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High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results.

Publication ,  Journal Article
King, SC; Acker, JC; Kussin, PS; Marks, LB; Weeks, KJ; Leopold, KA
Published in: Int J Radiat Oncol Biol Phys
October 1, 1996

PURPOSE: The treatment of nonsmall cell lung cancer (NSCLC) with conventional radiotherapy (RT) results in inadequate local tumor control and survival. We report results of a Phase II trial designed to treat patients with a significantly increased total dose administered in a reduced overall treatment time using a hyperfractionated, accelerated treatment schedule with a concurrent boost technique. METHODS AND MATERIALS: A total of 49 patients with unresectable Stage IIIA/IIIB (38 patients) or medically inoperable Stage I/II (11 patients) NSCLC were prospectively enrolled in this protocol. Radiation therapy was administered twice daily, 5 days/week with > 6 h between each treatment. The primary tumor and adjacent enlarged lymph nodes were treated to a total dose of 73.6 Gy in 46 fractions of 1.6 Gy each. Using a concurrent boost technique, electively irradiated nodal regions were simultaneously treated with a dose of 1.25 Gy/fraction for the first 36 fractions to a total dose of 45 Gy. RESULTS: Median survival for the entire group of 49 patients is 15.3 months. Actuarial survival at 2 years is 46%: 60% for 11 Stage I/II patients, 55% for 21 Stage IIIA patients, and 26% for 17 Stage IIIB patients. The actuarial rate of freedom from local progression at 2 years is 64% for the entire group of 49 patients: 62% for Stage I/II patients, 70% for Stage IIIA patients, and 55% for Stage IIIB patients. Patients who underwent serial bronchoscopic reevaluation (4 Stage I/II, 8 Stage IIIA, and 6 Stage IIIB) have an actuarial rate of local control of 71% at 2 years. The median total treatment time was 32 days. Nine of 49 patients (18%) experienced Grade III acute esophageal toxicity. The 2-year actuarial risk of Grade III or greater late toxicity is 30%. The 2-year actuarial rate of severe-late pulmonary and skin-subcutaneous toxicity is 20% and 15%, respectively. CONCLUSION: This treatment regimen administers a substantially higher biologically effective dose compared with conventional and pure hyperfractionation treatment schedules. The overall rate of acute and late toxicity was acceptable. Preliminary rates of overall survival and local control and freedom from local progression compare favorably to results reported with pure hyperfractionated radiotherapy and chemoradiotherapy.

Duke Scholars

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

October 1, 1996

Volume

36

Issue

3

Start / End Page

593 / 599

Location

United States

Related Subject Headings

  • Survival Analysis
  • Skin
  • Radiotherapy Dosage
  • Radiation Injuries
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lung Neoplasms
 

Citation

APA
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MLA
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King, S. C., Acker, J. C., Kussin, P. S., Marks, L. B., Weeks, K. J., & Leopold, K. A. (1996). High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results. Int J Radiat Oncol Biol Phys, 36(3), 593–599. https://doi.org/10.1016/s0360-3016(96)00353-7
King, S. C., J. C. Acker, P. S. Kussin, L. B. Marks, K. J. Weeks, and K. A. Leopold. “High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results.Int J Radiat Oncol Biol Phys 36, no. 3 (October 1, 1996): 593–99. https://doi.org/10.1016/s0360-3016(96)00353-7.
King SC, Acker JC, Kussin PS, Marks LB, Weeks KJ, Leopold KA. High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results. Int J Radiat Oncol Biol Phys. 1996 Oct 1;36(3):593–9.
King, S. C., et al. “High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results.Int J Radiat Oncol Biol Phys, vol. 36, no. 3, Oct. 1996, pp. 593–99. Pubmed, doi:10.1016/s0360-3016(96)00353-7.
King SC, Acker JC, Kussin PS, Marks LB, Weeks KJ, Leopold KA. High-dose, hyperfractionated, accelerated radiotherapy using a concurrent boost for the treatment of nonsmall cell lung cancer: unusual toxicity and promising early results. Int J Radiat Oncol Biol Phys. 1996 Oct 1;36(3):593–599.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

October 1, 1996

Volume

36

Issue

3

Start / End Page

593 / 599

Location

United States

Related Subject Headings

  • Survival Analysis
  • Skin
  • Radiotherapy Dosage
  • Radiation Injuries
  • Prospective Studies
  • Oncology & Carcinogenesis
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lung Neoplasms