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J Korean Cancer Assoc > Volume 30(6); 1998 > Article
Journal of the Korean Cancer Association 1998;30(6): 1110-1118.
Concomitant Boost Radiotherapy for Stage 3 Non - Small Cell Lung Cancer
Kyung Hwan Shin, Charn Il Park, Young Soo Shim, Yung Jue Bang, Sung Koo Han
1Department of Therapeutic Radiology, Seoul National University College of Medicine,Korea.
2Department of Internal Medicine, Seoul National University College of Medicine,Korea.
3Department of Institute of Radiation Medicine, Seoul National University College of Medicine,Korea.
4Department of Radiation Oncology, Samsung Medical Center, Seoul, Korea.
This study was undertaken to evaluate the treatment outcome and side effects of accelerated radiotherapy (RT) using concomitant boost for stage III non-small cell lung cancer (NSCLC).
Between April 1991 and December 1994, 102 patients with stage III NSCLC who had the favorable prognostic factors by CALGB criteria, were treated with concomitant boost radiotherapy. Patients were treated with standard large fields to 54 Gy in 6 weeks. The boost treatment was administered concomitantly during the last 2 weeks with a dose of 13 Gy in 10 fractions. The interfraction interval was at least 6 hours. The total tumor dose was 66-70 Gy, given over 6 weeks.
With 30 months median follow-up period for survivors, median survival was 15 months with 2 and 3-year overall survival rates of 34% and 19%, respectively. Thirty patients (29%) who had achieved complete remission after RT showed significantly better 2-year survival rates than those without complete remission (58% vs 22%, p 0.001). Local failure and distant metastases as the first or only failure occurred in 40 (44%) and 13 (14%), respectively, and ultimate local and distant failure rates were 45% and 29%, respectively. Although Grade IV esophageal complication of T-E fistula was observed in one patient, most patients with pulmonary complication showed mild, transient radiation pneumonitis.
This result suggests that the treatrnent of stage III NSCLC with concomitant boost RT may improve survival rates without enhanced radiation induced toxicity compared with conventional RT. Further investigation of dose escalation by conformal radiotherapy of combining chemotherapy and accelerated RT is warranted.
Key words: Stage III non-small cell lung cancer;Concomitant boost radiotherapy
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