Conservative Split Course Radiation Therapy for Unresectable Stage III Non-Small Cell Lung Carcinoma with Poor Prognostic Factors

ABSTRACT

PURPOSE: Many studies for unresectable stage III non-small cell lung carcinomas (NSCLC) have focused on patients with good prognostic factors. However, there have been few reports on patients with poor prognostic factors. Herein, those patients with poor prognostic factors were treated with conservative split course radiation therapy (RT) alone, and the feasibility and survivals evaluated. Methods and Materials Between Jan 1997 and Dec 2001, 73 patients started conservative split course RT. They were confirmed to have unresectable stage III NSCLC with poor prognostic factors; performance scale> or = ECOG 2 or weight loss> or =5% during the last 6 months. They initially received 30 Gy of radiation in 2.5 or 3 Gy per fractions to the gross tumor volume (GTV). The tumor response was evaluated 2~3 weeks later. A second course of RT was also recommended for good responders > or =50% tumor diameter reduction or improved distal atelectasis. The treatment related toxicity was also evaluated. RESULTS: Nine patients failed to finish the initial course of RT (3~27 Gy) due to disease progression or personal reasons. Thirty-four (53.1%) of the 64 patients who completed the first course of RT showed a good tumor response. Twenty-seven good responders received the second course of RT, with a total of 51 to 60 Gy. Seven of these did not receive the second course of RT due to distant metastasis or poor performance. The two-year survival rate and median survival in all patients and in the 27 good responders who completed the second course of RT were 19.7% and 12 months and 30.3 and 20 months, respectively. Five (12.8%) of the 39 evaluable patients had grade III radiation esophagitis (N=1) or pneumonitis (N=4). Conclusions: Conservative split course RT was a tolerable and effective modality for unresectable stage III NSCLC with poor prognostic factors. In addition, it was able to produce relatively good survival results in patients showing a good response after the first course and who completed the second course of RT