Different fraction schedules and combinations with chemotherapy in radiation treatment of non-small cell lung cancer.
In locally advanced non-small cell lung cancer (NSCLC), studies demonstrating advantages with hyperfractionated accelerated radiotherapy versus conventional radiotherapy have been published, so have studies demonstrating the value of chemotherapy concomitantly with radiotherapy. However, the value of non-conventional fractionation together with concomitant chemotherapy has not been investigated. Consecutive patients from a single institution were studied in a retrospective non-randomised fashion. Inclusion criteria were stage III NSCLC, treatment with curative intent and a total dose above 50 Gy. Eighty-two patients were included and further divided into four different treatment groups. Multivariate analysis indicated a survival advantage with non-conventional radiotherapy (NCRT), especially if combined with concomitant chemotherapy. Toxicity was feasible, however there was a trend towards higher toxicity, mainly esophagitis, in patients given concomitant chemotherapy with NCRT. Our results suggest that accelerated hyperfractionated radiotherapy with concomitant chemotherapy could be an interesting test-arm in a future prospective study.