Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-10T21:00:31.006Z Has data issue: false hasContentIssue false

Accelerated hypofractionated radiotherapy for advanced lung cancer

Published online by Cambridge University Press:  27 June 2017

Christina Armpilia*
Affiliation:
Medical School, Aretaieion Hospital, National and Kapodistrian University of Athens, Athens, Greece Radiation Therapy Department, Iatriko Medical Center, Athens, Greece
Andriani Harpidou
Affiliation:
Oncology Unit, Third Department of Medicine, University of Athens, Sotiria General Hospital, Athens, Greece
Zoi Kalaitzi
Affiliation:
Oncology Unit, Third Department of Medicine, University of Athens, Sotiria General Hospital, Athens, Greece
Charilaos Tsapas
Affiliation:
Oncology Unit, Third Department of Medicine, University of Athens, Sotiria General Hospital, Athens, Greece
Sofia Tsagouli
Affiliation:
Oncology Unit, Iatriko Medical Center, Athens, Greece
Ioannis Gkiozos
Affiliation:
Oncology Unit, Third Department of Medicine, University of Athens, Sotiria General Hospital, Athens, Greece
Konstantinos Syrigos
Affiliation:
Oncology Unit, Third Department of Medicine, University of Athens, Sotiria General Hospital, Athens, Greece
*
Correspondence to: Christina Armpilia, Aretaieion University Hospital, Vas.Sofias 76 Avenue, 11528 Athens, Greece. Tel: 0030 210 728 6267. E-mail: charbilia@med.uoa.gr

Abstract

Introduction – purpose

The aim of this study is to review the results of applying a hypofractionated radiotherapy schedule for locally advanced inoperable lung cancer in patients who have received chemotherapy. Lung cancer and especially non-small-cell lung cancer is prone to accelerated repopulation and shorter treatment schedules in the form of accelerated radiotherapy have been shown to improve treatment outcome.

Patients – method

In total, 29 patients with inoperable lung cancer (stage II, IIIa,b, IV) were treated with accelerated hypofractionated 3D conformal radiotherapy. All patients received a dose of 55 Gy in 20 fractions (daily dose of 2·75 Gy). The median age was 65·5 years, 87% of patients had stage III–IV disease, 93% of patients received sequential chemotherapy with their radiotherapy. Median follow-up of patients was 36 months.

Results

The median overall survival from time of diagnosis was 16·5 months and the 1 year overall survival was 31%. Complications were present in 44·8% of the patients and the most common complication (20·7%) was pneumonitis alone. The complication rate was not significantly different according to histological type, stage, type of chemotherapy, presence of recurrence or death.

Conclusion

Although our study limitation is the small number of patients, these data suggest that the efficacy of this hypofractionated schedule could be considered as alternative option to the conventional regimen of 66 Gy given in 33 fractions.

Type
Original Articles
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Marcu Loredana, G. Altered fractionation in radiotherapy: from radiobiological rationale to therapeutic gain. Cancer Treat Rev 2010; 36: 606614.Google Scholar
2. Fu, XL, Jiang, G L, Wang, L J et al. Hyperfractionated accelerated radiation therapy for non-small lung cancer: clinical phase I/II trial. Int J Radiat Oncol Biol Phys 1997; 39: 545552.Google Scholar
3. Saunders M, Dische S, Barrett A et al. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee. Radioth Oncol 1999; 52 (2): 137148.CrossRefGoogle Scholar
4. Sause, W, Kolesar, P, Taylor, S IV et al. Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer (RTOG, EGOG & SWOG). Chest 2000; 117: 358364.Google Scholar
5. De Ruysscher, D, Wanders, R, van Haren, E et al. HI-CHART: a phase I/II study on the feasibility of high-dose continuous hyperfractionated accelerated radiotherapy in patients with inoperable non-small cell lung cancer. J Radiat Oncol Biol Phys 2008; 71 (1): 132138.Google Scholar
6. Bonomi, M, Blanco-Savorio, A, Cerchietti, L et al. Continuous hyperfractionated accelerated radiation therapy week-end less in combination with neoadjuvant chemotherapy for the treatment of stage III non-small-cell lung cancer. Lung Cancer 2008; 60 (1): 7582.Google Scholar
7. Rojas, A M, Lyn, B E, Wilson, E M et al. Toxicity and outcome of a phase II trial of taxane-based neoadjuvant chemotherapy and 3-dimensional, conformal, accelerated radiotherapy in locally advanced nonsmall cell lung cancer. Cancer 2006; 107 (6): 13211330.CrossRefGoogle ScholarPubMed
8. Zwitter, M, Kovac, V, Smrdel, U, Strojan, P. Gemcitabine, cisplatin, and hyperfractionated accelerated radiotherapy for locally advanced non-small cell lung cancer. J Thorac Oncol 2006; 1 (7): 662666.Google Scholar
9. Fowler, J F. Review Article. 21 years of biologically effective dose. Br J Radiol 2010; 83: 554568.Google Scholar
10. Detterbeck, F, Boffa, D J, Tanoue, L T. The new lung cancer staging system. Chest 2009; 136: 260271.Google Scholar
11. Marks, L B, Yorke, E D, Jackson, A et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 2010; 76 (3 suppl): S10S19.Google Scholar
12. Mehta, M, Scrimger, R, Mackie, R et al. A new approach to dose escalation in non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2001; 49: 2223.Google Scholar
13. Koukourakis, M, Patlakas, G, Froudarakis, M et al. Hypofractionated accelerated radiochemotherapy with cytoprotection (chemo-hypoARC) for inoperable non-small cell lung carcinoma. Anticancer Res 2007; 27: 36253632.Google Scholar
14. Din, O, Harden, S V, Hudson, E et al. Accelerated hypo-fractionated radiotherapy for non-small cell lung cancer: results from 4 UK centres. Radiother Oncol 2013; 109 (1): 812.CrossRefGoogle ScholarPubMed
15. Gandara, D R, Chansky, K, Albain, K S et al. Consolidation docetaxel after concurrent chemoradiotherapy in stage IIIB non-small cell lung cancer: phase II Southwest Oncology Group Study S9504. J Clin Oncol 2003; 21 (10): 20042010.Google Scholar
16. Hanna, N, Neubauer, M, Yiannoutsos, C et al. Phase III study of cisplatin, etoposide, and concurrent chest radiation with or without consolidation docetaxel in patients with inoperable stage III non-small cell lung cancer: the Hoosier Oncology Group and U.S. Oncology. J Clin Oncolol 2008; 26 (35): 57555760.Google Scholar
17. Curran, W J, Paulus, R, Langer, C J et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst 2011; 103 (19): 14521460.Google Scholar
18. Furuse, K, Fukuola, M, Kawahara, M et al. Phase III study of concurrent versus sequential thoracic radiotherapy in combination with mitomycin, vindesine, and cisplatin in unresectable stage III non-small-cell lung cancer. J Clin Oncol 1999; 17 (9): 26922699.Google Scholar
19. Bradley, J D, Paulus, R, Komaki, R et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small cell lung cancer (RTOG 0617): a randomized, two by two factorial phase 3 study. Lancet Oncol 2015; 16 (2): 187199.CrossRefGoogle ScholarPubMed
20. Faria, S L, Souhami, L, Portelance, L et al. Absence of toxicity with hypofractionated 3-dimensional radiation therapy for inoperable, early stage non-small cell lung cancer. Radiat Oncol 2006; 1: 42.Google Scholar