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“Lessons learned” from the ongoing MGH/MDACC Phase III
NSCLC trial (approx. 150 patients presently accrued)
➢
peer review of contours is critical;
➢
image guidance with daily kV imaging and weekly CT scans is very important;
➢
modifications to treatment plans to adapt to changes in tumor or anatomy were
needed in
20% of IMRT cases and 55% of proton cases*
➢
~ 70% of all patients could be randomized, and among the randomized patients,
75% were at 74 Gy (RBE) and 25% at 66 Gy (RBE) dose levels;
➢
among patients for whom the plan could not meet the stipulated dose constraints,
the modality that achieved higher target dose without violating dose-volume
constraints was used to deliver the treatment
➢
the rate of treatment interruption or incompletion has been extremely low.
➢
early findings suggest that the outcomes in both the IMRT and proton groups
are better than those of historical controls
.
*Note: personal experience only about 10%