Hyperfractionated accelerated radiotherapy (HART) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (NSCLC): Results of a phaseII study for patients ineligible for combination radiochemotherapy

Purpose: To evaluate a hyperfractionated and accelerated radiotherapy (HART ) protocol in patients with inoperable non-small cell lung carcinoma (NSCLC ) who were ineligible for combination radiochemotherapy studies. Methods and Materials: From February 1989 through August 1994, 23 patients ineligible for available combined modality protocols in our institution wer e enrolled and treated with HART, consisting of 63 Gy given in 42 fractions of 1.5 Gy each, twice daily, with a minimum time interval of 6 h between f ractions, 5 days a week, over an elapsed time of 4.2 weeks, or 29 days. The re was no planned interruption. Results: The 1-, 2-, and 3-year survival rates were 61%, 39%, and 19%, resp ectively, with a median survival of 16.8 months. At the time of analysis, 4 patients are alive and 19 have died, 16 from NSCLC and 3 from cardiac dise ase. Overall response rate was 48%, with 22% of patients achieving a comple te response and 26% a partial response. Correlation between acute response rate and survival was poor. First site of relapse was local-regional in 8 p atients (35%), distant in 6 patients (26%), and local-regional and distant in 4 (17%) patients. One patient had Grade IV and 2 had Grade III esophagit is. One patient presented with chronic Grade III lung toxicity. There were no treatment-related deaths. Conclusion: In this group of 23 patients ineligible for radiochemotherapy, this HART regime was quite feasible and was followed by little toxicity. Re sults in this particularly poor prognosis NSCLC patient category should be compared to series with a similar patient profile; however, median survival is at least similar to that obtained in recent series of combination radio chemotherapy. (C) 1999 Elsevier Science Inc.