Twice daily irradiation increases locoregional control in patients with medically inoperable or surgically unresectable stage II-IIIB non-small-cell lung cancer.
OBJECTIVE
To evaluate the effect of q.d. or b.i.d. radiotherapy (RT) on the outcome of patients with locally advanced non-small-cell lung cancer.


METHODS
We retrospectively reviewed the outcome of 261 patients with medically inoperable or surgically unresectable Stage II-IIIB non-small-cell lung cancer, who were treated with combined modality cisplatin-based chemotherapy and RT. Chemotherapy was administered either sequentially or concurrently with thoracic RT. The median follow-up was 18 months (range 2-92). Treatment groups included sequential chemotherapy and q.d. RT (n = 109), concurrent chemotherapy and q.d. RT (n = 48), and concurrent chemotherapy and b.i.d. RT (n = 104). Of the 261 patients, 97% had a Karnofsky performance score > or =80, and 86.2% had < or =5% weight loss in the 3 months before diagnosis; 66.7% had nonsquamous cell histologic features. All but 8 patients had Stage IIIA-B disease.


RESULTS
The 2- and 5-year locoregional control rate was 42.4% and 25.7% for the q.d. group and 70.6% and 45.8% for the b.i.d. group, respectively (p = 0.0001). The 2- and 5-year disease-free survival rate was 26.7% and 6.5% for the q.d. group and 39.6% and 27.3% for the b.i.d. group, respectively (p = 0.0114). The corresponding overall survival rates were 35.9% and 9.4% for the q.d. group and 38.7% and 26.1% for the b.i.d. group. No difference was found in the rate of distant metastasis between the 2 groups. Multivariate analysis indicated that b.i.d. RT was a favorable prognostic factor for locoregional control and disease-free survival.


CONCLUSIONS
RT b.i.d. significantly improved locoregional control and disease-free survival compared with RT q.d. in patients with Stage IIIA-B non-small-cell lung cancer.
Liao
Zhongxing
Z
Division of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 97, Houston, TX 77030, USA. zliao@mdanderson.org
Komaki
Ritsuko
R
Stevens
Craig
C
Kelly
Jason
J
Fossella
Frank
F
Lee
Jin S
JS
Allen
Pamela
P
Cox
James D
JD
D000328:Adult; D000704:Analysis of Variance; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D002945:Cisplatin