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    NEED TO CONFIRM GIRAUD DATA WHEN WE GET FULL PAPER
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    1. 1. Graphic courtesy of Dr. Damien Dupuy. Dupuy D. Radiofrequency ablation can destroy small lung tumors while avoiding the toxicity of thoracotomy or radiation. 42nd ASCO; June 2-6, 2006. Slide 14. Progression-Free Interval After RFAProgression-Free Interval After RFA of Lung Tumorsof Lung Tumors Size MattersSize Matters 100 80 60 40 20 0 0 12 24 36 48 60 72 ≤ 3 cm > 3 cm P = .0002 Progression-Free(%) Months Since Radiofrequency Ablation
    2. 2. Graphic courtesy of Dr. Damien Dupuy. Dupuy D. Radiofrequency ablation can destroy small lung tumors while avoiding the toxicity of thoracotomy or radiation. 42nd ASCO; June 2-6, 2006. Slide 14. Radiofrequency Ablation/RadiationRadiofrequency Ablation/Radiation Therapy in NSCLCTherapy in NSCLC Pre-RFA 2 Weeks Post-RFA 6 Months Post-RFA/XRT RFA = radiofrequency ablation; XRT = radiation therapy.
    3. 3. Copyright © Radiological Society of North America, 2005. Wang H, et al. Radiology. 2005;235:289-298. Before Cryotherapy After Cryotherapy CT Images During Cryotherapy and atCT Images During Cryotherapy and at Follow-Up for Treatment of SmallFollow-Up for Treatment of Small Pulmonary MassPulmonary Mass
    4. 4. Stereotactic Body Radiation TherapyStereotactic Body Radiation Therapy (SBRT) for NSCLC(SBRT) for NSCLC Graphic courtesy of Dr. Hak Choy.
    5. 5. BED = biological equivalent dose. Optimization of Radiation TherapyOptimization of Radiation Therapy Stereotactic Body Radiation TherapyStereotactic Body Radiation Therapy Indiana UniversityIndiana University11 JapanJapan22 ~88% ~68% 100 80 60 40 20 0 0 12 24 36 48 LocalTumorControl(%) Months from Therapy 100 80 60 40 20 0 0 1 2 3 4 5 6 7 Time (Years) P < .05 OverallSurvival(%) BED < 100 Gy (n = 23) BED ≥ 100 Gy (n = 64) 1. Adapted from Cancer, Vol. 101, 2004: 1623-1631. Copyright © 2004 American Cancer Society. This material is reproduced with permission of Wiley-Liss, Inc., a subsidiary of John Wiley & Sons, Inc. 2. Adapted from J Clin Oncol, 2006; 24: 4833, with permission from the American Society of Clinical Oncology.
    6. 6. Study Design PCI 20–30 Gy in 5–12 Fractions No PCI RandomAny response Stratification: performance score and institute <5 Weeks 4–6 Weeks No Response Chemotherapy (4–6 Cycles) Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357:664-672, 2007). Prophylactic Cranial Irradiation inProphylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung CancerExtensive-Disease Small-Cell Lung Cancer (EORTC 08993-22993)(EORTC 08993-22993)
    7. 7. 0 4 8 12 16 20 24 28 32 36 0 10 20 30 40 50 60 70 80 90 100 PCI Control 1 Year: 14.6% vs 40.4% HR: 0.27 (0.16–0.44) SymptomaticBrainMetastases(%) Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer Symptomatic Brain Metastases P < .001 Time Since Randomization (Months) Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357:664-672, 2007).
    8. 8. Time Since Randomization (Months) 0 4 8 12 16 20 24 28 32 36 0 10 20 30 40 50 60 70 80 90 100 PCI Control 1 Year: 27.1% vs 13.3% HR: 0.68 (0.52–0.88) OverallSurvival(%) Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer Overall Survival P = .003 Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357:664-672, 2007).
    9. 9. S T R A T I F Y R A N D O M I Z E RPA Class2 1 (<65 y and no extracranial cancer vs 2 (>65 y or extracranial metastases) Number of Brain Metastases2 1 vs 2/3 Extent of Extracranial Disease2 Yes vs no WBRT + SRS WBRT + SRS + Temozolomide WBRT + SRS + Erlotinib Eligibility1 NSCLC 1–3 brain metastases Max. lesion: 4 cm No brainstem metastases No actively progressing extracranial cancer x 1 month WBRT = whole brain radiation therapy; SRS = stereotactic radiosurgery; RPA = recursive partitioning analysis. 1. ClinicalTrials.gov Web site. http://www.clinicaltrials.gov/ct/show/NCT00096265?order=1. 2. Sperduto PW, et al. Slide 4. www.rtog.org/members/protocols/0320/0320Presentation.pdf. Phase III Trial of WBRT and SRSPhase III Trial of WBRT and SRS with Temozolomide or Erlotinibwith Temozolomide or Erlotinib RTOG 0320RTOG 0320
    10. 10. On multivariate analysis, PET response was a more significant predictor (P = .006) than Karnofsky performance status (P = .09) and weight loss (P = .14). N = 57 MacManus M, et al. 36th ASCO; May 20-23, 2000. Abstract 1888; Slide 22. Response to Chemoradiotherapy onResponse to Chemoradiotherapy on FDG-PET Correlates with SurvivalFDG-PET Correlates with Survival 100 80 60 40 20 0 0 3 9 15 48 EstimatedSurvival(%) Months Following PET Scan 2118126 CR PR NR/PD P = .0033 18% 53% 36% 84%84%
    11. 11. R E G I S T E R PP EE TT Concurrent chemotherapy/ radiation therapy (+/- adjuvant chemotherapy per MD) PET or PET-CT to be done 12–16 weeks following radiation therapyPET or PET-CT to be done 12–16 weeks following radiation therapy and at least 4 weeks after adjuvant chemotherapy (if given)and at least 4 weeks after adjuvant chemotherapy (if given) N = 250 PP EE TT Machtay M, et al. 2004. ACR Web site. p 3. http://www.acrin.org/files/protocol_docs/A6668partial_summary.pdf. Lung Cancer PET StudyLung Cancer PET Study ACRIN 6668/RTOG 0235 DesignACRIN 6668/RTOG 0235 Design
    12. 12. AuthorAuthor NN MethodMethod ImpactImpact HebertHebert11 2020 VisualVisual 6/206/20 KifferKiffer22 1515 VisualVisual 4/154/15 NestleNestle33 3434 VisualVisual 12/3412/34 MunleyMunley44 3535 VisualVisual 12/3512/35 VanuytselVanuytsel55 7373 DirectDirect 45/7345/73 GiraudGiraud66 1212 Image fusionImage fusion 5/125/12 BradleyBradley77 2626 Image fusionImage fusion 8/268/26 1. Hebert ME, et al. Am J Clin Oncol. 1996;19:416. 2. Kiffer JD, et al. Lung Cancer. 1998;19:167. 3. Nestle U, et al. Int J Radiat Oncol Biol Phys. 1999;44:593. 4. Munley MT, et al. Lung Cancer. 1999;23:105. 5. Vanuytsel LJ, et al. Radiother Oncol. 2000;55:317. 6. Giraud P, et al. Cancer Radiother. 2001;5:725. 7. Bradley J, et al. Int J Radiat Oncol Biol Phys. 2004;59:78. Impact of PET on Radiation TherapyImpact of PET on Radiation Therapy Volumes in Lung CancerVolumes in Lung Cancer

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