Outcomes and Toxicity following High-Dose Radiation Therapy in 15 Fractions for Non-Small Cell Lung Cancer

Publication date: Available online 9 March 2017
Source:Practical Radiation Oncology
Author(s): Penny Fang, Cameron W. Swanick, Todd A. Pezzi, Zhongxing Liao, James Welsh, Steven H. Lin, Daniel R. Gomez
Background and PurposeAccelerated hypofractionated radiation therapy (AHRT) is increasingly used for select lung cancer patients. We evaluated clinical outcomes and predictors of pulmonary/esophageal toxicity in patients treated with ≥52.5Gy in 15 fractions.Material and MethodsWe evaluated 229 patients treated with RT doses ≥52.5Gy in 15 fractions for non-small cell lung cancer from January 2009–January 2016. Toxicity was scored using Common Terminology Criteria for Adverse Events, v4.0. Univariate and multivariate logistic regression was used to identify predictors of toxicity. Overall survival (OS), progression-free survival (PFS), and local control (LC) were estimated using Kaplan–Meier method. Predictors of clinical outcome were modeled using Cox proportional hazards regression.ResultsMedian follow-up was 7months. Forty-two patients (19%) developed grade≥2 pneumonitis, and nine (4%) grade≥3 esophagitis. In multivariate analysis, age>75years (OR2.56, 95%CI 1.24–5.25, P=0.01) and lung V10≥32% were associated with grade≥2 pneumonitis (OR2.79, 95%CI 1.39–5.79, P=0.005). On univariate analysis, esophagus mean dose ≥17Gy (OR10.14, 95%CI 1.82–189.8, P=0.006), GTV size ≥71cm3 (P=0.002) and PTV size ≥409cm3 (P=0.02) were associated with development of grade≥3 esophagitis. In patients with stage II/III disease (n=73), median LC was not reached, median OS 14months, and median PFS 6months.ConclusionsAHRT in 15 fractions can be safe and effective. Consideration for using AHRT with immunotherapy and sequential chemotherapy for improved out-of-radiation field and distant control is warranted.



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