Concurrent radiation therapy and chemotherapy, known as chemoradiation, is a common treatment for locally advanced cancers. Adding concurrent chemotherapy can improve the effectiveness of radiation therapy but can also enhance the appearance of toxic side effects. This means that some cancer patients, especially those with comorbidities or poor health status, are ineligible for concurrent chemoradiation. Researchers at Baylor Scott & White Research Institute (BSWRI) are contributing to critical clinical trials to improve the effectiveness of radiation therapy for cancer patients, including those who are not eligible for concurrent chemoradiation.
One of these researchers is Mehul Patel, MD, the section chief for radiation oncology and a radiation oncologist at Baylor Scott & White Medical Center – Round Rock and Baylor Scott & White Medical Center – Temple. In a recent study, Dr. Patel and colleagues tested whether delivery of hypofractionated image-guided radiotherapy (IGRT), in place of conventionally fractionated radiotherapy (CFRT), could improve outcomes for patients with non-small-cell lung cancer who are not candidates for concurrent chemoradiation. Using IGRT can reduce the amount of healthy tissue exposed to radiation and permit a higher radiation dose to be delivered in each session.
The results of this Phase 3 randomized trial were published in JAMA Oncology in August 2021. The multicenter trial, which included 103 patients in 9 cancer centers across Texas, found no difference in the primary endpoint of 1-year overall survival for those receiving IGRT (60 Gy in 15 fractions) compared to those receiving CFRT (60 Gy in 30 fractions) (37.7% vs. 44.6% for IGRT and CFRT, respectively). They also found no difference in the other endpoints, including progression-free survival and appearance of toxic effects of grade 3 or higher.
Although this study did not show a benefit of IGRT, it is part of a larger program to optimize advanced radiation techniques for patients who are poor candidates for concurrent chemoradiation. As the largest study of its kind, it demonstrates the potential for high accrual in radiation oncology studies for NSCLC. Furthermore, exploratory analyses revealed interesting trends that could form the basis of future studies. For instance, the IGRT group reported more grade 2 toxic effects, which may have contributed to the lack of improvement. The researchers note that favorable outcomes from IGRT have been observed in other studies, and further treatment modifications, such as the addition of immunotherapy, may lead to a radiation regimen that is effective and well-tolerated.
Dr. Patel’s radiation oncology research is just one of the nearly 2,000 clinical studies at BSWRI sites in North and Central Texas. The Baylor Scott & White Central Texas Accelerating Oncology Research Network (ACORN) links research hospitals throughout Central Texas into a collaborative network to facilitate clinical trials and reach out to a diverse population of Texans spread across a large geographic region. The ACORN leverages the infrastructure available through BSWRI, including clinical trials staffing, regulatory support, and data management. All of this takes place in the Baylor Scott & White Health System, the largest not-for-profit healthcare system in Texas and one of the largest in the US.