{"doi":"10.1200/jco.24.00022","title":"Primary Results of NRG-RTOG1106/ECOG-ACRIN 6697: A Randomized Phase II Trial of Individualized Adaptive (chemo)Radiotherapy Using Midtreatment <sup>18</sup> F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Stage III Non–Small Cell Lung Cancer","abstract":"PURPOSE NRG-RTOG0617 demonstrated a detrimental effect of uniform high-dose radiation in stage III non–small cell lung cancer. NRG-RTOG1106/ECOG-ACRIN6697 (ClinicalTrials.gov identifier: NCT01507428 ), a randomized phase II trial, studied whether midtreatment 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) can guide individualized/adaptive dose-intensified radiotherapy (RT) to improve and predict outcomes in patients with this disease. MATERIALS AND METHODS Patients fit for concurrent chemoradiation were randomly assigned (1:2) to standard (60 Gy/30 fractions) or FDG-PET–guided adaptive treatment, stratified by substage, primary tumor size, and histology. All patients had midtreatment FDG-PET/CT; adaptive arm patients had an individualized, intensified boost RT dose to residual metabolically active areas. The primary therapeutic end point was 2-year centrally reviewed freedom from local-regional progression (FFLP), defined as no progression in or near the planning target volume and/or regional nodes. FFLP was analyzed on a modified intent-to-treat population at a one-sided Z -test significance level of 0.15. The primary imaging end point was centrally reviewed change in SUV peak from baseline to midtreatment; its association with FFLP was assessed using the two-sided Wald test on the basis of Cox regression. RESULTS Of 138 patients enrolled, 127 were eligible. Adaptive-arm patients received a mean 71 Gy in 30 fractions, with mean lung dose 17.9 Gy. There was no significant difference in centrally reviewed 2-year FFLP (59.5% and 54.6% in standard and adaptive arms; P = .66). There were no significant differences in protocol-specified grade 3 toxicities, survival, or progression-free survival ( P &gt; .4). Median SUV peak and metabolic tumor volume (MTV) in the adaptive arm decreased 49% and 54%, from pre-RT to mid-RT PET. However, ΔSUV peak and ΔMTV were not associated with FFLP (hazard ratios, 0.997; P = .395 and .461). CONCLUSION Midtreatment PET-adapted RT dose escalation as given in this study was safe and feasible but did not improve efficacy outcomes.","journal":"Journal of Clinical Oncology","year":2024,"id":419671,"datarank":1.108800987918964,"base_score":3.6888794541139363,"endowment":3.6888794541139363,"self_citation_contribution":0.5533319181170905,"citation_network_contribution":0.5554690698018736,"self_endowment_contribution":0.5533319181170905,"citer_contribution":0.5554690698018736,"corpus_percentile":null,"corpus_rank":null,"citation_count":39,"citer_count":37,"citers_with_citation_signal":19,"citers_with_endowment":19,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9499,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT01507428"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":257981,"name":"Chen Hu","orcid":"0000-0003-4672-1981","position":1,"is_corresponding":false},{"id":332201,"name":"Daniel A. 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