Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer

Sergio L Faria, Luis Souhami, Lorraine Portelance, Marie Duclos, Te Vuong, David Small, Carolyn R Freeman, Sergio L Faria, Luis Souhami, Lorraine Portelance, Marie Duclos, Te Vuong, David Small, Carolyn R Freeman

Abstract

Purpose: Hypofractionated radiotherapy may overcome repopulation in rapidly proliferating tumors such as lung cancer. It is more convenient for the patients and reduces health care costs. This study reports our results on patients with medically inoperable, early stage, non-small cell lung cancer (NSCLC) treated with hypofractionation.

Materials and methods: Stage T1-2N0 NSCLC patients were treated with hypofractionation alone, 52.5 Gy/15 fractions, in 3 weeks, with 3-dimensional conformal planning. T1-2N1 patients with the hilar lymphnode close to the primary tumor were also eligible for this treatment. We did not use any approach to reduce respiratory motion, but it was monitored in all patients. Elective nodal radiotherapy was not performed. Routine follow up included assessment for acute and late toxicity and radiological tumor response. Median follow up time was 29 months for the surviving patients.

Results: Thirty-two patients with a median age of 76 years, T1 = 15 and T2 = 17, were treated. Median planning target volume (PTV) volume was 150cc and median V16 of both lungs was 13%. The most important finding of this study is that toxicity was minimal. Two patients had grade < or = 2 acute pneumonitis and 3 had mild (grade 1) acute esophagitis. There was no late toxicity. Actuarial 1 and 2-year overall survival rates are 78% and 56%, cancer specific survival rates (CSS) are 90% and 74%, and local relapse free survival rates are 93% and 76% respectively.

Conclusion: 3-D planning, involved field hypofractionation at a dose of 52.5 Gy in 15 daily fractions is safe, well tolerated and easy radiation treatment for medically inoperable lung cancer patients. It shortens by half the traditional treatment. Results compare favorably with previously published studies. Further studies are needed to compare similar technique with other treatments such as surgery and stereotactic radiotherapy.

Figures

Figure 1
Figure 1
Example of a lung tumor in the right lower lobe easily seen by fluoroscopy with normal breathing during expiration (A) and inspiration (B). The radiation field, in spite of the motion, encompasses appropriately the tumor. The maximum displacement is only 4 mm.
Figure 2
Figure 2
Example of typical 3-dimensional planning with 2 fields avoiding the esophagus, heart and spinal cord.
Figure 3
Figure 3
Overall (OS) (lower) and Cancer Specific (CSS) (upper) actuarial survival curves.

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Source: PubMed

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