ACRIN 6697: To determine whether the relative change in SUVpeak from the
baseline to the during-treatment FDG-PET/CT, defined as (during-treatment
SUVpeak – baseline SUVpeak)/baseline SUVpeak x 100%, can predict the LRPF
with a 2-year follow up.

Participants:
Patients must be > 18 and have FDG-avid (maximum SUV ≥ 4.0) and histologically
or cytologically proven non-small cell lung cancer.

Study Design:
The primary objective of RTOG 1106/ACRIN 6697 is to determine whether tumor
dose can be escalated to improve the "freedom from local-regional progression" rate after
two years of treatment using FDG-PET/CT scans to individualize adaptive RT plans.
All participants will undergo a baseline FDG-PET/CT scan as part of their treatment planning.
Participants in both arms will receive RT once a day 5 days a week for 6 weeks. After 4 weeks
of treatment, participants of both arms will undergo a second FDG-PET/CT scan. Participants
in the experimental arm will have the RT planning modified to provide as high a dose as
possible to the residual metabolically active tumor while keeping doses to normal lung
tissue constant (mean lung dose of 20 Gy) and doses to other adjacent organs within
safe limits whereas participants in the control arm will complete the initial treatment as planned.

In a subset of the study’s participants, 18F-fluoromisonidazole (FMISO)-PET/CT will be conducted
at baseline to identify the presence of hypoxia, which inhibits the production of the oxygen-free
radicals that cause radiation to damage DNA and to kill tumor cells. The trial will test the use of
imaging to identify hypoxic areas and to target those areas with higher levels of radiation. The
important question is whether areas of hypoxia identified at baseline will contain residual disease
at mid-treatment stage since it’s the slowest to die off.