Feasibility of high-dose three-dimensional radiation therapy in the treatment of localised non-small-cell lung cancer

• Published in: Cancer radiothérapie Vol. 13; no. 4; pp. 298 - 304
• Main Authors: Bellière, A., Girard, N., Chapet, O., Khodri, M., Kubas, A., Souquet, P.-J., Mornex, F.
• Format: Journal Article
• Language: English
• Published: Paris Elsevier SAS 01.07.2009; Elsevier
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Cancer bronchique non à petites cellules; Carcinoma, Large Cell - drug therapy; Carcinoma, Large Cell - pathology; Carcinoma, Large Cell - radiotherapy; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Squamous Cell - drug therapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - radiotherapy; Combined Modality Therapy - methods; Conformal radiotherapy; Diseases of the respiratory system; Dose escalation; Dose Fractionation; Dose–volume histogram; Escalade de dose; Feasibility Studies; Female; Heart Diseases - etiology; Histogramme dose–volume; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Medical sciences; Middle Aged; Non-small-cell lung cancer; Radiotherapy, Conformal - adverse effects; Radiotherapy, Conformal - methods; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Radiothérapie de conformation; Regression Analysis; Remission Induction; Retrospective Studies; Toxicity; Toxicité; Tumors; Conformal radiotherapy; Dose escalation; Toxicity; Toxicité; Cancer bronchique non à petites cellules; Dose–volume histogram; Non-small-cell lung cancer; Radiothérapie de conformation; Escalade de dose; Histogramme dose–volume; Human; Lung disease; Nuclear medicine; Histogram; Respiratory disease; Lung cancer; Cardiovascular disease; Malignant tumor; non-small cell lung carcinoma; Radiation dose; Cancerology; Treatment; Heart disease; Unresectable; Radiology; Bronchus disease; Complication; High dose; Pneumopathy; Cancer
• ISSN: 1278-3218; 1769-6658
• DOI: 10.1016/j.canrad.2009.04.004

Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B non-small-cell lung cancer (NSCLC). Aware of the necessity to increase local control in locally advanced NSCLC, we analyzed the feasibility of high-dose three-dimensional conformal radiation therapy (3D-CRT) in the treatment of localised NSCLC. We undertook a retrospective analysis of consecutive patients with non-resectable NSCLC treated with high-dose (74 Gy) standard-fractionation 3D-CRT, with particular attention to the relationship between lung and heart radiation-induced toxicities. Fifty patients (41 males, 9 females) were included. A total of 35 (70%) patients received the planned total dose of 74 Gy. Patients irradiated to inferior doses interrupted the treatment because of limiting toxicities. Induction and concurrent chemotherapy was delivered to 39 (78%) and 14 (28%) patients, respectively. Eight (16%) patients experienced grade 3-4 acute lung toxicity, all of them having a history of pulmonary disease, a FEV1 below 1.6 L, and a lung V 20 of at least 25%. Three (6%) patients were deemed to experience radiation-induced cardiac toxicity. This study assesses the feasibility of delivering a total dose of 74 Gy combined with chemotherapy in locally advanced NSCLC. High lung and heart V 20 increases the risk of radiation-induced lung and cardiac toxicity, the later being highly difficult to precisely assess, as late deaths are rarely documented, and responsibility of the treatment might be often underestimated. The precise evaluation of cardiac condition may be helpful to spare fragile patients from potentially toxic effects of high-dose radiation, especially in controlled trials. La chimioradiothérapie est le traitement standard des cancers bronchiques non à petites cellules inopérables et/ou non résécables de stade IIIA/B. L’escalade des doses d’irradiation, utilisant les techniques d’irradiation conformationelle a pour objectif d’améliorer les taux de contrôle local chez ces patients. Nous avons conduit une analyse rétrospective des dossiers de patients atteints de cancer bronchique non à petites cellules non résécables et traités par irradiation conformationelle standard à la dose totale de 74 Gy. Cinquante patients (41 hommes et 9 femmes) ont été inclus. Au total, 35 (70 %) patients ont reçu la dose prévue de 74 Gy. Le traitement a été interrompu dans 30 % des cas à des doses totales inférieures, du fait d’une toxicité limitante. Une chimiothérapie d’induction a été délivrée à 39 (78 %) patients. Les huit (16 %) patients ayant souffert d’une toxicité pulmonaire aiguë de grade 3 ou 4 étaient atteints d’une affection pulmonaire préexistante, avec un volume maximal expiratoire seconde (VEMS) de moins de 1,6 L et ont été traités avec un V 20 pulmonaire (volume recevant 20 Gy et plus) d’au moins 25 %. Trois (6 %) patients ont souffert d’une toxicité cardiaque aiguë. Cette étude montre la faisabilité d’une chimioradiothérapie à la dose totale de 74 Gy en cas de cancer bronchique non à petites cellules localement évolué. Le V 20 pulmonaire et cardiaque est associé à un risque de toxicité élevé. La toxicité cardiaque est difficile à évaluer, du fait de la survenue possible d’événements tardifs, pour lesquels la responsabilité de la radiothérapie pourrait être sous-estimée. Une évaluation précise de la fonction cardiaque pourrait permettre une sélection des patients éligibles pour une radiothérapie de haute dose, dans le cadre d’essais contrôlés.