Hyperfractionated accelerated radiation therapy for nonsmall cell lung cancer

Clinical phase I/II trial

Xiao Long Fu, Guo Liang Jiang, Li Juan Wang, Hao Qian, Sen Fu, Ming Yie, Feng Ming Kong, Sen Zhao, Shao Qin He, Tai Fu Liu

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

Purpose: In an attempt to improve local control and survival of nonsmall cell lung cancer (NSCLC), hyperfractionated accelerated radiation therapy (HART) was carried nut as a clinical phase I/II trial. Methods and Materials: HART was delivered by 1.1 Gy/fraction, three fractions per day with intervals of 4 h and five treatment days per week. The clinical tumors were irradiated to 74.3 Gy (72.6-75.9)/66-69 fx, 33 days (29-40) (not corrected for lung density) and the subclinical lesions, to 50.0 Gy (48.4-50.6)/44-46 fx, 33 days (29-40). Sixty-nine patients with NSCLC were enrolled in this study. Nine patients were withdrawn from the study during HART due to different reasons. Sixty patients formed the study for outcome analyses. They were 57 males and 3 females with median age of 61 years (21-77). There were 41 cases of squamous cell carcinoma, 15 cases of adenocarcinoma, and 4 cases of large cell carcinoma. Overall, favorable patients (KPS ≤ 70, weight loss < 5% and Stages I, II, IIIa) accounted for 73% (44 of 60) of all patients. Forty-four patients (73%) received adjuvant chemotherapy (DDP + VP16) with median cycles of 1.8 before and/or after HART. In order to compare the outcome of HART with conventional irradiation, 50 NSCLC patients treated by conventional fractionated irradiation (CFI) during the same period were chosen as the basis to evaluate relative effects of HART. They derived from the control group of another clinical trial of hyperfractionated irradiation for NSCLC in the same department. They received median tumor dose of 63.9 Gy (62.8- 65.0)/34 fx (32-36), 48 days (45-53). Results: 1. Acute and late complications: (a) In HART, 87% of patients (52 cases) developed acute radiation esophagitis: Grade 1-2, 46 cases (77%) and Grade 3, 6 cases (10%), at 2.5 weeks (2-3.5 weeks) after HART began. Five patients with Grade 3 esophagitis had their HART interrupted for ≤7 days. In CFI, esophagitis was much less (44%, p < 0.05) with 38% of Grade 1-2 and 6% of Grade 3. (b) In HART, acute pulmonary symptoms (RTOG Grade 1-2) occurred in 17% (10 cases), and acute radiation pneumonitis (Grade 3), in 8% (5 cases), while in CFI, they were 24% and 2% (p > 0.05), respectively. Late lung fibrosis (RTOG Grade 1-2) appeared in 20% (12 cases), whereas 18% in CFI (p > 0.05). (c) No other severe acute or late complications have been observed so far in HART. 2. Immediate response. In HART, 20% of patients (12 cases) achieved CR, 60% (36 cases), PR and 20% (12 cases), NR or PD. In CFI, the above three percentages were 10, 28, and 62%, respectively (p < 0.001). 3. Follow-up. The 1-, 2-, and 3-year actuarial survivals were 72, 47, and 28% for HART, and 60, 18, and 6% far CFI, respectively (p < 0.001). Better local control was seen in HART than in CFI with 1-, 2-, and 3-year local control rates being 71, 44, 29%, and 60, 20, and 5%, respectively (p = 0.001). Distant metastases developed less in HART than in CFI. The 1-, 2-, and 3-year distant metastasis rates were 23, 36, and 50% in HART, but 30, 48, and 80% in CFI (p = 0.021). Conclusion: 1. HART could he tolerated by most of the favorable NSCLC patients. The predominant complication was acute esophagitis. No other severe acute or late complications have been observed so far. 2. HART resulted in better survivals and local controls, and less distant metastases than CFI.

Original languageEnglish (US)
Pages (from-to)545-552
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume39
Issue number3
DOIs
StatePublished - Oct 1 1997

Fingerprint

Phase II Clinical Trials
Clinical Trials, Phase I
Non-Small Cell Lung Carcinoma
lungs
radiation therapy
Radiotherapy
cancer
metastasis
Neoplasm Metastasis
Survival
Large Cell Carcinoma
fibrosis
Lung
Nuts
Esophagitis
chemotactic factor inactivator
lesions
Weight Loss
Squamous Cell Carcinoma
grade

Keywords

  • Accelerated irradiation
  • Accelerated proliferation
  • Hyperfractionated accelerated irradiation
  • Hyperfractionated irradiation
  • Nonsmall cell lung caner
  • Radiotherapy

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Hyperfractionated accelerated radiation therapy for nonsmall cell lung cancer : Clinical phase I/II trial. / Fu, Xiao Long; Jiang, Guo Liang; Wang, Li Juan; Qian, Hao; Fu, Sen; Yie, Ming; Kong, Feng Ming; Zhao, Sen; He, Shao Qin; Liu, Tai Fu.

In: International Journal of Radiation Oncology Biology Physics, Vol. 39, No. 3, 01.10.1997, p. 545-552.

Research output: Contribution to journalArticle

Fu, Xiao Long ; Jiang, Guo Liang ; Wang, Li Juan ; Qian, Hao ; Fu, Sen ; Yie, Ming ; Kong, Feng Ming ; Zhao, Sen ; He, Shao Qin ; Liu, Tai Fu. / Hyperfractionated accelerated radiation therapy for nonsmall cell lung cancer : Clinical phase I/II trial. In: International Journal of Radiation Oncology Biology Physics. 1997 ; Vol. 39, No. 3. pp. 545-552.
@article{890ec90163e94d19a4f1d457a36a961f,
title = "Hyperfractionated accelerated radiation therapy for nonsmall cell lung cancer: Clinical phase I/II trial",
abstract = "Purpose: In an attempt to improve local control and survival of nonsmall cell lung cancer (NSCLC), hyperfractionated accelerated radiation therapy (HART) was carried nut as a clinical phase I/II trial. Methods and Materials: HART was delivered by 1.1 Gy/fraction, three fractions per day with intervals of 4 h and five treatment days per week. The clinical tumors were irradiated to 74.3 Gy (72.6-75.9)/66-69 fx, 33 days (29-40) (not corrected for lung density) and the subclinical lesions, to 50.0 Gy (48.4-50.6)/44-46 fx, 33 days (29-40). Sixty-nine patients with NSCLC were enrolled in this study. Nine patients were withdrawn from the study during HART due to different reasons. Sixty patients formed the study for outcome analyses. They were 57 males and 3 females with median age of 61 years (21-77). There were 41 cases of squamous cell carcinoma, 15 cases of adenocarcinoma, and 4 cases of large cell carcinoma. Overall, favorable patients (KPS ≤ 70, weight loss < 5{\%} and Stages I, II, IIIa) accounted for 73{\%} (44 of 60) of all patients. Forty-four patients (73{\%}) received adjuvant chemotherapy (DDP + VP16) with median cycles of 1.8 before and/or after HART. In order to compare the outcome of HART with conventional irradiation, 50 NSCLC patients treated by conventional fractionated irradiation (CFI) during the same period were chosen as the basis to evaluate relative effects of HART. They derived from the control group of another clinical trial of hyperfractionated irradiation for NSCLC in the same department. They received median tumor dose of 63.9 Gy (62.8- 65.0)/34 fx (32-36), 48 days (45-53). Results: 1. Acute and late complications: (a) In HART, 87{\%} of patients (52 cases) developed acute radiation esophagitis: Grade 1-2, 46 cases (77{\%}) and Grade 3, 6 cases (10{\%}), at 2.5 weeks (2-3.5 weeks) after HART began. Five patients with Grade 3 esophagitis had their HART interrupted for ≤7 days. In CFI, esophagitis was much less (44{\%}, p < 0.05) with 38{\%} of Grade 1-2 and 6{\%} of Grade 3. (b) In HART, acute pulmonary symptoms (RTOG Grade 1-2) occurred in 17{\%} (10 cases), and acute radiation pneumonitis (Grade 3), in 8{\%} (5 cases), while in CFI, they were 24{\%} and 2{\%} (p > 0.05), respectively. Late lung fibrosis (RTOG Grade 1-2) appeared in 20{\%} (12 cases), whereas 18{\%} in CFI (p > 0.05). (c) No other severe acute or late complications have been observed so far in HART. 2. Immediate response. In HART, 20{\%} of patients (12 cases) achieved CR, 60{\%} (36 cases), PR and 20{\%} (12 cases), NR or PD. In CFI, the above three percentages were 10, 28, and 62{\%}, respectively (p < 0.001). 3. Follow-up. The 1-, 2-, and 3-year actuarial survivals were 72, 47, and 28{\%} for HART, and 60, 18, and 6{\%} far CFI, respectively (p < 0.001). Better local control was seen in HART than in CFI with 1-, 2-, and 3-year local control rates being 71, 44, 29{\%}, and 60, 20, and 5{\%}, respectively (p = 0.001). Distant metastases developed less in HART than in CFI. The 1-, 2-, and 3-year distant metastasis rates were 23, 36, and 50{\%} in HART, but 30, 48, and 80{\%} in CFI (p = 0.021). Conclusion: 1. HART could he tolerated by most of the favorable NSCLC patients. The predominant complication was acute esophagitis. No other severe acute or late complications have been observed so far. 2. HART resulted in better survivals and local controls, and less distant metastases than CFI.",
keywords = "Accelerated irradiation, Accelerated proliferation, Hyperfractionated accelerated irradiation, Hyperfractionated irradiation, Nonsmall cell lung caner, Radiotherapy",
author = "Fu, {Xiao Long} and Jiang, {Guo Liang} and Wang, {Li Juan} and Hao Qian and Sen Fu and Ming Yie and Kong, {Feng Ming} and Sen Zhao and He, {Shao Qin} and Liu, {Tai Fu}",
year = "1997",
month = "10",
day = "1",
doi = "10.1016/S0360-3016(97)00332-5",
language = "English (US)",
volume = "39",
pages = "545--552",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
number = "3",

}

TY - JOUR

T1 - Hyperfractionated accelerated radiation therapy for nonsmall cell lung cancer

T2 - Clinical phase I/II trial

AU - Fu, Xiao Long

AU - Jiang, Guo Liang

AU - Wang, Li Juan

AU - Qian, Hao

AU - Fu, Sen

AU - Yie, Ming

AU - Kong, Feng Ming

AU - Zhao, Sen

AU - He, Shao Qin

AU - Liu, Tai Fu

PY - 1997/10/1

Y1 - 1997/10/1

N2 - Purpose: In an attempt to improve local control and survival of nonsmall cell lung cancer (NSCLC), hyperfractionated accelerated radiation therapy (HART) was carried nut as a clinical phase I/II trial. Methods and Materials: HART was delivered by 1.1 Gy/fraction, three fractions per day with intervals of 4 h and five treatment days per week. The clinical tumors were irradiated to 74.3 Gy (72.6-75.9)/66-69 fx, 33 days (29-40) (not corrected for lung density) and the subclinical lesions, to 50.0 Gy (48.4-50.6)/44-46 fx, 33 days (29-40). Sixty-nine patients with NSCLC were enrolled in this study. Nine patients were withdrawn from the study during HART due to different reasons. Sixty patients formed the study for outcome analyses. They were 57 males and 3 females with median age of 61 years (21-77). There were 41 cases of squamous cell carcinoma, 15 cases of adenocarcinoma, and 4 cases of large cell carcinoma. Overall, favorable patients (KPS ≤ 70, weight loss < 5% and Stages I, II, IIIa) accounted for 73% (44 of 60) of all patients. Forty-four patients (73%) received adjuvant chemotherapy (DDP + VP16) with median cycles of 1.8 before and/or after HART. In order to compare the outcome of HART with conventional irradiation, 50 NSCLC patients treated by conventional fractionated irradiation (CFI) during the same period were chosen as the basis to evaluate relative effects of HART. They derived from the control group of another clinical trial of hyperfractionated irradiation for NSCLC in the same department. They received median tumor dose of 63.9 Gy (62.8- 65.0)/34 fx (32-36), 48 days (45-53). Results: 1. Acute and late complications: (a) In HART, 87% of patients (52 cases) developed acute radiation esophagitis: Grade 1-2, 46 cases (77%) and Grade 3, 6 cases (10%), at 2.5 weeks (2-3.5 weeks) after HART began. Five patients with Grade 3 esophagitis had their HART interrupted for ≤7 days. In CFI, esophagitis was much less (44%, p < 0.05) with 38% of Grade 1-2 and 6% of Grade 3. (b) In HART, acute pulmonary symptoms (RTOG Grade 1-2) occurred in 17% (10 cases), and acute radiation pneumonitis (Grade 3), in 8% (5 cases), while in CFI, they were 24% and 2% (p > 0.05), respectively. Late lung fibrosis (RTOG Grade 1-2) appeared in 20% (12 cases), whereas 18% in CFI (p > 0.05). (c) No other severe acute or late complications have been observed so far in HART. 2. Immediate response. In HART, 20% of patients (12 cases) achieved CR, 60% (36 cases), PR and 20% (12 cases), NR or PD. In CFI, the above three percentages were 10, 28, and 62%, respectively (p < 0.001). 3. Follow-up. The 1-, 2-, and 3-year actuarial survivals were 72, 47, and 28% for HART, and 60, 18, and 6% far CFI, respectively (p < 0.001). Better local control was seen in HART than in CFI with 1-, 2-, and 3-year local control rates being 71, 44, 29%, and 60, 20, and 5%, respectively (p = 0.001). Distant metastases developed less in HART than in CFI. The 1-, 2-, and 3-year distant metastasis rates were 23, 36, and 50% in HART, but 30, 48, and 80% in CFI (p = 0.021). Conclusion: 1. HART could he tolerated by most of the favorable NSCLC patients. The predominant complication was acute esophagitis. No other severe acute or late complications have been observed so far. 2. HART resulted in better survivals and local controls, and less distant metastases than CFI.

AB - Purpose: In an attempt to improve local control and survival of nonsmall cell lung cancer (NSCLC), hyperfractionated accelerated radiation therapy (HART) was carried nut as a clinical phase I/II trial. Methods and Materials: HART was delivered by 1.1 Gy/fraction, three fractions per day with intervals of 4 h and five treatment days per week. The clinical tumors were irradiated to 74.3 Gy (72.6-75.9)/66-69 fx, 33 days (29-40) (not corrected for lung density) and the subclinical lesions, to 50.0 Gy (48.4-50.6)/44-46 fx, 33 days (29-40). Sixty-nine patients with NSCLC were enrolled in this study. Nine patients were withdrawn from the study during HART due to different reasons. Sixty patients formed the study for outcome analyses. They were 57 males and 3 females with median age of 61 years (21-77). There were 41 cases of squamous cell carcinoma, 15 cases of adenocarcinoma, and 4 cases of large cell carcinoma. Overall, favorable patients (KPS ≤ 70, weight loss < 5% and Stages I, II, IIIa) accounted for 73% (44 of 60) of all patients. Forty-four patients (73%) received adjuvant chemotherapy (DDP + VP16) with median cycles of 1.8 before and/or after HART. In order to compare the outcome of HART with conventional irradiation, 50 NSCLC patients treated by conventional fractionated irradiation (CFI) during the same period were chosen as the basis to evaluate relative effects of HART. They derived from the control group of another clinical trial of hyperfractionated irradiation for NSCLC in the same department. They received median tumor dose of 63.9 Gy (62.8- 65.0)/34 fx (32-36), 48 days (45-53). Results: 1. Acute and late complications: (a) In HART, 87% of patients (52 cases) developed acute radiation esophagitis: Grade 1-2, 46 cases (77%) and Grade 3, 6 cases (10%), at 2.5 weeks (2-3.5 weeks) after HART began. Five patients with Grade 3 esophagitis had their HART interrupted for ≤7 days. In CFI, esophagitis was much less (44%, p < 0.05) with 38% of Grade 1-2 and 6% of Grade 3. (b) In HART, acute pulmonary symptoms (RTOG Grade 1-2) occurred in 17% (10 cases), and acute radiation pneumonitis (Grade 3), in 8% (5 cases), while in CFI, they were 24% and 2% (p > 0.05), respectively. Late lung fibrosis (RTOG Grade 1-2) appeared in 20% (12 cases), whereas 18% in CFI (p > 0.05). (c) No other severe acute or late complications have been observed so far in HART. 2. Immediate response. In HART, 20% of patients (12 cases) achieved CR, 60% (36 cases), PR and 20% (12 cases), NR or PD. In CFI, the above three percentages were 10, 28, and 62%, respectively (p < 0.001). 3. Follow-up. The 1-, 2-, and 3-year actuarial survivals were 72, 47, and 28% for HART, and 60, 18, and 6% far CFI, respectively (p < 0.001). Better local control was seen in HART than in CFI with 1-, 2-, and 3-year local control rates being 71, 44, 29%, and 60, 20, and 5%, respectively (p = 0.001). Distant metastases developed less in HART than in CFI. The 1-, 2-, and 3-year distant metastasis rates were 23, 36, and 50% in HART, but 30, 48, and 80% in CFI (p = 0.021). Conclusion: 1. HART could he tolerated by most of the favorable NSCLC patients. The predominant complication was acute esophagitis. No other severe acute or late complications have been observed so far. 2. HART resulted in better survivals and local controls, and less distant metastases than CFI.

KW - Accelerated irradiation

KW - Accelerated proliferation

KW - Hyperfractionated accelerated irradiation

KW - Hyperfractionated irradiation

KW - Nonsmall cell lung caner

KW - Radiotherapy

UR - http://www.scopus.com/inward/record.url?scp=0030884537&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0030884537&partnerID=8YFLogxK

U2 - 10.1016/S0360-3016(97)00332-5

DO - 10.1016/S0360-3016(97)00332-5

M3 - Article

VL - 39

SP - 545

EP - 552

JO - International Journal of Radiation Oncology Biology Physics

JF - International Journal of Radiation Oncology Biology Physics

SN - 0360-3016

IS - 3

ER -