Escalated dose for non-small-cell lung cancer with accelerated hypofractionated three-dimensional conformal radiation therapy

Background and Purpose: To prospectively assess the feasibility and efficacy of a hypofractionated accelerated radiotherapy regimen (72 Gy in 24 daily fractions, 3Gy per fraction) in patients (pts) with non-resectable non-small-cell lung cancer (NSCLC). Material and Methods: We included 25 Ins with a histologically or cytologically proven NSCLC, with KPS greater than or equal to 70 and less than or equal to 10% weight loss over prior three months, and with tumour stage I/II medically inoperable (9 pts) or non-resectable stage III a/b without pleural effusion (16 pts). Eleven pts received induction chemotherapy. No more than 30% of the combined lung volume could receive more than 25 Gy and the maximal biological effective dose to the spinal cord was maintained below 44 Gy. Results: No grade-4 acute toxicity event was reported. Two pts had a treatment break because of grade-3 acute oesophagitis. Twenty-two pts were evaluable for long-term toxicity (median follow-up = 9.7 months, range 4 to 30.2 months). There were 4 Grade-1 pulmonary and 2 Grade-1 oesophageal long-term toxicity events. Twenty-two pts were evaluable for tumour response with 7 complete and 8 partial responses, 5 stable diseases and 2 progressive diseases. The actuarial 1-year overall and thoracic-progression-free survival rates were 68% and 72% respectively. Conclusions: This study demonstrates the feasibility of the experimental radiotherapy schedule, however more data are needed to confirm its efficacy. (C) 2003 Published by Elsevier Ireland Ltd