title: Dose-intensive thoracic radiation therapy for patients at high risk with early-stage non-small-cell lung cancer.
abstract: Recent studies suggest that radiation therapy (RT) dose escalation in early-stage non-small-cell lung cancer (NSCLC) is feasible when 3-dimensional therapy is used. However, the accompanying prolongation of the treatment course when standard fractionation is used could be suboptimal from a practical and biologic standpoint. We report results of a compressed course of RT for patients with pathologically documented clinical stage 1 NSCLC who were unsuitable for curative surgery because of pulmonary dysfunction or other medical comorbidities. Thirty-one lesions were treated with dose-intensive RT (eg, fraction>or=2.25 Gy and nominal total dose>or=60 Gy) and have been followed up for >or=6 months from the completion of treatment. All patients completed therapy without interruption. Three patients developed grade 3 pulmonary toxicity 1-3 months after therapy. The overall tumor response rate was 88% (35% complete response and 53% partial response), whereas in-field tumor progression was documented for 5 of 31 lesions. Actuarial median survival was 38 months and 3-year overall survival was 60%, and most deaths were secondary to intercurrent disease. Moderately accelerated single daily fractionated RT is feasible for high-risk patients with early-stage NSCLC and merits further investigation.
authors.affiliation: Department of Radiation Oncology, SUNY Upstate Medical University, Syracuse, NY 13210, USA. bogartj@upstate.edu
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Bogart
authors.forename: Tracy E
authors.initials: TE
authors.lastname: Alpert
authors.forename: Mary C
authors.initials: MC
authors.lastname: Kilpatrick
authors.forename: Bonnie L
authors.initials: BL
authors.lastname: Keshler
authors.forename: Surjeet S
authors.initials: SS
authors.lastname: Pohar
authors.forename: Hemangini
authors.initials: H
authors.lastname: Shah
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Dexter
authors.forename: Jesse N
authors.initials: JN
authors.lastname: Aronowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies