Accelerated hypofractionated radiotherapy plus chemotherapy for inoperable locally advanced non-small-cell lung cancer: Final results of a prospective phase-II trial with a long-term follow-up

Elisabetta Parisi, Giovenzio Genestreti, Anna Sarnelli, Giulia Ghigi, Donatella Arpa, Marco Angelo Burgio, Giampaolo Gavelli, Alice Rossi, Emanuela Scarpi, Manuela Monti, Anna Tesei, Rolando Polico, Antonino Romeo

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Abstract

Background: Concurrent chemotherapy and radiation using conventional fractionation is the standard treatment for inoperable, locally advanced non-small-cell lung cancer (NSCLC). We tested accelerated hypofractionated radiotherapy (AHR) and chemotherapy for the treatment of locally advanced NSCLC. Methods: Eligible patients with locally advanced NSCLC were treated with induction chemotherapy (cisplatin and docetaxel), followed by AHR using tomotherapy and consolidation chemotherapy. The prescribed doses were 30 Gy/5 daily fractions at the reference isodose (60-70%) to the tumor, and 25 Gy/5 daily fractions to the clinically involved lymph nodes. The primary end-point was response rate (RR); the secondary end-points were acute and late side-effects, local progression-free survival (PFS), metastasis-free survival (MFS) and overall survival (OS). This trial closed before the first planned interim analysis due to poor accrual. Results: From January 2009 to January 2012, 17 of the 23 enrolled patients were evaluable. Treatment yielded an overall RR of 82%. Median follow-up was 87 months (range: 6-87), local PFS was 19.8 months (95% CI 9.7 - not reached), MFS was 9.7 months (95% CI 5.8-46.0) and OS was 23 months (95% CI 8.4-48.4). 70% of patients experienced acute G4 neutropenia, 24% G4 leukopenia, 24% G3 paresthesia, 4% G3 cardiac arrythmia, 4% underwent death after chemotherapy. Late toxicity was represented by 24% dyspnea G3. Conclusions: AHR combined with chemotherapy is feasible with no severe side-effects, and it appears highly acceptable by patients. Trial registration: This study is registered with the EudractCT registration 2008-006525-14. Registered on 9 December 2008.

Original languageEnglish
Article number112
JournalRadiation Oncology
Volume14
Issue number1
DOIs
Publication statusPublished - Jun 24 2019

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Keywords

  • Accelerated hypofractionation
  • Inoperable locally advanced non-small-cell lung cancer
  • Intensity modulated arc therapy (IMAT)
  • Radiotherapy and chemotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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