title: Neutron vs. photon radiation therapy for inoperable regional non-small cell lung cancer: results of a multicenter randomized trial.
abstract: OBJECTIVE
  To determine, with a prospective, multicenter randomized study, whether fast neutron radiation therapy improves the outcome for patients with non-small cell lung cancer, as compared to conventional photon radiotherapy.
  
  
  METHODS
  From September 1986 to March 1991, a total of 200 patients with inoperable regional non-small cell lung cancer were randomized to 20.4 Gy in 12 fractions with neutrons versus 66 Gy in 33 fractions with photons. Inoperable patients with Radiation Therapy Oncology Group Stages I, II, III, or IV(M0) disease, Karnofsky Performance Score > or = 70, and who had received no previous therapy for their non-small cell lung cancer were eligible for the study. Of the 200 patients randomized, a total of 193 patients, 99 on the neutron arm and 94 on the photon arm, were eligible for analysis. The two treatment groups were balanced with regards to prognostic factors. At the time of this analysis, the median at-risk follow-up was 33 months, with a minimum follow-up of 16 months.
  
  
  RESULTS
  No difference in overall survival was observed; however, there was a statistically significant improvement in survival for patients with squamous cell histology (p = 0.02), and a trend toward improved survival for those with favorable prognostic factors (i.e., patients who were not T4, N3, and had no pleural effusion or weight loss > 5% from baseline) (p = 0.15), favoring the neutron-treated group. With the exception of skin and subcutaneous changes, acute and late toxicity was similar in both arms.
  
  
  CONCLUSIONS
  In selected patients with inoperable regional non-small cell lung cancer (e.g., squamous cell histology, favorable prognostic factors), fast neutron irradiation provides a therapeutic benefit over conventional photon radiotherapy.
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, Seattle 98195.
authors.forename: W J
authors.initials: WJ
authors.lastname: Koh
authors.forename: J M
authors.initials: JM
authors.lastname: Krall
authors.forename: L J
authors.initials: LJ
authors.lastname: Peters
authors.forename: M H
authors.initials: MH
authors.lastname: Maor
authors.forename: G E
authors.initials: GE
authors.lastname: Laramore
authors.forename: C M
authors.initials: CM
authors.lastname: Burnison
authors.forename: L W
authors.initials: LW
authors.lastname: Davis
authors.forename: S
authors.initials: S
authors.lastname: Zink
authors.forename: T W
authors.initials: TW
authors.lastname: Griffin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D005214:Fast Neutrons / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D017785:Photons / Q000627:therapeutic use*; D011446:Prospective Studies; D015996:Survival Rate