Simultaneous Integrated Boost of intensity modulated radiation therapy to Stage II-III Non-Small Cell Lung Cancer with metastatic lymph nodes

Abstract

Background: Local tumor failure remains a major problem after radiation-based nonsurgical treatment for unresectable locally advanced Non-Small Cell Lung Cancer （NSCLC）and inoperable stage II NSCLC .The aim of this study was to evaluate the feasibility of Simultaneous Integrated Boos of intensity modulated radiation therapy (SIB-IMRT) to Stage II-III NSCLC with metastatic lymph nodes. Methods: Patients were diagnosed by pathology or PET-CT. PTV was divide into two parts as follow, the PTV of primary tumor (PTVp) and the PTV of metastatic lymph nodes (PTVn) .The radiation doses were simultaneously prescripted 78Gy (BED = 101.48Gy) for PTVp and 60-65Gy (BED = 73.6-81.25Gy) for PTVn, 26f/ 5.2 weeks .Response was scored according to WHO criteria. Radiotherapy toxicity was scored according to RTOG criteria .Hematology and gastrointestinal toxicity were scored according to CTCAE1.0 criteria. Results: A total of 20 patients were enrolled. 17 patients were diagnosed by pathology and 3 patients were diagnosed by PET-CT . All patients were treated with SIB-IMRT. The objective response rate (ORR) was 90%, with CR 25%, PR 65%, NC 10% and PD 0%. Although Radiation toxicitiy was common, there were no grade≥3，with Radiation pneumonitis (10 cases), esophagitis (17 cases) and dermatitis (12 cases). The local control rates at 1, 3 and 5 years were 85%, 75% and 70%, respectively. The overall survival（OS）and local progression-free survival(LPFS) rates at 1, 3 and 5 years were 90%, 42.6%, 35.5% and 84.4%, 35.5% , 28.4%, respectively. The MST was 24 months. Conclusions: SIB-IMRT can significantly improve ORR and suivival for stage II-III NSCLC with metastatic lymph nodes , with high safety and satisfactory efficacy . Keywords: cancer/non-small-cell lung cancer; radiation therapy /SIB-IMRT; efficacy; safety Retrospective Trial Registration： (ChiCTR 2000029304)

Chemoradiotherapy by intensity-modulated radiation therapy with simultaneous integrated boost in locally advanced or oligometastatic non-small-cell lung cancer—a two center experience

“…However, their reported case numbers are very low and FU time rather short, so one should await the results of their ongoing phase II trial. Li et al reported on 20 patients treated with IMRT for inoperable stage II-III NSCLC with metastatic lymph nodes [21]. They treated their patients with a total dose of 78 Gy and 60-65 Gy for the primary and the metastatic lymph nodes, respectively, prescribed simulta- By contrast, fiercely escalated hypofractionation to the primary tumor or subregions of high FDG-uptake in concurrent or sequential CRT has been shown to be feasible, but associated with higher acute and late toxicities compared to conventional CRT [22].…”