Accelerated hyperfractionation in patients with non-small cell bronchogenic cancers as a cost-effective and user- and patient-friendly schedule

We developed an accelerated hyperfractionation schedule with acceptable eff ect and toxicity in non-small cell bronchogenic carcinomas. An evolutionary institutional pilot was initiated in March 1995 as a modification of Radia tion Therapy Oncology Group (RTOG) 9205, thrice-daily fractionation schedul e. Twenty-nine patients with bronchogenic and 7 with head and neck cancers had treatment initiated and completed. A dose of 1.2 Gy was delivered to a mediastinal plus tumor field concomitantly with synchronous boost of 0.6Gy to a limited volume of gross tumor (twice daily for 21 treatments days in 4 weeks) with a total dose being 75.60 Cy to the primary gross tumor and 50. 4 Gy to the elective volume. The bronchogenic cancers were stages IB (medic ally unresectable, n = 3), IIB (n = 4), IIIA (n = 4), or IIIB (n = -18). El even patients had squamous cell cancers, 13 adenocarcinomas, 1 large cell, and 2 carcinomas not specified With 12 months median follow-up, tolerance h as been excellent without any patient complaining of at least Oncology Nurs ing Society (ONS) grade 3 esophagitis; treatment interruptions occurred in only one patient after 8 days. Weight loss occurred in 12 patients, averagi ng 4.8% for these patients and 2% overall. Seven patients had a complete re sponse and 20 a partial response. Median survival was 12 months, 1-year sur vival 58%, 2-year 21%, and 3-year 18%. Seven patients with bronchogenic can cer are still alive. Seven head and neck cancer patients were treated in wh ich five had base of tongue tumors stage T2 to 4, N0 to N1. Pharyngitis and mucositis were problematic in at least four patients. The outcomes are com parable with other RTOG experience. Hyper-fractionated synchronous concomit ant boost of total tumor dose to 75.6 Gy in 4 weeks for bronchogenic patien ts was well tolerated and acceptable to physicians and patients.