1. Progression-Free Interval After RFA of Lung Tumors Size Matters
100 80 60
≤ 3 cm
Progression-Free (%) 40
P = .0002 20
> 3 cm  12 24 36 48 60 72
Months Since Radiofrequency Ablation
Dupuy D. Radiofrequency ablation can destroy small lung tumors while avoiding the toxicity of thoracotomy or radiation. 42nd ASCO; June 2-6, Slide 14.
Graphic courtesy of Dr. Damien Dupuy.

2. Radiofrequency Ablation/Radiation Therapy in NSCLC
Pre-RFA
2 Weeks Post-RFA
6 Months Post-RFA/XRT
RFA = radiofrequency ablation; XRT = radiation therapy.
Dupuy D. Radiofrequency ablation can destroy small lung tumors while avoiding the toxicity of thoracotomy or radiation. 42nd ASCO; June 2-6, Slide 14.
Graphic courtesy of Dr. Damien Dupuy.

3. CT Images During Cryotherapy and at Follow-Up for Treatment of Small Pulmonary Mass
Before Cryotherapy
After Cryotherapy
Wang H, et al. Radiology. 2005;235:
Copyright © Radiological Society of North America, 2005.

4. Stereotactic Body Radiation Therapy (SBRT) for NSCLC
Graphic courtesy of Dr. Hak Choy.

5. Optimization of Radiation Therapy Stereotactic Body Radiation Therapy
100
100
BED ≥ 100 Gy (n = 64)
~88% 80 80
~68% 60 60
BED < 100 Gy (n = 23)
Local Tumor Control (%)
Overall Survival (%) 40 40
P < .05 20 20 12 24 36 48 1 2 3 4 5 6 7
Months from Therapy
Time (Years)
Indiana University1
Japan2
BED = biological equivalent dose.
1. Adapted from Cancer, Vol. 101, 2004: 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. Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer (EORTC 08993-22993)
Study Design
PCI
20–30 Gy in
5–12 Fractions
Chemotherapy
(4–6 Cycles)
No Response
Random
Any response
No PCI
<5 Weeks
4–6 Weeks
Stratification: performance score and institute
Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357: , 2007).

7. Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer Symptomatic Brain Metastases
100 90
1 Year: 14.6% vs 40.4%
HR: 0.27 (0.16–0.44) 80 70
P < .001 60
Symptomatic Brain Metastases (%) 50 40
Control 30 20
PCI 10 4 8 12 16 20 24 28 32 36
Time Since Randomization (Months)
Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357: , 2007).

8. Prophylactic Cranial Irradiation in Extensive-Disease Small-Cell Lung Cancer
Overall Survival
100 90
1 Year: 27.1% vs 13.3%
HR: 0.68 (0.52–0.88) 80 70 60
Overall Survival (%) 50
P = .003 40 30
PCI 20
Control 10 4 8 12 16 20 24 28 32 36
Time Since Randomization (Months)
Reprinted from Slotman BJ, et al. (ASCO 2007, #4; N Engl J Med. 357: , 2007).

9. Phase III Trial of WBRT and SRS with Temozolomide or Erlotinib RTOG 0320
Eligibility1
NSCLC 1–3 brain metastases
Max. lesion: 4 cm
No brainstem metastases
No actively progressing extracranial cancer
x 1 month
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
RANDOMI ZE
WBRT + SRS S T R A I F Y
WBRT + SRS + Temozolomide
WBRT + SRS + Erlotinib
WBRT = whole brain radiation therapy; SRS = stereotactic radiosurgery; RPA = recursive partitioning analysis.
1. ClinicalTrials.gov Web site Sperduto PW, et al. Slide 4.

10. Response to Chemoradiotherapy on FDG-PET Correlates with Survival
100
84%
84% 80
CR PR NR/PD 60
53%
Estimated Survival (%) 40
36%
P = .0033
N = 57 20
18% 3 6 9 12 15 18 21 48
Months Following PET Scan
On multivariate analysis, PET response was a more significant predictor (P = .006) than Karnofsky performance status (P = .09) and weight loss (P = .14).
MacManus M, et al. 36th ASCO; May 20-23, Abstract 1888; Slide 22.

11. Lung Cancer PET Study ACRIN 6668/RTOG 0235 Design
Concurrent chemotherapy/ radiation therapy
(+/- adjuvant chemotherapy per MD) P ET P ET
N = 250
PET or PET-CT to be done 12–16 weeks following radiation therapy and at least 4 weeks after adjuvant chemotherapy (if given)
Machtay M, et al ACR Web site. p 3.

12. Impact of PET on Radiation Therapy Volumes in Lung Cancer
Author N Method Impact
Hebert1 20 Visual 6/20
Kiffer2 15 Visual 4/15
Nestle3 34 Visual 12/34
Munley4 35 Visual 12/35
Vanuytsel5 73 Direct 45/73
Giraud6 12 Image fusion 5/12
Bradley7 26 Image fusion 8/26
NEED TO CONFIRM GIRAUD DATA WHEN WE GET FULL PAPER
1. Hebert ME, et al. Am J Clin Oncol. 1996;19: Kiffer JD, et al. Lung Cancer. 1998;19: Nestle U, et al. Int J Radiat Oncol Biol Phys. 1999;44: Munley MT, et al. Lung Cancer. 1999;23: Vanuytsel LJ, et al. Radiother Oncol. 2000;55: Giraud P, et al. Cancer Radiother. 2001;5: Bradley J, et al. Int J Radiat Oncol Biol Phys. 2004;59:78.