title: Toxicity and outcome results of a class solution with moderately hypofractionated radiotherapy in inoperable Stage III non-small cell lung cancer using helical tomotherapy.
abstract: OBJECTIVE
  To prospectively assess the feasibility, toxicity, and local control of a class solution protocol of moderately hypofractionated tomotherapy in Stage III, inoperable, locally advanced non-small-cell lung cancer patients.
  
  
  METHODS
  Eligible patients were treated according to a uniform class solution (70.5 Gy in 30 fractions) with fixed constraints and priorities using helical tomotherapy. Toxicity monitoring was performed using the Radiation Therapy Oncology Group criteria and the National Cancer Institute Common Terminology Criteria and Adverse Events (CTCAE) version 3.0. Pulmonary function tests were performed at the start and repeated at 3 months after treatment.
  
  
  RESULTS
  Our class solution resulted in a deliverable plan in all 40 consecutive patients. Acute Grade 3 lung toxicity was seen in 10% of patients. Two patients died during acute follow-up with pulmonary toxicity. Correlations were found between changes in pulmonary function test results and mean lung dose or the lung volume receiving 20 Gy (V(20)). The correlation was strongest for lung diffusion capacity for carbon monoxide. A V(20) of >27% and >32% were predictive for Grades 2 and 3 acute lung toxicity respectively (p < 0.05). Late Grade 3 toxicity was exclusively pulmonary, with an incidence of 16%. Overall Grade 3 lung toxicity correlated with a mean lung dose of >18 Gy and a median lung dose of >5 Gy (p < 0.05). Median survival was 17 months, and the 1-year and 2-year local progression-free survivals were 66% and 50%, respectively.
  
  
  CONCLUSIONS
  The current class solution using moderately hypofractionated helical tomotherapy in patients with locally advanced non-small-cell lung cancer is feasible. Toxicity was acceptable and in line with other reports on intensity-modulated radiotherapy. The local progression-free survival was encouraging considering the unselected population.
authors.affiliation: Department of Radiation Oncology, Oncology Center, Universitair Ziekenhuis Brussel (UZB), Brussels, Belgium. samuel.bral@uzbrussel.be
authors.forename: Samuel
authors.initials: S
authors.lastname: Bral
authors.forename: Michaël
authors.initials: M
authors.lastname: Duchateau
authors.forename: Harijati
authors.initials: H
authors.lastname: Versmessen
authors.forename: Benedikt
authors.initials: B
authors.lastname: Engels
authors.forename: Koen
authors.initials: K
authors.lastname: Tournel
authors.forename: Vincent
authors.initials: V
authors.lastname: Vinh-Hung
authors.forename: Mark
authors.initials: M
authors.lastname: De Ridder
authors.forename: Denis
authors.initials: D
authors.lastname: Schallier
authors.forename: Guy
authors.initials: G
authors.lastname: Storme
mesh_terms: D000328:Adult; 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; D004941:Esophagitis / Q000209:etiology / Q000473:pathology; D004947:Esophagus / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology / Q000528:radiation effects; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D017564:Radiation Pneumonitis / Q000401:mortality; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012129:Respiratory Function Tests; D016896:Treatment Outcome