title: Accelerated hypofractionated radiation therapy (AHRT) for non-small-cell lung cancer: can we leave standard fractionation?
abstract: OBJECTIVE
  To report interim results from a single-institution study conducted to assess accelerated hypofractionated radiotherapy (AHRT) delivered with 3D conformal radiotherapy in two groups of patients with non-small cell lung cancer: (1) patients with early stage disease unable to tolerate surgery and ineligible for stereotactic body radiation therapy, and (2) patients with locally advanced disease unsuitable for concurrent chemoradiotherapy.
  
  
  METHODS
  A total of 83 patients (51 stage I-II, 32 stage III) were included. Radiotherapy targets included the primary tumor and positive mediastinal areas identified on the pre-treatment PET-CT. Mean age was 77.8 ± 7.8 years. ECOG performance status (PS) was ≥2 in 50.6 % of cases. Radiotherapy was delivered in daily fractions of 2.75 Gy to a total dose of 66 Gy (BED1084 Gy). Acute and late toxicities were evaluated according to NCI CTC criteria.
  
  
  RESULTS
  At a median follow-up of 42 months, median overall survival (OS) and cause-specific survival (CSS) were 23 and 36 months, respectively. On the multivariate analysis, PS [HR 4.14, p = 0.0001)], stage [HR 2.51, p = 0.005)], and maximum standardized uptake values (SUVmax) [HR 1.04, p = 0.04)] were independent risk factors for OS. PS [HR 5.2, p = 0.0001)] and stage [HR 6.3, p = 0.0001)] were also associated with CSS. No cases of severe acute or late treatment-related toxicities were observed.
  
  
  CONCLUSIONS
  OS and CSS rates in patients treated with AHRT for stage I-II and stage III NSCLC were good. Treatment was well tolerated with no grade three or higher treatment-related toxicity. PS, stage, and SUV max were predictive for OS and CSS.
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain. nrodriguez@parcdesalutmar.cat.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain. nrodriguez@parcdesalutmar.cat.|Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Spain. nrodriguez@parcdesalutmar.cat.
authors.forename: N Rodríguez
authors.initials: NR
authors.lastname: de Dios
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.|Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Spain.
authors.forename: X
authors.initials: X
authors.lastname: Sanz
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.|Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Spain.
authors.forename: P
authors.initials: P
authors.lastname: Foro
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Membrive
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Reig
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Jiménez
authors.affiliation: Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, c/San José de la Montaña, 12, 08024, Barcelona, Spain.|Hospital del Mar Medical Research Institute (IMIM), Doctor Aiguader 88, 08003, Barcelona, Spain.|Pompeu Fabra University, Doctor Aiguader 80, 08003, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Algara
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D009367:Neoplasm Staging; D015995:Prevalence; D011379:Prognosis; D011832:Radiation Injuries / Q000453:epidemiology; D020266:Radiotherapy, Conformal / Q000592:standards*; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate
keywords: Hypofractionation; Non-small-cell lung cancer; Performance status; Radiotherapy