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Open Access 20-07-2022 | Radiotherapy | Original Article

The tumor core boost study: A feasibility study of radical dose escalation to the central part of large tumors with an integrated boost in the palliative treatment setting

Authors: Olaf Wittenstein, Fabian Krause, Mirko Fischer, Justus Domschikowski, Mirko Nitsche, Christoph Henkenberens, Daniel Habermehl, Juergen Dunst

Published in: Strahlentherapie und Onkologie | Issue 3/2023

Abstract

Purpose

For patients with large tumors palliative radiotherapy often is the only local treatment option. To prevent toxicity the administered doses are low. Dose escalation to the tumor could be an option to better smyptom control and prolong local control rates. In this prospective study we used a very pragmatic approach with a simultaneously integrated boost (SIB) to an almost geometrically defined tumor core to achieve this. The primary endpoint was to demonstrate feasibility.

Method

Patients with solid tumors > 4 cm in diameter of different histologies were eligible in this single arm, prospective, multi-institutional clinical feasibility trial with two treatment concepts: 5 × 5 Gy with an integrated boost to the tumor core of 5 × 10 Gy or 10 × 3 Gy with a boost of 10 × 6 Gy. The objective of dose escalation in this study was to deliver a minimum dose of 150% of the prescribed dose to the gross tumor volume (GTV) tumor core and to reach a maximum of at least 200% in the tumor core.

Results

In all, 21 patients at three study sites were recruited between January 2019 and November 2020 and were almost evenly spread (9 to 12) between the two concepts. The treated planning target volumes (PTV) averaged 389.42 cm³ (range 49.4–1179.6 cm³). The corresponding core volumes were 72.85 cm³ on average (range 4.21–338.3 cm³). Dose escalation to the tumor core with mean doses of 167.7–207.7% related to the nonboost prescribed isodose led to PTV mean doses of 120.5–163.3%. Treatment delivery and short-term follow-up was successful in all patients.

Conclusions

Palliative radiotherapy with SIB to the tumor core seems to be a feasible and well-tolerated treatment concept for large tumors. The applied high doses of up to 50 Gy in 5 fractions (or 60 Gy in 10 fractions) did not cause unexpected side effects in the 42 day follow-up period. Further research is needed for more information on efficacy and long-term toxicity.

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Title: The tumor core boost study: A feasibility study of radical dose escalation to the central part of large tumors with an integrated boost in the palliative treatment setting
Authors: Olaf Wittenstein
Fabian Krause
Mirko Fischer
Justus Domschikowski
Mirko Nitsche
Christoph Henkenberens
Daniel Habermehl
Juergen Dunst
Publication date: 20-07-2022
Publisher: Springer Berlin Heidelberg
Keyword: Radiotherapy
Published in: Strahlentherapie und Onkologie / Issue 3/2023
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-022-01976-5

At a glance: The STEP trials

Springer Medicine

The tumor core boost study: A feasibility study of radical dose escalation to the central part of large tumors with an integrated boost in the palliative treatment setting

Abstract

Purpose

Method

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusions

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