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Dose-per-fraction escalation of accelerated hypofractionated three-dimensional conformal radiotherapy in locally advanced non-small cell lung cancer
Journal of Thoracic Oncology, 07/01/09

Kepka L et al. - In a trial to determine the efficacy of accelerated hypofractionated 3-dimensional conformal radiotherapy (3D-CRT) with dose-per-fraction escalation for treatment of stage III non-small cell lung cancer (NSCLC), it appears that although dose escalation with accelerated hypofractionated 3D-CRT was limited, results and toxicity profiles obtained using this technique are promising.

Methods

173 pts with stage III NSCLC were treated using accelerated 3D-CRT and the simultaneous boost technique.
The total dose of 56.7 Gy (including 39.9 Gy to elective area) was delivered over 4 wks in fractions of 2.7 Gy (1.9 Gy to elective area).
Dose-per-fraction escalation study commenced after the outcomes of 70 pts had been evaluated.
Dose per fraction was increased from 2.7 through 2.8 Gy (level 1 escalation) to 2.9 Gy (level 2 escalation); total dose increased, respectively, from 56.7 Gy through 58.8 Gy to 60.9 Gy.
Dose to the elective area and overall treatment time remained unchanged.
Fit pts received 2 to 3 courses of chemotherapy before radiotherapy.

Results

2- and 3-yr overall survival rates were 32% and 19%, respectively.
Of the pts, 7% had grade III acute esophageal toxicity and 6% had grade III or greater late pulmonary toxicity.
2 of 9 pts who received level 2 escalation (60.9 Gy) died of pulmonary toxicity.
The study was terminated at a dose of 58.8 Gy; this schema was adopted as institutional policy for treatment of stage III NSCLC.

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