Abstract
PurposeIntegrating moderate hypofractionation to the macroscopic tumor with elective nodal irradiation while sparing the organs at risk (OAR) in chemoradiotherapy of locally advanced non-small-cell lung cancer.MethodsFrom 2010–2018, treatment, patient and tumor characteristics of 138 patients from two radiation therapy centers were assessed. Chemoradiotherapy by intensity-modulated radiation therapy (IMRT) with a simultaneous integrated boost (SIB) to the primary tumor and macroscopic lymph node metastases was used.ResultsA total of 124 (90%) patients received concurrent chemotherapy. 106 (76%) patients had UICC (Union for International Cancer Control) stage ≥IIIB and 21 (15%) patients had an oligometastatic disease (UICC stage IV). Median SIB and elective total dose was 61.6 and 50.4 Gy in 28 fractions, respectively. Furthermore, 64 patients (46%) had an additional sequential boost to the primary tumor after the SIB-IMRT main series: median 6.6 Gy in median 3 fractions. The median cumulative mean lung dose was 15.6 Gy (range 6.2–29.5 Gy). Median follow-up and radiological follow-up for all patients was 18.0 months (range 0.6–86.9) and 16.0 months (range 0.2–86.9), respectively. Actuarial local control rates at 1, 2 and 3 years were 80.4, 68.4 and 57.8%. Median overall survival and progression-free survival was 30.0 months (95% confidence interval [CI] 23.5–36.4) and 12.1 months (95% CI 8.2–16.0), respectively. Treatment-related toxicity was moderate. Radiation-induced pneumonitis grade 2 and grade 3 occurred in 13 (9.8%) and 3 (2.3%) patients.ConclusionsChemoradiotherapy using SIB-IMRT showed promising local tumor control rates and acceptable toxicity in patients with locally advanced and in part oligometastatic lung cancer. The SIB concept, resulting in a relatively low mean lung dose, was associated with low numbers of clinically relevant pneumonitis. The overall survival appears promising in the presence of a majority of patients with UICC stage ≥IIIB disease.
Highlights
The therapeutic intent in locally advanced non-small-cell lung cancer (NSCLC) is curative, and radiation therapy (RT) is a cornerstone of treatment
From 2010–2018, 138 patients suffering from locally advanced and in part oligometastatic NSCLC were treated in the department of radiation oncology, University of Würzburg and the Xcare practice for Radiation Therapy, Saarlouis with an identical definitive simultaneous integrated boost (SIB)-intensity-modulated radiation therapy (IMRT) protocol
Chemoradiotherapy by SIB-IMRT may result in excellent local tumor control
Summary
The therapeutic intent in locally advanced non-small-cell lung cancer (NSCLC) is curative, and radiation therapy (RT) is a cornerstone of treatment. RT is most commonly combined with simultaneous platinum-based chemotherapy, as a concurrent approach has been shown to be su- K. Strahlenther Onkol (2021) 197:405–415 radiation therapy (IMRT) combined with image-guided radiation therapy (IGRT) enables the use of moderate hypofractionation to the gross tumor volume (GTV) combined with elective nodal irradiation and possibly reduces exposure of uninvolved lung areas. We report on a two-center experience of chemoradiotherapy for locally advanced NSCLC using simultaneous-integrated boost IMRT (SIBIMRT)
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