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      How to integrate stereotactic body radiation therapy and hypofractionation in the management of stage III lung cancer in the age of immunotherapy Translated title: Cómo integrar la radioterapia estereotáxica fraccionada y el hipofraccionamiento en el manejo del cáncer de pulmón localmente avanzado en la era de la inmunoterapia

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          Abstract

          Abstract The constant advances in the field of lung cancer immunotherapy have recently reached the treatment of locally advanced disease with the approval of durvalumab after concurrent chemoradiation. However, radiation therapy continues to be key for controlling the disease at this stage. Over the years, different strategies have been employed to try to optimize outcomes using radiotherapy, with cardiac and pulmonary toxicity as the main limitation on its success. The interest in the use of hypofractionation and stereotactic body radiation therapy for stage III non-small cell lung cancer has increased as knowledge regarding these kinds of treatments has been enhanced. Hypofractionation is a relatively frequent treatment, although the level of evidence that supports it is limited. For its part, stereotactic body radiation therapy has been particularly studied as a boost after chemoradiation, with encouraging results. In both cases, study of how to integrate these tools with chemotherapy and particularly with immunotherapy is essential, as they may have an immunomodulatory role.

          Translated abstract

          Resumen Los constantes avances en el campo de la inmunoterapia en cáncer de pulmón se han visto reflejados en la aprobación de durvalumab para el tratamiento de la enfermedad localmente avanzada tras radioterapia y quimioterapia concurrente. Sin embargo, la radioterapia sigue siendo clave para el control de la enfermedad en este estadio. A lo largo de los años se han utilizado varias estrategias para tratar de optimizar su papel, siendo la toxicidad cardíaca y la pulmonar las principales barreras. En este contexto, el interés por el uso del hipofraccionamiento y la radioterapia estereotáxica fraccionada para el cáncer de pulmón no microcítico estadio III ha ido en aumento. El hipofraccionamiento es un tratamiento relativamente extendido aunque el nivel de evidencia que lo acompaña sea limitado. Por su parte, la radioterapia estereotáxica fraccionada se ha estudiado especialmente como una técnica para sobredosificar áreas concretas de la enfermedad tras el tratamiento con radioquimioterapia. En ambos casos, el estudio de cómo integrar estas herramientas radioterápicas con la quimioterapia, y especialmente con la inmunoterapia, es esencial, dado que pueden jugar además un papel inmunomodulador.

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          Most cited references48

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          The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer.

          The IASLC Staging and Prognostic Factors Committee has collected a new database of 94,708 cases donated from 35 sources in 16 countries around the globe. This has now been analysed by our statistical partners at Cancer Research And Biostatistics and, in close collaboration with the members of the committee proposals have been developed for the T, N, and M categories of the 8th edition of the TNM Classification for lung cancer due to be published late 2016. In this publication we describe the methods used to evaluate the resultant Stage groupings and the proposals put forward for the 8th edition.
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            Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC

            An earlier analysis in this phase 3 trial showed that durvalumab significantly prolonged progression-free survival, as compared with placebo, among patients with stage III, unresectable non-small-cell lung cancer (NSCLC) who did not have disease progression after concurrent chemoradiotherapy. Here we report the results for the second primary end point of overall survival.
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              Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up.

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                Author and article information

                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                August 2020
                : 43
                : 2
                : 225-234
                Affiliations
                [1] Pamplona orgnameComplejo Hospitalario de Navarra orgdiv1Oncological Radiotherapy Department
                Article
                S1137-66272020000200012 S1137-6627(20)04300200012
                10.23938/assn.0855
                34750595
                fcccd4bb-1a29-44fc-98b7-4d06025e9c18

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 08 October 2019
                : 23 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 48, Pages: 10
                Product

                SciELO Spain

                Categories
                Reviews

                Cáncer de pulmón,Inmunoterapia,Hypofractionation,Hipofraccionamiento,Immunotherapy,Lung cancer,SBRT

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