Moderately escalated hypofractionated (chemo) radiotherapy delivered with helical intensity-modulated technique in stage III unresectable non-small cell lung cancer

Purpose:To assess clinical outcomes and toxicities in patients with stage III unresectable non-small cell lung cancer (NSCLC) treated with a moderately escalated hypofractionated radiotherapy delivered with Helical Intensity-ModulatedTechnique in combination with sequential or concurrent chemotherapy. Materials and Methods: Sixty-one consecutive patients considered non-progressive after two cycles of induction chemotherapy were treated with a moderately escalated hypofractionated radiation course of 30 daily fractions of 2.25–2.28 Gy each administered in 6weeks up to a total dose of 67.5–68.4 Gy (range, 64.5–71.3 Gy). Thirty-two received sequential RT after two more cycles (total=4 cycles) of chemotherapy, while 29were treated with concurrent chemo-radiation.The target was considered the gross tumor volume and the clinically proven nodal regions, without elective nodal irradiation. Results:With a median follow up of 27 months (range 6–40), 1-year and 2-year OS rate for all patients was 77 and 53%, respectively, with a median survival duration of 18.6 months in the sequential group and 24.1 months in the concomitant group. No Grade !4 acute and late toxicity was reported. Acute Grade 3 treatment-related pneumonitis was detected in 10% of patients.Two patients, both receiving the concurrent schedule, developed a Grade 3 acute esophagitis.The overall incidence of late Grade 3 lung toxicity was 5%. No patients experienced a Grade 3 late esophageal toxicity. Conclusion: A moderately hypofractionated radiation course delivered with a Helical Intensity-ModulatedTechnique is a feasible treatment option for patients with unresectable locally advanced NSCLC receiving chemotherapy (sequentially or concurrently). Hypofractionated radiotherapy with a dedicated technique allows safely dose escalation, minimizing the effect of tumor repopulation that may occur with prolonged treatment time.