title: Accelerated hypofractionated radiotherapy for early-stage non-small-cell lung cancer: long-term results.
abstract: OBJECTIVE
  To retrospectively review the results of a single-institution series of accelerated hypofractionated radiotherapy for early-stage non-small-cell lung cancer (NSCLC) in patients who are medically inoperable or who refuse surgery.
  
  
  METHODS
  Peripherally located T1 to T3 N0 M0 tumors were treated with 48 to 60 Gy in 12 to 15 fractions between 1996 and 2007. No elective nodal irradiation was delivered. Patient, tumor, and treatment information was abstracted from the medical records.
  
  
  RESULTS
  A total of 124 tumors were treated in 118 patients (56 male and 62 female). Median age at diagnosis was 76.3 years (range, 49-90 years). In all, 113 patients (95.8%) were not surgical candidates because of medical comorbidities. The 2- and 5-year overall survival (OS) rates were 51.0% and 23.3%, respectively, and the 2- and 5-year cause-specific survival (CSS) rates were 67.6% and 59.8%, respectively. The 2- and 5-year actuarial local control (LC) rates were 76.2% and 70.1%, respectively. Univariate analysis revealed that tumor size less than 3 cm compared with greater than 3 cm resulted in significantly improved OS (40.0% vs. 5.0% at 5 years; p = 0.0002), CSS (69.7% vs. 45.1% at 5 years; p = 0.0461), and a trend toward better LC (82.5% vs. 66.9% at 2 years, 76.6% vs. 60.8% at 5 years; p = 0.0685). Treatment was well tolerated and there were no treatment delays because of acute toxicity.
  
  
  CONCLUSIONS
  Accelerated hypofractionated radiotherapy with 48 to 60 Gy using fractions of 4 Gy per day provides very good results for small tumors in medically inoperable patients with early-stage NSCLC.
authors.affiliation: Department of Radiation Oncology, Sunnybrook Health Sciences Centre and Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Hany
authors.initials: H
authors.lastname: Soliman
authors.forename: Patrick
authors.initials: P
authors.lastname: Cheung
authors.forename: Latifa
authors.initials: L
authors.lastname: Yeung
authors.forename: Ian
authors.initials: I
authors.lastname: Poon
authors.forename: Judith
authors.initials: J
authors.lastname: Balogh
authors.forename: Lisa
authors.initials: L
authors.lastname: Barbera
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Spayne
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Max
authors.initials: M
authors.lastname: Dahele
authors.forename: Yee
authors.initials: Y
authors.lastname: Ung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D047368:Tumor Burden