The Radiotherapy: Basic Concepts And Recent Techniques Advances For Thoracic Malignancies
DOI:
https://doi.org/10.48729/pjctvs.355Keywords:
radiotherapy, lung cancerAbstract
Radiation therapy (RT) is a clinical modality treatment that uses ionizing radiation in the approach of malignant tumors, (and occasionally benign diseases). Since its inception, the goal of RT has been to cure cancer without excessive side effects. The most important factors affecting the results of RT are the tumor histology, its location and regional extent, the anatomic area of involvement and the geometric accuracy with which a calculated radiation dose is delivered. Radiotherapy is one of the basic treatment modalities in thoracic malignancies and is used across all histology types and stages. Technical developments of radiotherapy have further strengthened and redefined its place in the management of lung cancer. High precision intensity-modulated radiation therapy, volumetric modulated arc therapy, and stereotactic body radiation therapy (SBRT), coupled with management of tumor motion and on-board imaging, increased efficacy and markedly decreased treatment-related toxicity. With this brief review, the authors pretend to present basic concepts and recent techniques advances in the use of radiation therapy for thoracic malignancies.
Downloads
References
Finazzi T, Schneiders FL, Senan S. Developments in radiation techniques for thoracic malignancies. European Respiratory Review [Internet]. 2021 Jun 30 [cited 2023 Feb 28];30(160). Available from: https://err.ersjournals. com/content/30/160/200224
Cella L, Palma G. Radiation Therapy in Thoracic Tumors: Recent Trends and Current Issues. Cancers 2022, Vol 14, Page 2706 [Internet]. 2022 May 30 [cited 2023 Feb 28];14(11):2706. Available from: https://www.mdpi. com/2072-6694/14/11/2706/htm
Daguenet E, Khalifa J, Tolédano A, Borchiellini D, Pointreau Y, Rodriguez-Lafrasse C, et al. To exploit the 5 “R” of radiobiology and unleash the 3 “E” of immunoediting: ’RE’-inventing the radiotherapy-immunotherapy combination. Ther Adv Med Oncol [Internet]. 2020 [cited 2023 Feb 28];12. Available from: https://pubmed.ncbi.nlm.nih. gov/32426043/
Burnette B, Weichselbaum RR. Radiation as an immune modulator. Semin Radiat Oncol [Internet]. 2013 Oct [cited 2023 Feb 28];23(4):273–80. Available from: https:// pubmed.ncbi.nlm.nih.gov/24012341/
Yi BSK, Perks J, Houston R, Stern R, Purdy JA, Chen AM. Changes in position and volume of lung cancer target volumes during stereotactic body radiotherapy (SBRT): is image guidance necessary? Technol Cancer Res Treat [Internet]. 2011 [cited 2023 Feb 28];10(5):495–504. Available from: https://pubmed.ncbi.nlm.nih.gov/21895034/
Qiu B, Aili A, Xue L, Jiang P, Wang J. Advances in Radiobiology of Stereotactic Ablative Radiotherapy. Front On- col [Internet]. 2020 Aug 7 [cited 2023 Feb 28];10:1165. Available from: /pmc/articles/PMC7426361/
Tubin S, Popper HH, Brcic L. Novel stereotactic body radiation therapy (SBRT)-based partial tumor irradiation targeting hypoxic segment of bulky tumors (SBRT-PATHY): improvement of the radiotherapy outcome by exploiting the bystander and abscopal effects. Radiat Oncol [In- ternet]. 2019 Jan 29 [cited 2023 Feb 28];14(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30696472/
