title: Feasibility and efficacy of helical intensity-modulated radiotherapy for stage III non-small cell lung cancer in comparison with conventionally fractionated 3D-CRT.
abstract: BACKGROUND
  The standard treatment for stage III non-small-cell lung cancer (NSCLC) is still 60 Gy in conventional fractions combined with concurrent chemotherapy; however, the resulting local controls are disappointing. The aim of this study was to compare and assess the feasibility and efficacy of hypofractionated chemoradiotherapy using helical tomotherapy (HT) with conventional fractionation as opposed to using three-dimensional conformal radiotherapy (3D-CRT) for stage III NSCLC.
  
  
  METHODS
  Sixty-nine patients with stage III (AJCC 7th edition) NSCLC who underwent definitive radiation treatment at our institution between July 2011 and November 2013 were reviewed and analyzed retrospectively. A dose of 60 Gy in 20 fractions was delivered in the HT group (n=34), whereas 60 Gy in 30 fractions in the 3D-CRT group (n=35). Primary endpoints were toxicity, overall response rate, overall survival (OS) and progression-free survival (PFS).
  
  
  RESULTS
  The median follow-up period was 26.4 months. V20 (P=0.005), V30 (P=0.001), V40 (P=0.004), mean lung dose (P=0.000) and max dose of spinal cord (P=0.005) were significantly lower in the HT group than in the 3D-CRT group. There was no significant difference in the incidences of acute radiation pneumonitis (RP) ≥ grade 2 between the two groups, whereas the incidences of acute radiation esophagitis ≥ grade 2 were significantly lower in the HT group than in the 3D-CRT group (P=0.027). Two-year overall response rate was significantly higher in the HT group than in the 3D-CRT group (P=0.015). One- and 2-year OS rates were significantly higher in the HT group (95.0% and 68.7%, respectively) than in the 3D-CRT group (85.5% and 47.6%, respectively; P=0.0236). One- and 2-year PFS rates were significantly higher in the HT group (57.8% and 26.3%, respectively) than in the 3D-CRT group (32.7% and 11.4%, respectively; P=0.0351). Univariate analysis indicated that performance status (PS), T stage and radiotherapy technique were significant prognostic factors for both OS and PFS. Multivariate analysis indicated that PS and radiotherapy technique were independent prognostic factors of OS and PS was independent prognostic factor of PFS.
  
  
  CONCLUSIONS
  Hypofractionated chemoradiotherapy via HT can shorten the radiotherapy time without increasing treatment-related toxicity. The preliminary findings are that OS and PFS can be improved by hypofractionated chemoradiotherapy via HT for patients with stage III NSCLC.
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jian
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Yixing
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Shiming
authors.initials: S
authors.lastname: Shi
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Luxi
authors.initials: L
authors.lastname: Ye
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Radiation Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
authors.forename: Zhaochong
authors.initials: Z
authors.lastname: Zeng
keywords: Lung cancer; chemoradiotherapy; helical tomotherapy (HT); overall survival (OS); progression-free survival (PFS); stage III; toxicity