Accelerated hyperfractionation for bronchogenic cancer - Radiation TherapyOncology Group 9205

RTOG 92-05 was a phase II trial developed to evaluate the feasibility, toxi city, and acceptance of a three times daily accelerated hyperfractionation radiation therapy schedule delivering 110 cGy, three times daily, to 79.2 G y uncorrected tumor dose in 72 fractions, in 24 treatment days, in patients with bronchogenic cancer. The radiographically visible tumor received acce lerated hyperfractionation and the other radiation volume received standard hyperfractionation. Three times a day, a dose of 110 cGy was delivered, wi th an interfractional interval of 4 hours; the middle fraction was a gross tumor boost. This schedule allowed treatment to be completed in approximate ly 4(1)/(2) weeks in an effort to minimize repopulation, to have a better b iologically modeled therapeutic ratio than other schedules that have been c ompleted in cooperative groups, and to use doses within cooperative group e xperience. In 33 months 35 patients were entered into the study; 15 of the patients had squamous cell carcinomas, 10 had adenocarcinomas, 8 had large- cell undifferentiated carcinomas, and 2 had unspecified non-small-cell canc ers. Nineteen patients had AJCC stage IIIB; 13, IIIA; 14, T4; 10, T3; 13, N 2; and 7, N3. Twenty-one patients (60%) had greater than 5% weight loss. Th e Karnofsky performance status was 90 to I00 in 12 patients and 70 to 80 in 23 patients. Treatment was completed in 91% of patients. Acute toxicity >R TOG grade TI occurred in three patients: one skin, one lung, and two esopha gus (one each III and IV, the only grade IV in the study). Overall late tox icity greater than or equal to grade III occurred in six patients: three lu ng, one thyroid, one esophagus, and one subcutaneous tissue tall grade mj. The median survival was 10.5 months, 1-year survival was 42%, and 3-year su rvival was 18%. The outcome in this group of patients with many adverse pro gnostic variables compared favorably to prior RTOG radiation-alone studies.