ICRU Report 62, Prescribing, Recording and Reporting Photon Beam Therapy (Supplement to ICRU 50) – ICRU [Internet]. [cited 2023 Feb 28]. Available from: https://www.icru.org/report/prescribing-recording-and-reporting-photon-beam-therapy-report-62/
ICRU Report 83, Prescribing, Recording, and Reporting Intensity-Modulated Photon-Beam Therapy (IMRT) – ICRU [Internet]. [cited 2023 Feb 28]. Available from: https://www.icru.org/report/prescribing-recording-and-reporting-intensity-modulated-photon-beam-therapy-imrticru-report-83/
Pollom EL, Chin AL, Diehn M, Loo BW, Chang DT. Normal Tissue Constraints for Abdominal and Thoracic Stereo- tactic Body Radiotherapy. Semin Radiat Oncol [Internet]. 2017 Jul 1 [cited 2023 Feb 28];27(3):197–208. Available from: https://pubmed.ncbi.nlm.nih.gov/28577827/
Chun SG, Hu C, Choy H, Komaki RU, Timmerman RD, Schild SE, et al. Impact of Intensity-Modulated Radiation Therapy Technique for Locally Advanced Non-Small-Cell Lung Cancer: A Secondary Analysis of the NRG Oncology RTOG 0617 Randomized Clinical Trial. J Clin Oncol [Inter- net]. 2017 Jan 1 [cited 2023 Feb 28];35(1):56–62. Available from: https://pubmed.ncbi.nlm.nih.gov/28034064/
Vinod SK, Hau E. Radiotherapy treatment for lung can- cer: Current status and future directions. Respirology [Internet]. 2020 Nov 1 [cited 2023 Feb 28];25(S2):61– 71. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13870
Chan C, Lang S, Rowbottom C, Guckenberger M, Faivre-Finn C. Intensity-modulated radiotherapy for lung cancer: current status and future developments. J Thorac Oncol [Internet]. 2014 Nov 1 [cited 2023 Feb 28];9(11):1598–608. Available from: https://pubmed. ncbi.nlm.nih.gov/25436795/
Silva SR, Surucu M, Steber J, Harkenrider MM, Choi M. Clinical Application of a Hybrid RapidArc Radiotherapy Technique for Locally Advanced Lung Cancer. Technol Cancer Res Treat [Internet]. 2017 Apr 1 [cited 2023 Feb 28];16(2):224–30. Available from: https://pubmed.ncbi. nlm.nih.gov/27680023/
Tsurugai Y, Takeda A, Sanuki N, Eriguchi T, Aoki Y, Oku Y, et al. Stereotactic body radiotherapy for patients with non-small-cell lung cancer using RapidArc delivery and a steep dose gradient: prescription of 60% isodose line of maximum dose fitting to the planning target volume. J Radiat Res [Internet]. 2019 May 1 [cited 2023 Feb 28];60(3):364–70. Available from: https://pubmed.ncbi. nlm.nih.gov/30668868/
Blom GJ, Verbakel WFAR, Dahele MAX, Hoffmans D, Slotman BJ, Senan S. Improving radiotherapy planning for large volume lung cancer: A dosimetric compari- son between hybrid-IMRT and RapidArc. http://dx.doi.org/103109/0284186X2014963888 [Internet]. 2015 Mar 1 [cited 2023 Feb 28];54(3):427–32. Available from: https://www.tandfonline.com/doi/abs/10.3109/028418 6X.2014.963888
Bradley JD, Hu C, Komaki RR, Masters GA, Blumenschein GR, Schild SE, et al. 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 [Internet]. 2020 Mar 1 [cited 2023 Feb 28];38(7):706–14. Avail- able from: https://pubmed.ncbi.nlm.nih.gov/31841363/
Shafiq J, Hanna TP, Vinod SK, Delaney GP, Barton MB. A Population-based Model of Local Control and Survival Benefit of Radiotherapy for Lung Cancer. Clin Oncol (R Coll Radiol) [Internet]. 2016 Oct 1 [cited 2023 Feb 28];28(10):627–38. Available from: https://pubmed.ncbi. nlm.nih.gov/27260488/
Senthi S, Haasbeek CJA, Slotman BJ, Senan S. Outcomes of stereotactic ablative radiotherapy for central lung tu- mours: a systematic review. Radiother Oncol [Internet]. 2013 [cited 2023 Feb 28];106(3):276–82. Available from: https://pubmed.ncbi.nlm.nih.gov/23462705/
Simone CB, Bogart JA, Cabrera AR, Daly ME, DeNunzio NJ, Detterbeck F, et al. Radiation Therapy for Small Cell Lung Cancer: An ASTRO Clinical Practice Guideline. PractRadiat Oncol [Internet]. 2020 May 1 [cited 2023 Feb 28];10(3):158–73. Available from: https://pubmed.ncbi. nlm.nih.gov/32222430/
Kong FM, Lally BE, Chang JY, Chetty IJ, Decker RH, Gins- burg ME, et al. ACR appropriateness criteria® radiation therapy for small-cell lung cancer. American Journal of Clinical Oncology: Cancer Clinical Trials [Internet]. 2013 Apr [cited 2023 Feb 28];36(2):206–13. Available from: https://journals.lww.com/amjclinicaloncology/Full- text/2013/04000/ACR_Appropriateness_Criteria__Radi- ation_Therapy.18.aspx
Bezjak A, Paulus R, Gaspar LE, Timmerman RD, Straube WL, William ;, et al. Safety and Efficacy of a Five-Fraction Stereotactic Body Radiotherapy Schedule for Centrally Located Non-Small-Cell Lung Cancer: NRG Oncology/ RTOG 0813 Trial [Internet]. Vol. 37, J Clin Oncol. 2019. Available from: https://doi.org/10.
Higgins KA, Pillai RN, Chen Z, Tian S, Zhang C, Patel P, et al. Concomitant Chemotherapy and Radiotherapy with SBRT Boost for Unresectable Stage III Non-Small Cell
Lung Cancer: A Phase I Study. J Thorac Oncol [Internet]. 2017 Nov 1 [cited 2023 Feb 28];12(11):1687–95. Available from: https://pubmed.ncbi.nlm.nih.gov/28919394/
Hepel JT, Leonard KL, Safran H, Ng T, Taber A, Khurshid H, et al. Stereotactic Body Radiation Therapy Boost After Concurrent Chemoradiation for Locally Advanced NonSmall Cell Lung Cancer: A Phase 1 Dose Escalation Study. Int J Radiat Oncol Biol Phys [Internet]. 2016 Dec 1 [cited 2023 Feb 28];96(5):1021–7. Available from: https://pubmed.ncbi.nlm.nih.gov/27745983/
Watanabe S, Yamazaki H, Kimoto T, Shiomi H, Yamada K, Suzuki G. Potential benefit of dose-escalated stereo- tactic body radiation therapy using CyberKnife for early-stage primary lung cancer. Asia Pac J Clin Oncol [Internet]. 2022 [cited 2023 Feb 28]; Available from: https://pubmed.ncbi.nlm.nih.gov/36085553/
WangB,DongY,YuX,LiF,WangJ,ChenH,etal.Safety and Efficacy of Stereotactic Ablative Radiotherapy for Ultra-Central Lung Cancer. Front Oncol [Internet]. 2022 Apr 29 [cited 2023 Feb 28];12. Available from: https://pubmed.ncbi.nlm.nih.gov/35600391/
Crockett CB, Samson P, Chuter R, Dubec M, Faivre-Finn C, Green OL, et al. Initial Clinical Experience of MR-Guid- ed Radiotherapy for Non-Small Cell Lung Cancer. Front Oncol [Internet]. 2021 Mar 10 [cited 2023 Feb 28];11. Available from: /pmc/articles/PMC7988221/
Park JM, Wu HG, Kim HJ, Choi CH, Kim JI. Comparison of treatment plans between IMRT with MR-linac and VMAT for lung SABR. Radiation Oncology [Internet]. 2019 Jun 13 [cited 2023 Feb 28];14(1):1–8. Available from: https:// ro-journal.biomedcentral.com/articles/10.1186/s13014-019-1314-0
Giraud P, Houle A. Respiratory Gating for Radiotherapy: Main Technical Aspects and Clinical Benefits. ISRN Pulm- onol. 2013 Mar 19;2013:1–13.
