Dose escalation using 3-dimensional conformal radiotherapy in management of non-small cell lung cancer; preliminary results on 22 patients

Abstract

Purpose

To determine the feasibility of radiation dose escalation > 70 Gy to Gross Tumour Volume (GTV) using 3-Dimensional Conformal Radiotherapy (3-DCRT).

Methods and Materials

From December 1997 to November 1998, 22 patients with non-small cell lung cancer (NSCLC) were included. Tumour stage was I in 3 cases, II in 6 cases, III in 10 cases, and there were 3 locoregional recurrences after surgery. A 3-D treatment planning system with BEV was used for all patients. Patients underwent limited elective nodal irradiation of 56 Gy. The GTV with 1 cm margin received a dose of at least 70 Gy. Acute and late toxicity were estimated according to the RTOG/EORTC score.

Results

The mean follow-up was 217 (80–360) days. Seventeen patients received 74 Gy, two had 72 Gy, and one had 70 Gy. In one patient with the largest irradiation volume a toxic death due to radiation pneumonitis occured. Except this fatality acute toxicity was acceptable. Seventeen patients were evaluable for response. There were 3 (18%) complete responses, all in patients staged I and II, seven (41%) partial responses, 5 (29%) non-responses and two (12%) local progressions. Two local progressions and two distant failures occured in stage III patients.

Conclusions

Dose escalation >70 Gy using 3-DCRT in management of NSCLC is feasible with acceptable acute toxicity.