title: Personalized Radiation Therapy (PRT) for Lung Cancer.
abstract: This chapter reviews and discusses approaches and strategies of personalized radiation therapy (PRT) for lung cancers at four different levels: (1) clinically established PRT based on a patient's histology, stage, tumor volume and tumor locations; (2) personalized adaptive radiation therapy (RT) based on image response during treatment; (3) PRT based on biomarkers; (4) personalized fractionation schedule. The current RT practice for lung cancer is partially individualized according to tumor histology, stage, size/location, and combination with use of systemic therapy. During-RT PET-CT image guided adaptive treatment is being tested in a multicenter trial. Treatment response detected by the during-RT images may also provide a strategy to further personalize the remaining treatment. Research on biomarker-guided PRT is ongoing. The biomarkers include genomics, proteomics, microRNA, cytokines, metabolomics from tumor and blood samples, and radiomics from PET, CT, SPECT images. Finally, RT fractionation schedule may also be personalized to each individual patient to maximize therapeutic gain. Future PRT should be based on comprehensive considerations of knowledge acquired from all these levels, as well as consideration of the societal value such as cost and effectiveness.
authors.affiliation: Cancer Center, Georgia Regents University, Augusta, GA, USA.
authors.forename: Jian-Yue
authors.initials: JY
authors.lastname: Jin
authors.affiliation: Cancer Center, Georgia Regents University, Augusta, GA, USA. fkong@gru.edu.
authors.forename: Feng-Ming Spring
authors.initials: FM
authors.lastname: Kong
mesh_terms: D014408:Biomarkers, Tumor / Q000235:genetics* / Q000378:metabolism; D049109:Cell Proliferation / Q000528:radiation effects; D002470:Cell Survival / Q000528:radiation effects; D004307:Dose-Response Relationship, Radiation; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy*; D014411:Neoplastic Stem Cells / Q000378:metabolism / Q000473:pathology / Q000528:radiation effects; D049268:Positron-Emission Tomography; D057285:Precision Medicine / Q000295:instrumentation / Q000379:methods*; D011836:Radiation Tolerance / Q000235:genetics; D019275:Radiopharmaceuticals / Q000627:therapeutic use*; D055752:Small Cell Lung Carcinoma / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000532:radiotherapy*; D047368:Tumor Burden / Q000528:radiation effects
chemical_list: D014408:Biomarkers, Tumor; D019275:Radiopharmaceuticals
keywords: Adaptive radiation therapy; Biomarkers; Lung cancer; Personalized radiation therapy; Radiomics