Accelerated hyperfractionation for bronchogenic cancer: Radiation Therapy Oncology Group 9205

Area of Science:

• Oncology
• Radiation Oncology
• Clinical Trials

Background:

• Bronchogenic cancer treatment often involves radiation therapy.
• Accelerated hyperfractionation aims to improve therapeutic ratios by altering dose fractionation.
• Previous studies established benchmarks for radiation-alone outcomes in lung cancer.

Purpose of the Study:

• To assess the feasibility, toxicity, and patient acceptance of a novel accelerated hyperfractionation radiation therapy schedule.
• To deliver a total dose of 79.2 Gy in 72 fractions over 24 days, with three daily fractions of 110 cGy.
• To minimize tumor repopulation and enhance the biologically modeled therapeutic ratio.

Main Methods:

• A phase II clinical trial (RTOG 92-05) involving 35 patients with bronchogenic cancer.
• Administered 110 cGy per fraction, three times daily, with a 4-hour interfractional interval.
• The gross tumor received a boost during the middle fraction; other volumes received standard hyperfractionation.

Main Results:

• Treatment completion was achieved in 91% of patients.
• Acute toxicity >RTOG grade II occurred in 3 patients; overall late toxicity >= grade III in 6 patients.
• Median survival was 10.5 months, with 1-year survival at 42% and 3-year survival at 18%.

Conclusions:

• The accelerated hyperfractionation schedule was feasible and generally well-tolerated in this patient group.
• Despite numerous adverse prognostic variables, outcomes were comparable or favorable to prior radiation-alone studies.
• This approach warrants consideration for selected lung cancer patients, particularly those with poor prognostic factors.