Hypofractionated three-dimensional conformal radiotherapy for medically inoperable early stage non-small-cell lung cancer

Lee, Joo Ho; Wu, Hong‐Gyun; Kim, Hak Jae; Park, Charn Il; Lee, Sehoon; Kim, Dong-Wan; Heo, Dae Seog

doi:10.3857/roj.2013.31.1.18

Cited by 9 publications

(10 citation statements)

References 22 publications

(40 reference statements)

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“…The largest retrospective Canadian study reported a 2-year LC rate of 76.2% in 118 patients following a total dose of 48-60 Gy in 12-15 fractions, in which most patients received 48 Gy (59.7%) or 52 Gy (37.1%) [8]. Lee et al [14] reported a 2-year LC rate of 74.6% in 26 patients following median 70 Gy (range, 60 to 72 Gy) in 15-18 fractions. In the current study, the authors achieved a 2-year LC rate of 75.2% in group 3 following 60 Gy in 15 fractions, which was quite comparable with other studies mentioned above [8,13,14].…”

Section: Discussionmentioning

confidence: 99%

“…Lee et al [14] reported a 2-year LC rate of 74.6% in 26 patients following median 70 Gy (range, 60 to 72 Gy) in 15-18 fractions. In the current study, the authors achieved a 2-year LC rate of 75.2% in group 3 following 60 Gy in 15 fractions, which was quite comparable with other studies mentioned above [8,13,14]. Actually, the 2-year LC rate following 60 Gy in 15 fractions as in the current study was numerically superior to those achieved by the authors following 60 Gy in 20 fractions: 56.9% in the current study (as in group 2); and 57.9% in a previous study [7].…”

Section: Discussionmentioning

confidence: 99%

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Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

et al. 2016

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PurposeHigh dose definitive radiation therapy (RT) alone is recommended to patients with cT1-3N0 non-small cell lung cancer, who are unfit for surgery or stereotactic RT. This study was conducted to evaluate the clinical outcomes and cost-effectiveness following RT alone using two different modest hypofractionation dose schemes.Materials and MethodsBetween 2001 and 2014, 124 patients underwent RT alone. From 2001 till 2010, 60 Gy in 20 fractions was delivered to 79 patients (group 1). Since 2011, 60 Gy in 20 fractions (group 2, 20 patients), and 60 Gy in 15 fractions (group 3, 25 patients) were selectively chosen depending on estimated risk of esophagitis.ResultsAt follow-up of 16.7 months, 2-year rates of local control, progression-free survival, and overall survival were 62.6%, 39.1%, and 59.1%, respectively. Overall survival was significantly better in group 3 (p=0.002). In multivariate analyses, cT3 was the most powerful adverse factor affecting clinical outcomes. Incidence and severity of radiation pneumonitis were not different among groups, while no patients developed grade 2 esophagitis in group 3 (p=0.003). Under current Korean Health Insurance Policy, RT cost per person was 22.5% less in group 3 compared with others.ConclusionThe current study demonstrated that 60 Gy in 15 fractions instead of 60 Gy in 20 fractions resulted in comparable clinical outcomes with excellent safety, direct cost saving, and improved convenience to the patients with tumors located at ≥ 1.5 cm from the esophagus.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

et al. 2016

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“…Thus, the radiation doses were 57, 60, 63 and 66 Gy in 11.8%, 20.6%, 44.0% and 23.6% of patients, respectively. The total dose of 66 Gy in 22 fractions was the maximum recommended dose for this study based on hypofractionated and SBRT studies, 12,18 which had less restrictive criteria in terms of tumour size and late toxicity and proposed biological equivalent doses in the range of 83.2-146 Gy.…”

Section: Radiotherapy Techniquementioning

confidence: 99%

“…Some studies of HFRT using various radiation-dose schedules resulted in improved outcomes beyond those achieved with conventionally fractionated RT. [11][12][13] The purpose of this study was to assess the toxicity and clinical outcome of dose-escalation HFRT with 3D RT for medically inoperable early-stage NSCLC.…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated 3D radiotherapy for inoperable T1-3 N0-1 non-small-cell lung cancer

