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Non-uniform dose/time fractionated radiation therapy and chemotherapy for non-small cell lung cancer
M Mohiuddin1, K L Zeitzer, D J Moylan
1Department of Radiation Medicine, A.B. Chandler Medical Center, University of Kentucky, Lexington 40536, USA.
Purpose:
A Non-uniform Fractionation schedule of large priming doses combined with concurrent chemotherapy and protracted RT was undertaken for the treatment of NSCLC. With several 5-year survivors, this study is reviewed with regard to local control, toxicity, and survival of patients.
Methods And Materials:
Forty-two patients with unresectable NSCLC were treated prospectively with initial priming doses followed by large field irradiation to the tumor and regional nodes to 3500 cGy. Patients were given a 1-week break and the treatment was repeated. A total dose of 7000 cGy was delivered over 9 weeks. Thirteen patients (Group A) were treated with RT alone. Twenty-nine patients (Group B) received concurrent chemotherapy; Cisplatin, 100 mg/m2, and 5-FU, 1 g/m2 for 24 h times 5 days. Sixteen patients also received Vinblastine, 3 mg/m2 on a weekly schedule. All patients have been followed more than 5 years.
Results:
Overall complete response rate was 36% and partial response rate was 57%. Absolute survival at 2 years was 26% and at 5 years was 14%. Local failure occurred in 28/42 (67%) patients. Late complications included pulmonary fibrosis (3), and osteochondritis (2).
Conclusion:
This approach of high-dose Non-uniform fractionated radiation therapy has yielded an absolute 5-year survival of 14%, which appears better than the long-term results often seen in treatment of NSCL cancer.