title: 73.6 Gy and beyond: hyperfractionated, accelerated radiotherapy for non-small-cell lung cancer.
abstract: OBJECTIVE
  To assess results with twice-daily high-dose radiotherapy (RT) for non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  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.
  
  
  RESULTS
  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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Maguire
authors.forename: L B
authors.initials: LB
authors.lastname: Marks
authors.forename: G S
authors.initials: GS
authors.lastname: Sibley
authors.forename: J E
authors.initials: JE
authors.lastname: Herndon
authors.forename: R W
authors.initials: RW
authors.lastname: Clough
authors.forename: K L
authors.initials: KL
authors.lastname: Light
authors.forename: M L
authors.initials: ML
authors.lastname: Hernando
authors.forename: P A
authors.initials: PA
authors.lastname: Antoine
authors.forename: M S
authors.initials: MS
authors.lastname: Anscher
mesh_terms: D000206:Actuarial Analysis; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects; D016019:Survival Analysis