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Hypofractionated three-dimensional conformal radiotherapy for medically inoperable early stage

Radiation Oncology Journal
2013년 31권 1호 p.18 ~ p.24
이주호 ( Lee Joo-Ho ) - Seoul National University College of Medicine Department of Radiation Oncology

우홍균 ( Wu Hong-Gyun ) - Seoul National University College of Medicine Department of Radiation Oncology
김학재 ( Kim Hak-Jae ) - Seoul National University College of Medicine Department of Radiation Oncology
박찬일 ( Park Charn-Il ) - Seoul National University College of Medicine Department of Radiation Oncology
이세훈 ( Lee Se-Hoon ) - Seoul National University College of Medicine Department of Internal Medicine
김동완 ( Kim Dong-Wan ) - Seoul National University College of Medicine Department of Internal Medicine
허대석 ( Heo Dae-Seog ) - Seoul National University College of Medicine Department of Internal Medicine

Abstract

Purpose: The purpose of this study was to assess the clinical outcomes of hypofractionated radiotherapy (HFRT) with three-dimensional conformal technique for medically inoperable patients with early stage non-small-cell lung cancer (NSCLC) and to evaluate prognostic factors. Materials and Methods: We performed a retrospective review of 26 patients who underwent HFRT for early stage NSCLC between September 2005 and August 2011. Only clinical stage T1-3N0 was included. The median RT dose was 70 Gy (range, 60 to 72 Gy) and the median biologically equivalent dose (BED) was 94.5 Gy (range, 78.0 to 100.8 Gy). In 84.6% of patients, 4 Gy per fraction was used. Neoadjuvant chemotherapy with paclitaxel and cisplatin was given to 2 of 26 patients. Results: The median follow-up time for surviving patients was 21 months (range, 13 to 49 months). The overall response rate was 53.9%, and the initial local control rate was 100%. The median survival duration was 27.8 months. Rates of 2-year overall survival, progression-free survival (PFS), local control (LC), and locoregional-free survival (LRFS) were 54.3%, 61.1%, 74.6%, and 61.9%, respectively. Multivariate analysis showed that BED (>90 vs. ≤90 Gy) was an independent prognostic factor influencing PFS, LC, and LRFS. Severe toxicities over grade 3 were not observed. Conclusion: Radical HFRT can yield satisfactory disease control with acceptable rates of toxicities in medically inoperable patients with early stage NSCLC. HFRT is a viable alternative for clinics and patients ineligible for stereotactic ablative radiotherapy. BED over 90 Gy and 4 Gy per fraction might be appropriate for HFRT.

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