title: High-dose radiation improved local tumor control and overall survival in patients with inoperable/unresectable non-small-cell lung cancer: long-term results of a radiation dose escalation study.
abstract: OBJECTIVE
  To determine whether high-dose radiation leads to improved outcomes in patients with non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  This analysis included 106 patients with newly diagnosed or recurrent Stages I-III NSCLC, treated with 63-103 Gy in 2.1-Gy fractions, using three-dimensional conformal radiation therapy (3D-CRT) per a dose escalation trial. Targets included the primary tumor and any lymph nodes > or =1 cm, without intentionally including negative nodal regions. Nineteen percent of patients (20/106) received neoadjuvant chemotherapy. Patient, tumor, and treatment factors were evaluated for association with outcomes. Estimated median follow-up was 8.5 years.
  
  
  RESULTS
  Median survival was 19 months, and 5-year overall survival (OS) was 13%. Multivariate analysis revealed weight loss (p = 0.011) and radiation dose (p = 0.0006) were significant predictors for OS. The 5-year OS was 4%, 22%, and 28% for patients receiving 63-69, 74-84, and 92-103 Gy, respectively. Although presence of nodal disease was negatively associated with locoregional control under univariate analysis, radiation dose was the only significant predictor when multiple variables were included (p = 0.015). The 5-year control rate was 12%, 35%, and 49% for 63-69, 74-84, and 92-103 Gy, respectively.
  
  
  CONCLUSIONS
  Higher dose radiation is associated with improved outcomes in patients with NSCLC treated in the range of 63-103 Gy.
authors.affiliation: Department of Radiation Oncology, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA. Fengkong@med.umich.edu
authors.forename: Feng-Ming
authors.initials: FM
authors.lastname: Kong
authors.forename: Randall K
authors.initials: RK
authors.lastname: Ten Haken
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schipper
authors.forename: Molly A
authors.initials: MA
authors.lastname: Sullivan
authors.forename: Ming
authors.initials: M
authors.lastname: Chen
authors.forename: Carlos
authors.initials: C
authors.lastname: Lopez
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Kalemkerian
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; 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; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D015996:Survival Rate