PILOT-STUDY OF ACCELERATED HYPERFRACTIONATED THORACIC RADIATION-THERAPY IN PATIENTS WITH UNRESECTABLE STAGE-III NONSMALL CELL LUNG-CARCINOMA

Background. The primary goal of this study was to determine the incide nce of severe or greater acute radiation toxicity, and secondarily, re sponse, survival, and local control in patients with unresectable Stag e IIIA or B non-small cell lung cancer treated with accelerated hyperf ractionated thoracic radiation therapy (AHTRT). Methods. From Septembe r, 1989 through March, 1990, 21 evaluable patients with unresectable S tage IIIA or B non-small cell lung cancer were treated with AHTRT, usi ng 6000 cGy in 40 fractions of 150 cGy twice daily, 6 hours between fr actions, with a 2-week break midway through treatment. Results. Two pa tients (9.5%) had acute Grade 3 radiation esophagitis requiring intrav enous hydration, and two patients (9.5%) had acute Grade 3 radiation p neumonitis requiring oxygen and steroids. Only one patient had chronic toxicity, a Grade 3 radiation pneumonitis. Five patients (24%) achiev ed a complete response, whereas eight (38%) had a partial response or regression. With minimum follow-up of nearly 3 years, 3 patients are a live and 18 are dead. The median survival time and 1-, 2-, and 3-year survival rates were 10.8 months, 48%, 29%, and 14%, respectively. Loca l control was achieved in 11 of 21 (52%) patients. Conclusions. This A HTRT regimen can be given with an acceptable incidence of acute radiat ion toxicity. Response, survival, and local control rates in this unfa vorable group of patients are encouraging. A North Central Cancer Trea tment Group Phase III study of standard thoracic radiation therapy (60 00 cGy in 30 fractions of 200 cGy daily) versus AHTRT (+/- chemotherap y) is now open.