Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Hypofractionated three-dimensional conformal radiotherapy for medically inoperable early stage non-small-cell lung cancer

  • Lee, Joo Ho (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Wu, Hong-Gyun (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Kim, Hak Jae (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Park, Charn Il (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Lee, Se-Hoon (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Kim, Dong-Wan (Department of Internal Medicine, Seoul National University College of Medicine) ;
  • Heo, Dae Seog (Department of Internal Medicine, Seoul National University College of Medicine)
  • Received : 2012.11.06
  • Accepted : 2013.01.16
  • Published : 2013.03.31
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Abstract

Purpose: The purpose of this study was to assess the clinical outcomes of hypofractionated radiotherapy (HFRT) with three-dimensional conformal technique for medically inoperable patients with early stage non-small-cell lung cancer (NSCLC) and to evaluate prognostic factors. Materials and Methods: We performed a retrospective review of 26 patients who underwent HFRT for early stage NSCLC between September 2005 and August 2011. Only clinical stage T1-3N0 was included. The median RT dose was 70 Gy (range, 60 to 72 Gy) and the median biologically equivalent dose (BED) was 94.5 Gy (range, 78.0 to 100.8 Gy). In 84.6% of patients, 4 Gy per fraction was used. Neoadjuvant chemotherapy with paclitaxel and cisplatin was given to 2 of 26 patients. Results: The median follow-up time for surviving patients was 21 months (range, 13 to 49 months). The overall response rate was 53.9%, and the initial local control rate was 100%. The median survival duration was 27.8 months. Rates of 2-year overall survival, progression-free survival (PFS), local control (LC), and locoregional-free survival (LRFS) were 54.3%, 61.1%, 74.6%, and 61.9%, respectively. Multivariate analysis showed that BED (>90 vs. ${\leq}90$ Gy) was an independent prognostic factor influencing PFS, LC, and LRFS. Severe toxicities over grade 3 were not observed. Conclusion: Radical HFRT can yield satisfactory disease control with acceptable rates of toxicities in medically inoperable patients with early stage NSCLC. HFRT is a viable alternative for clinics and patients ineligible for stereotactic ablative radiotherapy. BED over 90 Gy and 4 Gy per fraction might be appropriate for HFRT.

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References

  1. Scott WJ, Howington J, Feigenberg S, Movsas B, Pisters K; American College of Chest Physicians. Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007;132(3 Suppl):234S-42S. https://doi.org/10.1378/chest.07-1378
  2. Kaskowitz L, Graham MV, Emami B, Halverson KJ, Rush C. Radiation therapy alone for stage I non-small cell lung cancer. Int J Radiat Oncol Biol Phys 1993;27:517-23. https://doi.org/10.1016/0360-3016(93)90374-5
  3. Qiao X, Tullgren O, Lax I, Sirzen F, Lewensohn R. The role of radiotherapy in treatment of stage I non-small cell lung cancer. Lung Cancer 2003;41:1-11. https://doi.org/10.1016/S0169-5002(03)90518-6
  4. Fowler JF, Chappell R. Non-small cell lung tumors repopulate rapidly during radiation therapy. Int J Radiat Oncol Biol Phys 2000;46:516-7. https://doi.org/10.1016/S0360-3016(99)00364-8
  5. Bradley J, Graham MV, Winter K, et al. Toxicity and outcome results of RTOG 9311: a phase I-II dose-escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 2005;61:318-28. https://doi.org/10.1016/j.ijrobp.2004.06.260
  6. Kim W, Kim HJ, Park JH, Huh HD, Choi SH. Treatment results of CyberKnife radiosurgery for patients with primary or recurrent non-small cell lung cancer. J Korean Soc Ther Radiol Oncol 2011;29:28-35. https://doi.org/10.3857/jkstro.2011.29.1.28
  7. Timmerman R, Paulus R, Galvin J, et al. Stereotactic body radiation therapy for inoperable early stage lung cancer. JAMA 2010;303:1070-6. https://doi.org/10.1001/jama.2010.261
  8. Onishi H, Araki T, Shirato H, et al. Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 2004;101:1623-31. https://doi.org/10.1002/cncr.20539
  9. Potters L, Kavanagh B, Galvin JM, et al. American Society for Therapeutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the performance of stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2010;76:326-32. https://doi.org/10.1016/j.ijrobp.2009.09.042
  10. Bonfili P, Di Staso M, Gravina GL, et al. Hypofractionated radical radiotherapy in elderly patients with medically inoperable stage I-II non-small-cell lung cancer. Lung Cancer 2010;67:81-5. https://doi.org/10.1016/j.lungcan.2009.03.023
  11. Faria SL, Souhami L, Portelance L, et al. Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer. Radiat Oncol 2006;1:42. https://doi.org/10.1186/1748-717X-1-42
  12. Sandhu AP, Messer K, Fuster MM, et al. Hypofractionated radiotherapy for stage I non-small cell lung carcinoma in patients aged 75 years and older. J Cancer Ther 2011;2:167-71. https://doi.org/10.4236/jct.2011.22020
  13. Thirion P, Holmberg O, Collins CD, et al. Escalated dose for non-small-cell lung cancer with accelerated hypofractionated three-dimensional conformal radiation therapy. Radiother Oncol 2004;71:163-6. https://doi.org/10.1016/j.radonc.2003.09.006
  14. Cheung PC, Yeung LT, Basrur V, Ung YC, Balogh J, Danjoux CE. Accelerated hypofractionation for early-stage non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002;54:1014-23. https://doi.org/10.1016/S0360-3016(02)03045-6
  15. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47. https://doi.org/10.1016/j.ejca.2008.10.026
  16. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341-6. https://doi.org/10.1016/0360-3016(95)00060-C
  17. Jeremic B, Classen J, Bamberg M. Radiotherapy alone in technically operable, medically inoperable, early-stage (I/II) non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2002;54:119-30.
  18. Pan H, Simpson DR, Mell LK, Mundt AJ, Lawson JD. A survey of stereotactic body radiotherapy use in the United States. Cancer 2011;117:4566-72. https://doi.org/10.1002/cncr.26067
  19. Nagata Y, Hiraoka M, Mizowaki T, et al. Survey of stereotactic body radiation therapy in Japan by the Japan 3-D Conformal External Beam Radiotherapy Group. Int J Radiat Oncol Biol Phys 2009;75:343-7. https://doi.org/10.1016/j.ijrobp.2009.02.087
  20. Song SY, Choi W, Shin SS, et al. Fractionated stereotactic body radiation therapy for medically inoperable stage I lung cancer adjacent to central large bronchus. Lung Cancer 2009;66:89-93. https://doi.org/10.1016/j.lungcan.2008.12.016
  21. Martel MK, Strawderman M, Hazuka MB, Turrisi AT, Fraass BA, Lichter AS. Volume and dose parameters for survival of nonsmall cell lung cancer patients. Radiother Oncol 1997;44:23-9. https://doi.org/10.1016/S0167-8140(97)00081-9
  22. Pieterman RM, van Putten JW, Meuzelaar JJ, et al. Preoperative staging of non-small-cell lung cancer with positron-emission tomography. N Engl J Med 2000;343:254-61. https://doi.org/10.1056/NEJM200007273430404

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