title: Image guided hypofractionated 3-dimensional radiation therapy in patients with inoperable advanced stage non-small cell lung cancer.
abstract: OBJECTIVE
  Hypofractionated radiation therapy (HypoRT) can potentially improve local control with a higher biological effect and shorter overall treatment time. Response, local control, toxicity rates, and survival rates were evaluated in patients affected by inoperable advanced stage non-small cell lung cancer (NSCLC) who received HypoRT.
  
  
  METHODS
  Thirty patients with advanced NSCLC were enrolled; 27% had stage IIIA, 50% had stage IIIB, and 23% had stage IV disease. All patients underwent HypoRT with a prescribed total dose of 60 Gy in 20 fractions of 3 Gy each. Radiation treatment was delivered using an image guided radiation therapy technique to verify correct position. Toxicities were graded according to Radiation Therapy Oncology Group morbidity score. Survival rates were estimated using the Kaplan-Meier method.
  
  
  RESULTS
  The median follow-up was 13 months (range, 4-56 months). All patients completed radiation therapy and received the total dose of 60 Gy to the primary tumor and positive lymph nodes. The overall response rate after radiation therapy was 83% (3 patients with complete response and 22 patients with partial response). The 2-year overall survival and progression-free survival rates were 38.1% and 36%, respectively. Locoregional recurrence/persistence occurred in 11 (37%) patients. Distant metastasis occurred in 17 (57%) patients. Acute toxicities occurred consisting of grade 1 to 2 hematological toxicity in 5 patients (17%) and grade 3 in 1 patient; grade 1 to 2 esophagitis in 12 patients (40%) and grade 3 in 1 patient; and grade 1 to 2 pneumonitis in 6 patients (20%) and grade 3 in 2 patients (7%). Thirty-three percent of patients developed grade 1 to 2 late toxicities. Only 3 patients developed grade 3 late adverse effects: esophagitis in 1 patient and pneumonitis in 2 patients.
  
  
  CONCLUSIONS
  Hypofractionated curative radiation therapy is a feasible and well-tolerated treatment for patients with locally advanced NSCLC. Randomized studies are needed to compare HypoRT to conventional treatment.
authors.affiliation: Institute of Radiation Oncology, La Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
authors.forename: Linda
authors.initials: L
authors.lastname: Agolli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.forename: Teresa
authors.initials: T
authors.lastname: Falco
authors.forename: Stefano
authors.initials: S
authors.lastname: Bracci
authors.forename: Vitaliana
authors.initials: V
authors.lastname: De Sanctis
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
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*; D018450:Disease Progression; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000209:etiology; D004947:Esophagus / Q000528:radiation effects; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011832:Radiation Injuries / Q000150:complications; D017564:Radiation Pneumonitis / Q000209:etiology; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D013046:Specific Gravity; D015996:Survival Rate