Wang Z, Kong QT, Li J, Wu XH, Li B, Shen ZT, et al. Clinical outcomes of cyberknife stereotactic radiosurgery for lung metastases. J Thorac Dis [Internet]. 2015 [cit- ed 2023 Feb 28];7(3):407. Available from: /pmc/articles/ PMC4387394/
Ashworth A, Rodrigues G, Boldt G, Palma D. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer [Inter- net]. 2013 Nov [cited 2023 Feb 28];82(2):197–203. Available from: https://pubmed.ncbi.nlm.nih.gov/24051084/
Gomez DR, Blumenschein GR, Lee JJ, Hernandez M, Ye R, Camidge DR, et al. Local Consolidative Therapy versus Maintenance Therapy/Observation for Patients with Oligometastatic Non-Small Cell Lung Cancer without Progression after Front-Line Systemic Thera- py: Results of a Multi-Institutional Phase II Randomized Study. Lancet Oncol [Internet]. 2016 Dec 1 [cited 2023 Feb 28];17(12):1672. Available from: /pmc/articles/ PMC5143183/
Palma DA, Olson R, Harrow S, Gaede S, Louie A v., Haasbeek C, et al. Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastatic Cancers:
Long-Term Results of the SABR-COMET Phase II Randomized Trial. Journal of Clinical Oncology [Internet]. 2020 Sep 9 [cited 2023 Feb 28];38(25):2830. Available from: / pmc/articles/PMC7460150/
Palma DA, Olson R, Harrow S, Correa RJM, Schneiders F, Haasbeek CJA, et al. Stereotactic ablative radiothera- py for the comprehensive treatment of 4–10 oligomet- astatic tumors (SABR-COMET-10): study protocol for a randomized phase III trial. BMC Cancer [Internet]. 2019 Aug 19 [cited 2023 Feb 28];19(1). Available from: /pmc/ articles/PMC6699121/
Rodrigues G, Videtic GMM, Sur R, Bezjak A, Bradley J, Hahn CA, et al. Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline. PractRadiatOncol [Internet]. 2011 Apr [cited 2023 Feb 28];1(2):60. Available from: /pmc/articles/PMC3808743/
Lewis TS, Kennedy JA, Price GJ, Mee T, Woolf DK, Bayman NA, et al. Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival? Clin Oncol (R Coll Radiol) [Internet]. 2020 Oct 1 [cited 2023 Feb 28];32(10):674. Available from: /pmc/articles/PMC7492742/
Dehing-Oberije C, Ruysscher D de, Baardwijk A van, Yu S, Rao B, Lambin P. The importance of patient characteristics for the prediction of radiation-induced lung toxicity. Radiother Oncol [Internet]. 2009 Jun [cited 2023 Feb 28];91(3):421–6. Available from: https://pubmed.ncbi. nlm.nih.gov/19147245/
Käsmann L, Dietrich A, Staab-Weijnitz CA, Manapov F, Behr J, Rimner A, et al. Radiation-induced lung toxicity - cellular and molecular mechanisms of pathogenesis, management, and literature review. Radiat Oncol [Internet]. 2020 Sep 10 [cited 2023 Feb 28];15(1). Available from: https://pubmed.ncbi.nlm.nih.gov/32912295/
Meng J, Li Y, Wan C, Sun Y, Dai X, Huang J, et al. Targeting senescence-like fibroblasts radiosensitizes non-small cell lung cancer and reduces radiation-induced pulmonary fibrosis. JCI Insight [Internet]. 2021 Dec 8 [cited 2023 Feb 28];6(23). Available from: https://pubmed. ncbi.nlm.nih.gov/34877934/
Simone CB. Thoracic Radiation Normal Tissue Injury. Semin Radiat Oncol. 2017 Oct 1;27(4):370–7.