Mollà

Saez

Ramos

et al. 2016

BJR

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Objective: This study assessed the toxicity and clinical outcomes of three-dimensional (3D) hypofractionated radiotherapy (HFRT) for medically inoperable T1-3 N0-1 non-small-cell lung cancer (NSCLC). Methods: 34 patients with inoperable early-stage NSCLC were treated from August 2008 to April 2013. Prior to enrolment, patients were required to be evaluated by an experienced thoracic surgeon to determine the "operability". All received 57 Gy in 19 fractions followed by escalated doses of 3-Gy fractions, up to a total dose of 66 Gy using a 3D conformal technique. Toxicities were measured using the Common Terminology Criteria for Adverse Effects v. 4.0. Results: The median follow-up was 33 months (7-74 months). Toxicity grades $3 were not observed. Local control (LC) was 80.4% at 2 years, whereas regional control (RC) was 78%. The overall survival (OS), time to progression (TTP) and time to distant metastasis (TTM) at 2 years were 60%, 59% and 80%, respectively. For patients with T1-2 N0 and a tumour size ,45 mm (n 5 19), rates of OS, TTP and TTM at 2 years were 71%, 75% and 94%, respectively. LC and RC at 2 years were 85% and 94%, respectively. Conclusion: HFRT using 3.0-Gy fractions amounting to a total dose of 66 Gy is the recommended dose. A Phase 2 trial is warranted in order to assess the safety and efficacy of this fractionation scheme. Advances in knowledge: HFRT results in a favourable outcome in early-stage lung cancer without the usual restrictions in tumour size and/or location associated with previous treatment methods. No special equipment is required, therefore permitting its application in any centre.

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“…Several studies have shown that RT dose escalation improves locoregional control in NSCLC (Mehta et al, 2001, Rengan et al, 2004, Bradley et al, 2005, Rosenzweig et al, 2005, Ding et al, 2012, Lee et al, 2013, Liu et al, 2013, Zheng et al, 2013. Recently, intensity-modulated RT has been proposed as an effective modality to facilitate dose escalation to target volumes while sparing normal surrounding tissues.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcome of Helical Tomotherapy for Inoperable Non-Small Cell Lung Cancer: The Kyung Hee University Medical Center Experience

Kong¹,

Hong²

2014

Asian Pacific Journal of Cancer Prevention

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Background: Published studies on clinical outcome of helical tomotherapy for lung cancer are limited. The purpose of this study was to evaluate clinical outcomes and treatment-related toxicity in inoperable non-small cell lung cancer (NSCLC) patients treated with helical tomotherapy in Korea. Materials and Methods: Twentyseven patients with NSCLC were included in this retrospective study. Radiotherapy was performed using helical tomotherapy with a daily dose of 2.1-3 Gy delivered at 5 fractions per week resulting in a total dose of 62.5-69.3 Gy. We assessed radiation-related lung and esophageal toxicity, and analyzed overall survival, locoregional recurrence-free survival, distant metastasis-free survival, and prognostic factors for overall survival. Results: The median follow-up period was 28.9 months (range, 10.1-69.4). The median overall survival time was 28.9 months, and 1-, 2-, and 3-year overall survival rates were 96.2%, 92.0%, and 60.0%. The median locoregional recurrence-free survival time was 24.3 months, and 1-, 2-, and 3-year locoregional recurrence-free survival rates were 85.2%, 64.5%, and 50.3%. The median distant metastasis-free survival time was 26.7 months, and 1-, 2-, and 3-year distant metastasis-free survival rates were 92.3%, 83.9%, and 65.3%, respectively. Gross tumor volume was the most significant prognostic factor for overall survival. No grade 4 or more toxicity was observed. Conclusions: Helical tomotherapy in patients with inoperable NSCLC resulted in high survival rates with an acceptable level of toxicity, suggesting it is an effective treatment option in patients with medically inoperable NSCLC.

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Hypofractionated three-dimensional conformal radiotherapy for medically inoperable early stage non-small-cell lung cancer

Cited by 9 publications

References 22 publications

Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

Hypofractionated 3D radiotherapy for inoperable T1-3 N0-1 non-small-cell lung cancer

Clinical Outcome of Helical Tomotherapy for Inoperable Non-Small Cell Lung Cancer: The Kyung Hee University Medical Center Experience

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