73.6 Gy and Beyond: Hyperfractionated, Accelerated Radiotherapy for Non–Small-Cell Lung Cancer
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 of...
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Published in | Journal of clinical oncology Vol. 19; no. 3; pp. 705 - 711 |
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Main Authors | , , , , , , , , |
Format | Journal Article Conference Proceeding |
Language | English |
Published |
Baltimore, MD
American Society of Clinical Oncology
01.02.2001
Lippincott Williams & Wilkins |
Subjects | |
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Abstract | 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. |
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AbstractList | PURPOSE: To assess results with twice-daily high-dose radiotherapy (RT) for non–small-cell lung cancer (NSCLC).
PATIENTS AND METHODS: Between 1991 and 1998, 94 patients with unresectable NSCLC were prescribed ≥ 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.
RESULTS: Total doses received were ≥ 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 ≥ 3 toxicity included esophagus (14 patients; 15%), lung (three patients; 3% [one grade 5]), and skin (four patients; 4%). Grade ≥ 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%).
CONCLUSION: This regimen yielded favorable survival results, particularly for T1 lesions. Acute grade ≥ 3 toxicity seems greater than for conventional RT, though most patients recovered. Late grade ≥ 3 pulmonary toxicity occurred in 17%. Because of continued locoregional recurrences, we are currently using doses ≥ 86 Gy. 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. |
Author | Lawrence B. Marks Robert W. Clough Maria L. Hernando James E. Herndon II Gregory S. Sibley Patrick D. Maguire Kim L. Light Philip A. Antoine Mitchell S. Anscher |
Author_xml | – sequence: 1 givenname: Patrick D surname: MAGUIRE fullname: MAGUIRE, Patrick D organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 2 givenname: Lawrence B surname: MARKS fullname: MARKS, Lawrence B organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 3 givenname: Gregory S surname: SIBLEY fullname: SIBLEY, Gregory S organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 4 givenname: James E surname: HERNDON fullname: HERNDON, James E organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 5 givenname: Robert W surname: CLOUGH fullname: CLOUGH, Robert W organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 6 givenname: Kim L surname: LIGHT fullname: LIGHT, Kim L organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 7 givenname: Maria L surname: HERNANDO fullname: HERNANDO, Maria L organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 8 givenname: Philip A surname: ANTOINE fullname: ANTOINE, Philip A organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States – sequence: 9 givenname: Mitchell S surname: ANSCHER fullname: ANSCHER, Mitchell S organization: Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC, United States |
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Cites_doi | 10.1016/0360-3016(95)02016-0 10.1093/jnci/83.6.417 10.1016/S0360-3016(97)00343-X 10.1016/0360-3016(88)90348-3 10.1200/JCO.1996.14.4.1065 10.1200/JCO.1990.8.9.1543 10.1200/JCO.1998.16.11.3518 10.1016/S0360-3016(97)00831-6 10.1016/0360-3016(93)90238-Q 10.1016/S0360-3016(97)00251-4 10.1016/S0360-3016(99)00163-7 10.1093/jnci/87.3.198 10.1016/S0022-5223(99)70294-1 10.1200/JCO.1996.14.4.1055 10.1016/S0360-3016(98)00154-0 10.1016/S0140-6736(97)06305-8 10.1016/0360-3016(92)91013-D 10.1093/jnci/88.17.1210 10.1016/S0360-3016(96)00353-7 10.1080/01621459.1958.10501452 10.1016/0360-3016(95)02010-1 |
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Snippet | 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... PURPOSE: To assess results with twice-daily high-dose radiotherapy (RT) for non–small-cell lung cancer (NSCLC). PATIENTS AND METHODS: Between 1991 and 1998, 94... |
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SubjectTerms | 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 |
Title | 73.6 Gy and Beyond: Hyperfractionated, Accelerated Radiotherapy for Non–Small-Cell Lung Cancer |
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