Continuous hyperfractionated accelerated radiation therapy week-end less in combination with neoadjuvant chemotherapy for the treatment of stage III non-small-cell lung cancer.
OBJECTIVE
Current treatment for unresectable stage III lung cancer includes standard radiotherapy with chemotherapy. Continuous hyperfractionated radiotherapy has been shown to be more effective than standard radiotherapy but may be associated with increased toxicity. In this study, we evaluated the feasibility and outcomes of patients treated with a hyperfractionated accelerated regimen in combination with neoadjuvant chemotherapy.


METHODS
We prospectively studied 61 consecutive patients with unresectable stage III non-small-cell lung cancer. All patients received three dimensional conformal radiotherapy using three daily fractions of 1.5 Gy to a total dose of 54-60 Gy omitting elective mediastinal irradiation. Approximately two-thirds of the patients also received platinum-based neoadjuvant chemotherapy. The primary outcome was locoregional disease-free survival. Secondary analyses were performed to assess tolerability, response rates, and overall and disease-free survival among study participants.


RESULTS
Overall, 56% of patients had a complete response. Locoregional recurrence was observed in 55% of patients with only a 3% rate of dissemination to non-irradiated mediastinal lymph nodes. Median locoregional disease-free survival, disease-free survival, and overall survival were 16 months (95% CI: 12-20), 15 months (95% CI: 12-18), and 19 months (95% CI: 15-30), respectively. Additionally, no episodes of severe toxicity were reported among study participants. Poor performance status and radiation response were independent predictors of survival.


CONCLUSIONS
This study suggests that conformal three-dimensional hyperfractionated accelerated radiotherapy omitting elective node irradiation can be used in combination with neoadjuvant chemotherapy to treat patients with stage III lung cancer. Future studies should compare this approach with the standard treatments for patients with stage III lung cancer.
Bonomi
Marcelo
M
Department of Radiation Oncology, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina; Department of Translational Research, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina.
Blanco-Savorio
Alejandro
A
Department of Radiation Oncology, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina.
Cerchietti
Leandro
L
Department of Translational Research, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina.
Navigante
Alfredo
A
Department of Translational Research, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina; Department of Medicine, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina.
Castro
Monica
M
Department of Translational Research, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina.
Roth
Berta
B
Department of Radiation Oncology, Instituto Angel H. Roffo, Universidad de Buenos Aires, Argentina.
Wisnivesky
Juan P
JP
Divisions of General Internal Medicine and Pulmonary, Critical Care Medicine, and Sleep Medicine, Mount Sinai School of Medicine, New York, NY, United States. Electronic address: juan.wisnivesky@mssm.edu.
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D020266:Radiotherapy, Conformal / Q000009:adverse effects