Chargari C, Riet F, Mazevet M, Morel É, Lepechoux C, Deutsch É. Complications of thoracic radiotherapy. Presse Med [Internet]. 2013 [cited 2023 Feb 28];42(9 Pt 2). Available from: https://pubmed.ncbi.nlm.nih.gov/23972736/
Inoue A, Kunitoh H, Sekine I, Sumi M, Tokuuye K, Saijo N. Radiation pneumonitis in lung cancer patients: a ret- rospective study of risk factors and the long-term prog- nosis. International Journal of Radiation Oncology*Biology*Physics. 2001 Mar 1;49(3):649–55.
Choi NC, Kanarek DJ. Toxicity of thoracic radiotherapy on pulmonary function in lung cancer. Lung Cancer [Inter- net]. 1994 Mar 1 [cited 2023 Feb 28];10(SUPPL. 1):S219– 30. Available from: http://www.lungcancerjournal.info/ article/0169500294916853/fulltext
Murro D, Jakate S. Radiation esophagitis. Arch Pathol Lab Med [Internet]. 2015 Jun 1 [cited 2023 Feb 28];139(6):827–30. Available from: https://pubmed.ncbi.nlm.nih.gov/26030254/
Mohamed AA, Lu XL, Mounmin FA. Diagnosis and Treatment of Esophageal Candidiasis: Current Updates. Can J Gastroenterol Hepatol [Internet]. 2019 [cited 2023 Feb 28];2019. Available from: https://pubmed.ncbi.nlm.nih. gov/31772927/
Hanania AN, Mainwaring W, Ghebre YT, Hanania NA, Ludwig M. Radiation-Induced Lung Injury: Assessment and Management. Chest [Internet]. 2019 Jul 1 [cited 2023 Feb 28];156(1):150–62. Available from: https:// pubmed.ncbi.nlm.nih.gov/30998908/
Arroyo-Hernández M, Maldonado F, Lozano-Ruiz F, Muñoz-Montaño W, Nuñez-Baez M, Arrieta O. Radiation-induced lung injury: current evidence. BMC PulmMed [Internet]. 2021 Dec 1 [cited 2023 Feb 28];21(1). Available from: https://pubmed.ncbi.nlm.nih. gov/33407290/
Lee CB, Stinchcombe TE, Moore DT, Morris DE, Hayes DN, Halle J, et al. Late complications of high-dose (>/=66 Gy) thoracic conformal radiation therapy in combined mo- dality trials in unresectable stage III non-small cell lung cancer. J Thorac Oncol [Internet]. 2009 [cited 2023 Feb 28];4(1):74–9. Available from: https://pubmed.ncbi.nlm. nih.gov/19096310/
Hoppe BS, Laser B, Kowalski A v., Fontenla SC, Pena-Greenberg E, Yorke ED, et al. Acute skin toxicity following stereotactic body radiation therapy for stage I non-small-cell lung cancer: who’s at risk? Int J Radiat Oncol Biol Phys [Internet]. 2008 Dec 1 [cited 2023 Feb 28];72(5):1283–6. Available from: https://pubmed.ncbi.nlm.nih.gov/19028267/
Huang CJ, Hou MF, Luo KH, Wei SY, Huang MY, Su SJ, et al. RTOG, CTCAE and WHO criteria for acute radiation dermatitis correlate with cutaneous blood flow mea- surements. Breast [Internet]. 2015 Jun 1 [cited 2023 Feb 28];24(3):230–6. Available from: https://pubmed.ncbi. nlm.nih.gov/25777626/
Downloads
Published
How to Cite
License
Copyright (c) 2023 Portuguese Journal of Cardiac Thoracic and Vascular Surgery
This work is licensed under a Creative Commons Attribution 4.0 International License.
