title: DART-bid: dose-differentiated accelerated radiation therapy, 1.8 Gy twice daily: high local control in early stage (I/II) non-small-cell lung cancer.
abstract: BACKGROUND
  While surgery is considered standard of care for early stage (I/II), non-small-cell lung cancer (NSCLC), radiotherapy is a widely accepted alternative for medically unfit patients or those who refuse surgery. International guidelines recommend several treatment options, comprising stereotactic body radiation therapy (SBRT) for small tumors, conventional radiotherapy ≥ 60 Gy for larger sized especially centrally located lesions or continuous hyperfractionated accelerated RT (CHART). This study presents clinical outcome and toxicity for patients treated with a dose-differentiated accelerated schedule using 1.8 Gy bid (DART-bid).
  
  
  METHODS
  Between April 2002 and December 2010, 54 patients (median age 71 years, median Karnofsky performance score 70%) were treated for early stage NSCLC. Total doses were applied according to tumor diameter: 73.8 Gy for <  2.5 cm, 79.2 Gy for 2.5-4.5 cm, 84.6 Gy for 4.5-6 cm, 90 Gy for > 6 cm.
  
  
  RESULTS
  The median follow-up was 28.5 months (range 2-108 months); actuarial local control (LC) at 2 and 3 years was 88%, while regional control was 100%. There were 10 patients (19%) who died of the tumor, and 18 patients (33%) died due to cardiovascular or pulmonary causes. A total of 11 patients (20%) died intercurrently without evidence of progression or treatment-related toxicity at the last follow-up, while 15 patients (28%) are alive. Acute esophagitis ≤ grade 2 occurred in 7 cases, 2 patients developed grade 2 chronic pulmonary fibrosis.
  
  
  CONCLUSIONS
  DART-bid yields high LC without significant toxicity. For centrally located and/or large (> 5 cm) early stage tumors, where SBRT is not feasible, this method might serve as radiotherapeutic alternative to present treatment recommendations, with the need of confirmation in larger cohorts.
authors.affiliation: Univ.-Klinik für Radiotherapie und Radio-Onkologie, Univ.-Klinikum der Paracelsus Medizinischen Privatuniversität, Landeskrankenhaus Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria, f.zehentmayr@salk.at.
authors.forename: Franz
authors.initials: F
authors.lastname: Zehentmayr
authors.forename: Karl
authors.initials: K
authors.lastname: Wurstbauer
authors.forename: Heinz
authors.initials: H
authors.lastname: Deutschmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Fussl
authors.forename: Peter
authors.initials: P
authors.lastname: Kopp
authors.forename: Karin
authors.initials: K
authors.lastname: Dagn
authors.forename: Gerd
authors.initials: G
authors.lastname: Fastner
authors.forename: Peter
authors.initials: P
authors.lastname: Porsch
authors.forename: Michael
authors.initials: M
authors.lastname: Studnicka
authors.forename: Felix
authors.initials: F
authors.lastname: Sedlmayer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D016019:Survival Analysis