Definitive Radiotherapy in LocallyAdvanced Non-Small Cell Lung Cancer: Dose and Fractionation

Abstract

Definitive radiotherapy plays a major role in the treatment of locally advanced non-small cell lung cancer (LA NSCLC). After the impact of RT dose for lung cancer was established, a number of trials were structured with the aim of better local control and overall survival by either dose escalation or shortening the total treatment time through conventional/altered fractionation, even in combination with chemotherapy (CT) and other targeted agents. In spite of the increased number of these studies, the optimal dose or fractionation still remains to be determined. Another aspect questioned is the incorporation of these higher doses and shorter treatment times with chemotherapy or targeted agents. This review summarises the results of significant trials on dose and altered fractionation in the treatment of LA-NSCLC with an emphasis on possible future perspectives.

Keywords

• Dose, fractionation, non-small cell lung cancer, radiotherapy

References

1. 1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. Cancer J Clin 2012;62:10-29. [CrossRef]
2. 2. Perez CA, Stanley K, Rubin P, Kramer S, Brady L, Perez-Tamayo R, et al. A prospective randomize study of various irradiation doses and fractionation schedules in the treatment of inoperable non-oat-cell carcinoma of the lung. Cancer 1980;45:2744-53. [CrossRef]
3. 3. Martel MK, Ten Haken RK, Hazuka MB, Kessler ML, Strawderman M, Turrisi AT, et al. Estimation of tumor control probability model parameters from 3-D dose distributions of non-small cell lung cancer patients. Lung Cancer 1999;24: 31-7. [CrossRef]
4. 4. Bradley J, Graham MV, Winter K. Toxicity and outcome results of RTOG 9311: A phase I-II dose escalation study using three-dimensional conformal radiotherapy in patients with inoperable non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 2005;61:318-28. [CrossRef]
5. 5. Rosenzweig KE, Fox JL, Yorke E. Results of a phase I dose-escalation study using three-dimensional conformal radiotherapy in the treatment of inoperable nonsmall cell lung carcinoma. Cancer 2005;103: 2118-27. [CrossRef]
6. 6. Sause WT, Scott C, Taylor S, Johnson D, Livingston R, Komaki R, et al. Radiation Therapy Oncology Group (RTOG) 88-08 and Eastern Cooperative Oncology Group (ECOG) 4588: Preliminary results of a phase III trial in regionally advanced unresectable non-small-cell lung cancer. J Natl Cancer Inst 1995;87:198-205. [CrossRef]
7. 7. Bradley JD, Moughan J, Graham MV, Byhardt R, Govindan R, Fowler J, et al. A Phase I/II radiation dose escalation study with concurrent chemotherapy for patients with inoperable stages I to III non-small-cell lung cancer: Phase I results of RTOG 0117. Int J Radiat Oncol Biol Phys 2010;77:367-72. [CrossRef]
8. 8. Socinski MA, Rosenman JG, Halle J, Schell MJ, Lin Y, Russo S, et al. Dose-escalating conformal thoracic radiation therapy with induction and concurrent carboplatin/paclitaxel in unresectable stage IIIa/b nonsmall cell lung carcinoma: a modified phase I/II trial. Cancer 2001;92:1213-23. [CrossRef]

9. 9. Socinski MA, Blackstock AW, Bogart JA, Wang X, Munley M, Rosenman J, et al. Randomized phase II trial of induction chemotherapy followed by concurrent chemotherapy and dose escalated thoracic conformal radiotherapy (74 Gy) in stage III non-small-cell lung cancer: CALGB 30105. J Clin Oncol 2008;26:2457-63. [CrossRef]
10. 10. Salama JK, Stinchcombe TE, Gu L et al. Pulmonary toxicity in stage III non-small cell lung cancer patients treated with high-dose (74 Gy) 3-dimensional conformal thoracic radiotherapy and concurrent chemotherapy following induction chemotherapy: a secondary analysis of Cancer and Leukemia Group B (CALGB) trial 30105. Int J Radiat Oncol Biol Phys 2011;81:269-274. [CrossRef]