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

From the Department of Radiation Oncology and Cancer Center Biostatistics, Duke University Medical Center, Durham, NC.

Address reprint requests to Lawrence B. Marks, MD, Department of Radiation Oncology, Box 3085, Duke University Medical Center, Durham, NC 27710; email: marks{at}radonc.duke.edu

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.

Presented at the Forty-First Annual Meeting of the American Society of Therapeutic Radiology and Oncology, San Antonio, TX, October 30-November 4, 1999.

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