Results of a preliminary study using hypofractionated involved-field radiation therapy and concurrent carboplatin/paclitaxel in the treatment of locally advanced non-small-cell lung cancer

Matsuura, K.; Kimura, Tomoki; Kashiwado, K.; Fujita, K.; Akagi, Yukio; Yuki, Shintarou; Murakami, Yuji; Wadasaki, Koichi; Misawa, Yoshio; Ito, Atsushi; Kagemoto, Masayuki; Mori, Masaki; Ito, Katsuhide; Nagata, Yasushi

doi:10.1007/s10147-009-0889-0

Cited by 16 publications

(12 citation statements)

References 22 publications

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“…To our knowledge, no other study investigating hypofractionation in combination with concurrent chemotherapy has reported such impressive OS rates. Other studies using hypofractionation schemes used a number of fractions ranging from 15 to 30 with doses per fraction ranging from 2.40 Gy to 3.50 Gy [15][16][17][18]. Median OS ranged from 8 months to 29.5 months, compared to 31.5 months in our study.…”

Section: Discussionmentioning

confidence: 63%

Long-term follow-up of patients with locally advanced non-small cell lung cancer receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab

Walraven

Heuvel

Diessen

et al. 2016

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 63%

Long-term follow-up of patients with locally advanced non-small cell lung cancer receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab

Walraven

Heuvel

Diessen

et al. 2016

Radiotherapy and Oncology

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“…Theoretically, it was hypothesized that hypofractionated radiotherapy with concurrent chemotherapy could reasonably further increase efficacy. Therefore, studies exploring hypofractionated radiotherapy with concurrent chemotherapy are emerging [ 22 – 29 ]. These studies obtained inspiring survival results: the MST was 13.4–29.5 months, the 1-year OS was 56–90 %, and the 2-year OS was 30–58.3 % [ 24 – 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hypofractionated radiotherapy has a dosimetric advantage; it shortens the treatment time, increases the biological effective dose (BED), and can potentially reduce the effect of accelerated repopulation on local failure [ 6 , 11 ]. Compared with hyperfractionated radiation, hypofractionated radiotherapy has the advantages of convenience, economy, and easy implementation; thus, it has increasingly more clinical applications [ 12 – 29 ].…”

Section: Introductionmentioning

confidence: 99%

Accelerated hypofractionated three-dimensional conformal radiation therapy (3 Gy/fraction) combined with concurrent chemotherapy for patients with unresectable stage III non-small cell lung cancer: preliminary results of an early terminated phase II trial

et al. 2016

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BackgroundIncreasing the biological effective dose (BED) of radiotherapy for non-small cell lung cancer (NSCLC) can increase local control rates and improve overall survival. Compared with conventional fractionated radiotherapy, accelerated hypofractionated radiotherapy can yield higher BED, shorten the total treatment time, and theoretically obtain better efficacy. However, currently, there is no optimal hypofractionated radiotherapy regimen. Based on phase I trial results, we performed this phase II trial to further evaluate the safety and preliminary efficacy of accelerated hypofractionated three-dimensional conformal radiation therapy(3-DCRT) combined with concurrent chemotherapy for patients with unresectable stage III NSCLC.MethodsPatients with previously untreated unresectable stage III NSCLC received 3-DCRT with a total dose of 69 Gy, delivered at 3 Gy per fraction, once daily, five fractions per week, completed within 4.6 weeks. At the same time, platinum doublet chemotherapy was applied.ResultsAfter 12 patients were enrolled in the group, the trial was terminated early. There were five cases of grade III radiation esophagitis, of which four cases completed the radiation doses of 51 Gy, 51 Gy, 54 Gy, and 66 Gy, and one case had 16 days of radiation interruption. The incidence of grade III acute esophagitis in patients receiving an irradiation dose per fraction ≥2.7 Gy on the esophagus was 83.3 % (5/6). The incidence of symptomatic grade III radiation pneumonitis among the seven patients who completed 69 Gy according to the plan was 28.6 % (2/7). The median local control (LC) and overall survival (OS) were not achieved; the 1-year LC rate was 59.3 %, and the 1-year OS rate was 78.6 %.ConclusionFor unresectable stage III NSCLC, the accelerated hypofractionated radiotherapy with a total dose of 69 Gy (3 Gy/f) combined with concurrent chemotherapy might result in severe radiation esophagitis and pneumonitis to severely affect the completion of the radiotherapy. Therefore, we considered that this regimen was infeasible. During the hypofractionated radiotherapy with concurrent chemotherapy, the irradiation dose per fraction to esophagus should be lower than 2.7 Gy. Further studies should be performed using esophageal tolerance as a metric in dose escalation protocols.Trial registrationNCT02720614, the date of registration: March 23, 2016.

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“…One of the possible explanations for this counter intuitive finding was the higher toxicities in the higher dose group (23). The same results were obtained for HypoRT in the only randomized trial that has compared sequential and concurrent chemoradiation using an accelerated HypoRT scheme (there was no difference in outcomes) (24), although encouraging results had been found in smaller studies (25,26). Perhaps such combinations can be used in the future when less toxic agents have been developed and with more advanced radiation techniques such as proton radiation.…”

Section: Discussionmentioning

confidence: 84%

Sequential Chemoradiotherapy with Accelerated Hypofractionated Radiotherapy Compared to Concurrent Chemoradiotherapy with Standard Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer

Zhu

Liang

Fan

et al. 2014

Technol Cancer Res Treat

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To compare the outcomes and treatment-related toxicities of two chemoradiotherapy schedules given to the patients with unresectable locally advanced non-small cell lung cancer (NSCLC): sequential chemotherapy with accelerated hypofractionated radiotherapy (SCRT), and concurrent chemotherapy with standard radiotherapy (CCRT), 68 patients from two prospective clinical trials were included. Thirty-four patients were treated with SCRT using an accelerated hypofractionated radiation schedule, 34 patients received CCRT with standard radiation. Between the two treatment groups there were no significant differences in terms of overall survival, progression-free survival (PFS), locoregional-PFS or distant metastasis-PFS. For the SCRT group, the median survival time and 2- and 4-year overall survival rates were 19 months, 38.2%, and 23.5%, respectively, and for the CCRT group these were 19 months, 44.1%, and 19.6%. Esophageal and constitutional toxicities were more pronounced in the CCRT group, while there was no significant difference in pulmonary toxicities. The results suggest that for unresectable stage III NSCLC, the outcomes of SCRT with accelerated hypofractionated radiotherapy and CCRT with standard radiotherapy are similar, but the toxicities associated with treatment are less in the SCRT group.

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Results of a preliminary study using hypofractionated involved-field radiation therapy and concurrent carboplatin/paclitaxel in the treatment of locally advanced non-small-cell lung cancer

Abstract: Hypofractionated IFRT with weekly CBDCA/PTX was a feasible treatment regimen. Hypofractionated IFRT with a total dose of 67.5 Gy or more could be a promising modality to improve the treatment results in patients with locally advanced NSCLC.

Cited by 16 publications

References 22 publications

Long-term follow-up of patients with locally advanced non-small cell lung cancer receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab

Long-term follow-up of patients with locally advanced non-small cell lung cancer receiving concurrent hypofractionated chemoradiotherapy with or without cetuximab

Accelerated hypofractionated three-dimensional conformal radiation therapy (3 Gy/fraction) combined with concurrent chemotherapy for patients with unresectable stage III non-small cell lung cancer: preliminary results of an early terminated phase II trial

Sequential Chemoradiotherapy with Accelerated Hypofractionated Radiotherapy Compared to Concurrent Chemoradiotherapy with Standard Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer

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