A randomized phase I/II trial of hyperfractionated radiation therapy with total doses of 60.0 Gy to 79.2 Gy: possible survival benefit with greater than or equal to 69.6 Gy in favorable patients with Radiation Therapy Oncology Group stage III non-small-cell lung carcinoma: report of Radiation Therapy Oncology Group 83-11.

Abstract

A phase Ilate/II trial of hyperfractionated (HFX) radiation therapy for non-small-cell carcinoma of the lung (NSCCL) was conducted by the Radiation Therapy Oncology Group (RTOG) between 1983 and 1987. Fractions of 1.2 Gy were administered twice daily with greater than or equal to 4 hours between fractions. Patients were randomized to receive minimum total doses of 60.0, 64.8, and 69.6 Gy. After acceptable risks of acute and late effects were found, 74.4 Gy and 79.2 Gy arms were added, and the lowest total dose arms were closed. No significant differences in the risks of acute or late effects in normal tissues were found among the 848 patients analyzed in the five arms; risks of severe or life-threatening pneumonitis were 2.6% for 60.0 to 64.8 Gy, 5.7% for 69.6 to 74.4 Gy, and 8.1% for 79.2 Gy. Among 350 patients who had the same criteria as Cancer and Leukemia Group B (CALGB) protocol 84-33 (American Joint Committee on Cancer Staging [AJCCS], 1984, stage III; Karnofsky performance status [KPS] 70 to 100; less than 6% weight loss), there was a dose response for survival: survival with 69.6 Gy (median, 13.0 months; 2 years, 29%) was significantly (P = .02) better than the lower total doses. There were no differences in survival among the three highest total-dose arms. Comparisons with results in similar patients treated with 60 Gy in 30 fractions of 2.0 Gy 5 days per week for 6 weeks suggest benefit from HFX radiation therapy with 69.6 Gy. Improvement in survival with HFX radiation therapy at 69.6 Gy total dose without increase in normal tissue effects, justifies phase III comparison with standard fractionation alone and combined with systemic chemotherapy in this common presentation of NSCCL.

Observation of Interfractional Variations in Lung Tumor Position Using Respiratory Gated and Ungated Megavoltage Cone-Beam Computed Tomography

“…Part of this paper was presented in the 47 th ASTRO annual meeting, October [16][17][18][19][20] 2005, in Denver, Colorado. The work at MSKCC was supported in part by NIH grant P01-CA59017.…”

“…Two-year local control is 30-50% for medically inoperable stage I-II NSCLC tumors treated with RT and 15-20% for locally advanced disease 16 . Several studies have shown that higher radiation doses correlate with improved local control [17][18][19] . However, treatment dose is limited by the dose-volume constraints of normal lung 20,21 .…”

Small‐volume image‐guided radiotherapy using hypofractionated, coplanar, and noncoplanar multiple fields for patients with inoperable Stage I nonsmall cell lung carcinomas

“…everal studies [1][2][3] have shown that high-dose radiotherapy is an acceptable alternative to surgery in patients with inoperable nonsmall cell lung carcinoma (NSCLC). However, in most of these studies, patients were irradiated over large areas including not only the primary tumor but also regional lymph nodes in the hilum and mediastinum.…”

Alternating chemotherapy and accelerated split-course irradiation in locally advanced nonsmall cell lung carcinoma

“…11 Moreover, a variety of regimens of hyperfractionated radiation were tested, and survival improved for patients treated with the dose given in two fractions per day 31 or in a continuous hyperfractionated accelerated manner (CHART). 32 The choice of alternate chemotherapy and radiation therapy is supported by cytokinetic and pharmacologic data.…”