This is a prospective phase II study designed to evaluate an accelerated and adaptive RT
approach for locally-advanced non-small cell lung cancer (NSCLC). All eligible subjects will
have an interim PET-CT during radiation therapy to determine the metabolic complete response
rate. Radiation therapy will be given in an accelerated fashion (2 Gy/fraction, 6
fractions/week) with concurrent chemotherapy. Interim responses will be assessed using
PERCIST criteria.
Despite concurrent chemotherapy and radiation therapy, local/regional failure occurs in ~50%
of patients with locally-advanced NSCLC. Clinical studies have demonstrated that accelerated
fractionation (giving the same total dose in a shorter period of time) improves outcomes in
several malignancies, including lung cancer. Administering higher than conventional doses of
RT to all sites of original disease leads to inferior outcomes. Adapting the RT approach,
giving a higher dose to slowly responding disease as assessed with interim PET has been shown
to be feasible. PERCIST (Positron Emission Tomography Response Criteria in Solid Tumors)
provides guidelines on how to report responses to therapy based on PET-CT. PET-CT response
has been shown to be prognostic in a variety of clinical scenarios in lung cancer including
after induction therapy. In one study, PET was performed after neoadjuvant chemoradiotherapy
(40-50.4 Gy). Complete or partial metabolic response using PERCIST criteria was predictive of
loco-regional, distant, and overall progression-free survival.