Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition).
Vol 22, No 14S (July 15 Supplement), 2004: 7233
© 2004 American Society of Clinical Oncology

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Abstract

Intensity modulated radiation therapy (IMRT) may reduce the oesophageal toxicity of hypofractionated accelerated 3-D radiation for non small cell lung carcinoma

St Lukes Hospital, Dublin, Ireland

7233

Background: Several groups are assessing the feasibility of increasing the radiobiological impact of 3-D radiation for NSCLC by using high dose per fraction dose escalation. We report the most mature data of any trial using 3Gy /fraction (72 Gy/24 fractions). Methods: 30 pts with NSCLC with KPS>70% and wt loss <10% in 3 months, with inoperable stage I/II (11 ) or unresectable stage IIIa/b, no effusion (19 ). Initial chemotherapy was used in 13 pts. No more than 30% of the combined lungs could receive >=25 Gy (V25) and the max. dose to the cord was < 61%. No oesophageal dose limits were used. Results: 8 CR and 11 PR in 27 evaluable pts. Median time to local progression, progression and survival: 18.6, 17.3 and 12.6 months. No grade-4 acute toxicity occurred. 2 pts had grade-3 acute oesophageal toxicity and 1 pt a grade 3 acute lung toxicity. 26 pts were evaluable for long-term toxicity (median follow-up 9.5 months). Late grade-1 lung toxicity occurred in 5 pts. Late oesophageal toxicity was clinically dominant: grade 1 in 2 pts, grade 2 in 1 pt and grade 3 in 1 pt. There was a significant association between late toxicity and length of circumferential oesophagus receiving 97% of the prescribed dose. If this length was <1cm late oesophageal toxicity occurred in 0/16 vs. 4/10 if it exceeded 1cm. p< 0.05. We redesigned the treatment of patients with oesophageal toxicity and length of circumferential oesophagus receiving 97% of the prescribed dose >1cm, with IMRT to see if this length could be reduced. For 3 of 4 patients IMRT reduced the length without exceeding lung constraints. Conclusions: Oesophageal toxicity was the main toxicity of clinical concern, with 20% of pts experiencing acute or long-term toxicity. The trial continues with new oesophageal dose-volume constraints. IMRT may have the potential to avoid excessive irradiation of focal parts of the oesophagus.

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Abstract presentation from the 2004 ASCO Annual Meeting