Hypofractionated Accelerated Concurrent Chemoradiotherapy in Inoperable Stage III Non-small Cell Lung Cancer: SOCCAR. A Large Single-Centre Experience

Excessive esophageal toxicity in patients with locally advanced non-small cell lung cancer treated with concurrent hypofractionated chemoradiotherapy and 3-weekly platinum doublet chemotherapy

“…Plausible explanations are that the PET-boost trial had: less platinum doublet chemotherapy (56% platinum doublet chemotherapy versus 100% in our cohort), less nodal disease (N3: 14% versus 34% in our cohort, N0: 12% versus 2%), smaller median lymph node GTV (18 cc versus 59 cc in our cohort), more VMAT radiotherapy planning (40% versus none in our cohort), and lower esophageal radiation doses: (median D 0.1% 1.6 Gy lower, D mean 3.3 Gy lower, V 35 6% lower, and the V 66 5% lower) (Table 3). The majority of experience with concurrent mildly hypofractionated chemoradiation is with the phase III EORTC-08972 schedule (24×2.75 Gy within 32 days and daily 6 mg/m 2, ) [4][5][6]12,13], the SOCCAR schedule: 20×2.75 Gy in four weeks with cisplatin/vinorelbine [16,[21][22][23] and the Polish trial regimen: 21×2.8 Gy in four weeks with cisplatin/vinorelbine [24]. All report excellent median overall survival with FDG-PET staging and modern radiotherapy techniques (supplementary Table A).…”

“…The favorable outcome and low toxicity profile of the EORTC-08972 schedule has been established in both randomized [4,5], prospective [13] and retrospective studies [6,12]. Evidence for concurrent chemoradiation using the SOCCAR schedule is based on a randomized trial including 70 patients (prior to modern staging and radiotherapy) [16] and retrospective studies including 30, 100 and 163 patients, some of which used FDG-PET staging and image guided radiotherapy techniques [21][22][23]. Prospective data on toxicity are limited for the SOCCAR schedule [16].…”