title: Split-course chemoradiotherapy for locally advanced non-small cell lung cancer: a single-institution experience of 144 patients.
abstract: BACKGROUND
  Concurrent chemoradiotherapy (CRT) is a standard of care in the treatment of unresectable locally advanced non-small cell lung cancer (NSCLC). At Rush University Medical Center, patients with locally advanced NSCLC are treated with split-course CRT in an attempt to maximize efficacy and tolerability. We reviewed our experience in advanced NSCLC since 1999. Subset analysis was performed on poor-risk patients.
  
  
  METHODS
  All patients with a diagnosis of stage IIIA/IIIB NSCLC and treated with definitive split-course CRT between January 1999 and December 2008 were included in this retrospective study. The primary end point was overall survival. Poor-risk patients were defined in accordance with ongoing cooperative group trials.
  
  
  RESULTS
  One hundred forty-four patients were identified, 35% stage IIIA and 65% stage IIIB. There were 52 poor-risk patients and 92 average-risk patients. Median survival for all patients was 20.4 months with an actuarial 32.1% 3-year overall survival rate. Poor-risk patients demonstrated a median survival of 22.1 months, statistically indistinguishable from the remainder of the cohort (p = 0.21). Acute esophagitis was mild, with a 3% rate of grade 3 esophagitis and no cases of grade 4 or 5.
  
  
  CONCLUSIONS
  Split-course CRT appeared effective and was delivered with a favorable toxicity profile. Poor-risk patients experienced better than expected survival. Prospective evaluation of split-course CRT must be completed before it can be considered a standard treatment option in locally advanced NSCLC.
authors.affiliation: Department of Radiation Oncology, Rush University Medical Center, Chicago, Illinois 60612, USA. Benjamin_gielda@rush.edu
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Gielda
authors.forename: James C
authors.initials: JC
authors.lastname: Marsh
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Zusag
authors.forename: L Penfield
authors.initials: LP
authors.lastname: Faber
authors.forename: Michael
authors.initials: M
authors.lastname: Liptay
authors.forename: Sanjib
authors.initials: S
authors.lastname: Basu
authors.forename: William H
authors.initials: WH
authors.lastname: Warren
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Fidler
authors.forename: Marta
authors.initials: M
authors.lastname: Batus
authors.forename: Ross A
authors.initials: RA
authors.lastname: Abrams
authors.forename: Philip
authors.initials: P
authors.lastname: Bonomi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel