title: Moderately Escalated Hypofractionated (Chemo) Radiotherapy Delivered with Helical Intensity-Modulated Technique in Stage III Unresectable Non-Small Cell Lung Cancer.
abstract: OBJECTIVE
  To assess clinical outcomes and toxicities in patients with stage III unresectable non-small cell lung cancer (NSCLC) treated with a moderately escalated hypofractionated radiotherapy delivered with Helical Intensity-Modulated Technique in combination with sequential or concurrent chemotherapy.
  
  
  METHODS
  Sixty-one consecutive patients considered non-progressive after two cycles of induction chemotherapy were treated with a moderately escalated hypofractionated radiation course of 30 daily fractions of 2.25-2.28 Gy each administered in 6 weeks up to a total dose of 67.5-68.4 Gy (range, 64.5-71.3 Gy). Thirty-two received sequential RT after two more cycles (total = 4 cycles) of chemotherapy, while 29 were treated with concurrent chemo-radiation. The target was considered the gross tumor volume and the clinically proven nodal regions, without elective nodal irradiation.
  
  
  RESULTS
  With a median follow up of 27 months (range 6-40), 1-year and 2-year OS rate for all patients was 77 and 53%, respectively, with a median survival duration of 18.6 months in the sequential group and 24.1 months in the concomitant group. No Grade ≥4 acute and late toxicity was reported. Acute Grade 3 treatment-related pneumonitis was detected in 10% of patients. Two patients, both receiving the concurrent schedule, developed a Grade 3 acute esophagitis. The overall incidence of late Grade 3 lung toxicity was 5%. No patients experienced a Grade 3 late esophageal toxicity.
  
  
  CONCLUSIONS
  A moderately hypofractionated radiation course delivered with a Helical Intensity-Modulated Technique is a feasible treatment option for patients with unresectable locally advanced NSCLC receiving chemotherapy (sequentially or concurrently). Hypofractionated radiotherapy with a dedicated technique allows safely dose escalation, minimizing the effect of tumor repopulation that may occur with prolonged treatment time.
authors.affiliation: Department of Radiotherapy, Azienda Ospedaliera S.Camillo-Forlanini , Rome , Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Donato
authors.forename: Stefano
authors.initials: S
authors.lastname: Arcangeli
authors.forename: Alessia
authors.initials: A
authors.lastname: Monaco
authors.forename: Cristina
authors.initials: C
authors.lastname: Caruso
authors.forename: Michele
authors.initials: M
authors.lastname: Cianciulli
authors.forename: Genoveva
authors.initials: G
authors.lastname: Boboc
authors.forename: Cinzia
authors.initials: C
authors.lastname: Chiostrini
authors.forename: Roberta
authors.initials: R
authors.lastname: Rauco
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Pressello
keywords: chemo-radiation; dose escalation; helical tomotherapy; hypofractionated radiotherapy; unresectable NSCLC