14184530.
