Personalized Radiation Therapy—Spurning the “One Size Fits All” Approach
Mené entre 2011 et 2018 sur 217 patients atteints d'un cancer du poumon non à petites cellules (âge médian : 72 ans ; 59 % d'hommes ; durée médiane de suivi : 33 mois), cet essai multicentrique de phase II évalue l'efficacité, du point de vue du contrôle local, d'une radiochirurgie
Résumé en anglais
The concepts of personalized medicine and personalized oncology are steadily gaining steam in recent years. Yet, at times it may seem that personalized radiotherapy (RT) continues to lag, namely because RT dose/fractionation schemes continue to be relatively uniform and reflexive for many cancers. The article to which this invited commentary pertains, a nonrandomized phase 2 investigation of lung stereotactic ablative radiotherapy (SABR) conducted nearly exclusively at Stanford University, is an important step forward to personalize RT. The trial employed an individualized approach to lung SABR dose/fractionation regimens based on tumor volume, location, and histologic findings. This included the usage of less than 100 Gy10 biologically effective dose (BED, α/β = 10) regimens for small (≤10 cc) noncolorectal lesions, along with 112.5 Gy10 for small colorectal lesions or medium-sized (10-30 cc) lesions of any histologic type. For large (>30 cc) lesions, high (151.2 Gy10) BEDs were delivered for peripherally-situated disease, or hypofractionated ablative radiation therapy (HART, defined as ≥100 Gy10 BED in >5 fractions) for centrally located disease. This individualized strategy not only yielded high local control (LC) and low toxic effects, but also provides high-quality support for patients undergoing lung SABR to receive individualized dose/fractionation regimens based on tumor volume, location, and histology.
