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Non-Small Cell Lung Cancer in Stages I–IIIB

Long-Term Results of Definitive Radiotherapy with Doses ≥ 80 Gy in Standard Fractionation

Nichtkleinzelliges Bronchialkarzinom im Stadium I–IIIB. Langzeitergebnisse einer Radiotherapie mit ≥ 80 Gy in konventioneller Fraktionierung

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Abstract

Purpose:

To investigate therapeutic outcome of dose escalation ≥ 80 Gy in nonresected non-small cell lung cancer (NSCLC).

Patients and Methods:

124 consecutive patients with histologically/cytologically proven NSCLC were enrolled. Tumor stage I, II, IIIA, and IIIB was diagnosed in 30, eight, 39, and 47 patients, respectively. 38 patients (31%) had weight loss > 5% during the 3 months before diagnosis. A median dose of 88.2 Gy (range 80.0–96.0 Gy), 69.3 Gy (63.0–88.0 Gy) and 56.7 Gy was applied to primary lesions, involved lymph nodes, and elective nodes (within a region of about 6 cm cranial to macroscopically involved nodes), respectively. Daily fractional ICRU doses of 2.0–2.2 Gy were delivered by the conformal target-splitting technique. 58 patients (47%) received induction chemotherapy, in median two cycles prior to radiotherapy.

Results:

Median follow-up time of all patients was 19 months, of patients alive 72.4 months (69–121 months). The cumulative actual overall survival rate at 2 and 5 years amounts to 39% and 11.3%, respectively, resulting in a median overall survival time of 19.6 months. According to stages I, II, IIIA, and IIIB, the median overall survival times are 31.8, 31.4, 19.0, and 14.5 months, respectively. The locoregional tumor control rate at 2 years is 49%. Apart from one treatment-related death (pneumonitis), acute toxicity according to EORTC/RTOG scores was moderate: lung grade 2 (n = 7), grade 3 (n = 3); esophagus grade 1 (n = 11); heart grade 3 (n = 1, pericarditis). No late toxicity grade > 1 has been observed.

Conclusion:

Sequential, conventionally fractionated high-dose radiotherapy by conformal target splitting is well tolerated. The results for survival and locoregional tumor control seem to at least equalize the outcome of simultaneous chemoradiation approaches, which, at present, are considered “state of the art” for patients with nonresected NSCLC. A higher potential of radiation therapy might be reached by accelerated fractionation regimens.

Zusammenfassung

Ziel:

Evaluierung der Behandlung mit Dosen ≥ 80 Gy bei nichtoperierter Patienten mit nichtkleinzelligem Bronchialkarzinom (NSCLC).

Patienten und Methodik:

124 konsekutiv zugewiesene Patienten mit histologisch/zytologisch verifiziertem NSCLC wurden untersucht (Tabelle 1). Ein Tumorstadium I, II, IIIA und IIIB lag bei 30, acht, 39 bzw. 47 Patienten vor. Bei 38 Patienten (31%) zeigte sich ein Gewichtsverlust > 5% in den 3 Monaten vor Diagnosestellung. Primartumoren wurden im Mittel mit 88,2 Gy (Bandbreite 80,0–96,0 Gy), makroskopisch befallene Lymphknoten mit 69,3 Gy (63,0–88,0 Gy) und elektive Lymphknotenstationen (Region von etwa 6 cm kranial der makroskopisch befallenen Lymphknoten) mit 56,7 Gy behandelt (Tabelle 2). ICRU-Einzeldosen von 2,0–2,2 Gy wurden mit der konformalen „target-splitting“-Technik appliziert. 58 Patienten (47%) erhielten zwei Zyklen einer Induktionschemotherapie.

Ergebnisse:

Die noch lebenden Patienten wurden im Mittel 72,4 Monate nachbeobachtet (69–121 Monate). Die kumulativen 2- und 5-Jahres-Überlebensraten betragen 39% bzw. 11,3% bei einer medianen Überlebenszeit (ULZ) von 19,6 Monaten. Bezogen auf die Tumorstadien I, II, IIIA bzw. IIIB beträgt die mediane Überlebenszeit 31,8, 31,4, 19,0 bzw. 14,5 Monate. Die lokoregionare 2-Jahres-Tumorkontrollrate liegt bei 49%. Ein Patient verstarb infolge einer Pneumonitis, ansonsten war die Toxizitat gemessen an den EORTC/RTOG-Scoring-Kriterien moderat: Pneumonitis Grad 2 (n = 7), Grad 3 (n = 3); Osophagus Grad 1 (n = 11); Herz Grad 3 (n = 1, Perikarditis; Tabelle 3). Bei keinem Patienten trat eine Spattoxizitat > Grad 1 auf.

Schlussfolgerung:

Eine sequentielle, konventionell fraktionierte, hochdosierte Bestrahlung mittels „target-splitting“-Technik zeigt eine geringe Morbiditat. Die Ergebnisse bezüglich Überlebenszeit und lokaler Tumorkontrolle erscheinen gegenüber den Resultaten der simultanen Chemo-/Radiotherapie, die derzeit als „state of the art“ angesehen wird, zumindest als ebenbürtig (Tabelle 4). Eine weitere Steigerung des strahlentherapeutischen Potentials durfte mit akzelerierten Fraktionierungsschemata moglich sein.

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Authors and Affiliations

  1. University Clinic of Radiotherapy and Radiation Oncology and radART –, Institute for research and development on Advanced Radiation Technologies, Paracelsus Medical University, Salzburg, Austria

    Karl Wurstbauer, Hannes Weise, Heinz Deutschmann, Peter Kopp, Florian Merz & Felix Sedlmayer

  2. University Clinic of Pneumology, Paracelsus Medical University, Salzburg, Austria

    Michael Studnicka

  3. Heidelberg Ion Beam Therapy Center (HIT), Heidelberg, Germany

    Olaf Nairz

  4. Universitätsklinik für Radiotherapie und Radio-Onkologie, Müllner Hauptstraße 48, 5020, Salzburg, Austria

    Karl Wurstbauer

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  1. Karl Wurstbauer
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  2. Hannes Weise
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  3. Heinz Deutschmann
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  4. Peter Kopp
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Correspondence to Karl Wurstbauer.

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Wurstbauer, K., Weise, H., Deutschmann, H. et al. Non-Small Cell Lung Cancer in Stages I–IIIB. Strahlenther Onkol 186, 551–557 (2010). https://doi.org/10.1007/s00066-010-2108-3

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  • DOI: https://doi.org/10.1007/s00066-010-2108-3

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