title: High-dose fractionated radiotherapy to 80 Gy for stage I-II medically inoperable non-small-cell lung cancer.
abstract: BACKGROUND
  Management of medically inoperable non-small-cell lung cancer (NSCLC) has been historically challenging, with poor rates of local control and disease-specific survival. Nearly all published series of standard fractionation radiotherapy have utilised doses <70 Gy. The present investigation describes disease control and survival outcomes for a large series of patients prescribed high-dose radiotherapy for early-stage NSCLC.
  
  
  METHODS
  Retrospective analysis of disease control and survival outcomes for stages I-II NSCLC patients prescribed ≥70 Gy at 1.8-2.5 Gy per fraction.
  
  
  RESULTS
  Between May 1997 and August 2008, 100 primary lung tumours in 98 patients (two metachronous) were eligible for analysis. The median age was 71 years (range 49-93), and 92 patients were considered medically inoperable. Nearly all cases were clinical stage cT1N0 (51 patients) or cT2N0 (35). The median radiotherapy dose prescribed was 80.5 Gy (range 70-90). At a median follow-up of 18 months, 72 patients died (44 of/with disease) and 50 experienced recurrence. The estimated 3-year in-field control, progression-free survival, disease-specific, and overall survival rates were 50, 29, 30 and 24%, respectively. Univariate analyses demonstrated an inverse association between local control and tumour size. Medical inoperability was associated with decreased disease-specific and overall survivals. Patient age and biologically equivalent dose were also associated with overall survival.
  
  
  CONCLUSIONS
  Disease control and survival of fractionated radiotherapy for early-stage NSCLC remain suboptimal. Medical inoperability is associated with worse overall survival; however, local control remains a predominant pattern of failure despite 80 Gy in standard fractionation, particularly in patients with larger tumour size.
authors.affiliation: Department of Radiation Oncology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. john.m.watkins.md@hotmail.com
authors.forename: J M
authors.initials: JM
authors.lastname: Watkins
authors.forename: A E
authors.initials: AE
authors.lastname: Wahlquist
authors.forename: A J
authors.initials: AJ
authors.lastname: Zauls
authors.forename: E C
authors.initials: EC
authors.lastname: Fields
authors.forename: E
authors.initials: E
authors.lastname: Garrett-Mayer
authors.forename: E G
authors.initials: EG
authors.lastname: Aguero
authors.forename: G A
authors.initials: GA
authors.lastname: Silvestri
authors.forename: A K
authors.initials: AK
authors.lastname: Sharma
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000473:pathology / Q000528:radiation effects; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome