73.6 Gy and Beyond: Hyperfractionated, Accelerated Radiotherapy for Non–Small-Cell Lung Cancer

• Published in: Journal of clinical oncology Vol. 19; no. 3; pp. 705 - 711
• Main Authors: MAGUIRE, Patrick D, MARKS, Lawrence B, SIBLEY, Gregory S, HERNDON, James E, CLOUGH, Robert W, LIGHT, Kim L, HERNANDO, Maria L, ANTOINE, Philip A, ANSCHER, Mitchell S
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.02.2001; Lippincott Williams & Wilkins
• Subjects: Actuarial Analysis; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - radiotherapy; Disease-Free Survival; Dose Fractionation; Dose-Response Relationship, Radiation; Female; Humans; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; Radiation therapy and radiosensitizing agent; Radiotherapy - adverse effects; Survival Analysis; Treatment with physical agents; Treatment. General aspects; Tumors; Human; Lung disease; Respiratory disease; Toxicity; Malignant tumor; Radiotherapy; Survival; Bronchopulmonary; Increasing dose; Treatment; Bronchus disease; Clinical trial; High dose; Non small cell carcinoma
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2001.19.3.705

To assess results with twice-daily high-dose radiotherapy (RT) for non-small-cell lung cancer (NSCLC). Between 1991 and 1998, 94 patients with unresectable NSCLC were prescribed > or = 73.6 Gy via accelerated fractionation. Fifty were on a phase II protocol (P group); 44 were similarly treated off-protocol (NP group). The clinical target volume received 45 Gy at 1.25 Gy bid (6-hour interval). The gross target volume received 1.6 Gy bid to 73.6 to 80 Gy over 4.5 to 5 weeks using a concurrent boost technique. Overall survival (OS) and local progression-free survival (LPFS) were calculated by the Kaplan-Meier method. Median follow-up durations for surviving P and NP patients were 67 and 16 months, respectively. Total doses received were > or = 72 Gy in 97% of patients. The median OS by stage was 34, 13, and 12 months for stages I/II, IIIa, and IIIb, respectively. LPFS was significantly longer for patients with T1 lesions (median, 43 months) versus T2-4 (median, 7 to 10 months; P =.01). Results were similar in the P and NP groups. Acute grade > or = 3 toxicity included esophagus (14 patients; 15%), lung (three patients; 3% [one grade 5]), and skin (four patients; 4%). Grade > or = 3 late toxicity in 86 assessable patients included esophagus (three patients; 3%), lung (15 patients; 17% [three grade 5]), skin (five patients; 6%), heart (two patients; 2%), and nerve (one patient; 1%). This regimen yielded favorable survival results, particularly for T1 lesions. Acute grade > or = 3 toxicity seems greater than for conventional RT, though most patients recovered. Late grade > or = 3 pulmonary toxicity occurred in 17%. Because of continued locoregional recurrences, we are currently using doses > or = 86 Gy.