title: Hypofractionated three-dimensional conformal radiation therapy alone for centrally located cT1-3N0 non-small-cell lung cancer.
abstract: OBJECTIVE
  We retrospectively analyzed the treatment outcomes and toxicities by hypofractionated three-dimensional conformal radiation therapy (RT) alone in the patients with centrally located cT1-3N0 non-small-cell lung cancer (NSCLC).
  
  
  METHODS
  Sixty patients with centrally located cT1-3N0 NSCLC received definitive RT alone at 3.0 Gy per fraction for either medical comorbidity or refusal of surgery, between January 2001 and December 2010. The central tumor was defined as being within 2 cm around the proximal bronchial tree. The median total dose was 60 (39-60) Gy.
  
  
  RESULTS
  The local control (LC), overall survival (OS), and cause-specific survival rates at 2 and 5 years were 57.9%, 59.6%, 61.7%, and 50.1%, 33.5%, and 40.5%, respectively. Multivariate analyses showed that high cT stage (p = 0.007) and histology with NSCLC-not otherwise specified (p = 0.008) were the significantly unfavorable prognostic factors for OS, and that high cT stage (p = 0.031) and poor performance state (p = 0.007) were for LC. The LC rate at 2 years was 100% for cT1 tumor, 56.5% for cT2 tumor, and 28.6% for cT3 tumor, respectively. No patients experienced grade 3 or higher esophagitis, and three experienced grade 3 or higher pneumonitis.
  
  
  CONCLUSIONS
  Hypofractionated RT regimen for centrally located cT1-3N0 NSCLC proved safe with minimal toxicity, and, based on the excellent clinical outcomes in cT1 tumors, might serve as an alternative option for the patients who might not tolerate stereotactic body radiation therapy. As the clinical outcomes in cT2-3 tumors were still unsatisfactory, further dose intensifying regimen coupled with the use of concurrent systemic chemotherapy might be warranted.
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Dongryul
authors.initials: D
authors.lastname: Oh
authors.forename: Yong Chan
authors.initials: YC
authors.lastname: Ahn
authors.forename: Bokyong
authors.initials: B
authors.lastname: Kim
authors.forename: Hongryull
authors.initials: H
authors.lastname: Pyo
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D008198:Lymph Nodes; D008297:Male; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D017564:Radiation Pneumonitis / Q000209:etiology; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate