BACKGROUNDTo evaluate the therapeutic effect and acute side-effect of escalated hyperfractionated accelerated radiation therapy (EHART) combined with chemotherapy for stage IIIB non-small cell lung cancer (NSCLC).

METHODSFrom Aug. 1998 to Aug. 2001, a prospective trial for NSCLC was carried out in 112 patients with stage IIIB. These patients were nonrandomly divided into 2 groups: conventional fractionated radiation therapy group (CFRT 65 cases) and EHART group (47 cases). The CFRT patients were treated by 1.8-2 Gy/fraction per day, 5 treatment days per week; the total doses received in center of tumor were 54-70 Gy /27-40 fractions/37-85 days, the median was 60 Gy/30 factions/43 days. The EHART patients were treated by escalated doses: In the first and second weeks, 1.2 Gy/fraction twice a day was given, then 1.3 Gy , 1.4 Gy , and 1.5 Gy from third to fifth weeks respectively, twice fractions a day (over 6 hours interval), 5 treatment days each week, the total doses were 60-66 Gy/46-50 fractions/30-45 days, the median was 66 Gy /50 fractions/34 days. Radiation fields just covered the tumor mass which were determined by thoracic CT with 1.5 cm margins. A total of 4-6 cycles chemotherapy with MVP regimen mostly was delivered before (1-2 cycles) and after (3-5 cycles) radiotherapy. Each patient was followed up for 1 year.

RESULTSSeven cases were excluded from EHART, twelve from CFRT. There were 93 patients to be evaluated. The immediate response rate of tumor by EHART and CFRT was 72.5% and 64.2% respectively (Chi-square=1.02, P=0.346). The 1-year survival rate was 60.0% and 47.2% respectively (Chi-square=2.56, P=0.107), and the local control rate was 67.5% and 52.8% respectively (Chi-square=3.01, P=0.085). The incidence and degree of acute radiation esophagitis in EHART were more severe than that in CFRT (Chi-square=5.02, P=0.025).

CONCLUSIONSThe treatment effect by EHART for stage IIIB NSCLC is encouraging and its toxicities could be tolerated by most of patients. It is worthy of further study on survival rate and late complications in long term.

BACKGROUNDConcurrent chemotherapy plus radiotherapy is a trend in treatment of non-small cell lung cancer (NSCLC), but the treatment program is rather complicated and the toxicity is more severe than chemotherapy or radiotherapy alone. The aim of this study is to evaluate the early response and toxicity of concurrent chemoradiotherapy.

METHODSEighty unresectable stage IIIA-IIIB NSCLC patients pathologically proved were randomly divided into 2 groups. Group A: patients were treated with concurrent chemotherapy of vinorelbine (12.5mg/m², on days 1, 8, 29, 36) and cisplatin (40mg/m², on days 1, 8, 29, 36) (NP regimen) plus conventional radiotherapy. Patients were irradiated at 1.8-2.0Gy/Fx daily, 5 days per week. The total dose was 60Gy/30-33 Fx. After the radiation, 3 cycles of NP regimen were performed, but the dose of vinorelbine was 25mg/m². Group B: patients received sequential chemoradiotherapy. At first radiation was performed as same as group A. Then chemotherapy of NP (NVB 25mg/m², on days 1 and 8, DDP 80mg/m², on day 1) was followed for 4-5 cycles.

RESULTSThe overall response rate in concurrent and sequential groups was 80.0% and 57.5% respectively (Chi-Square=4.71, P < 0.05). Incidences of grade III-IV acute radiation esophagitis and leukopenia were 47.5% and 65.0% in group A, and 25.0% and 42.5% in group B respectively (P < 0.05). The acute radiation pneumonitis rate was 32.5% in group A and 20.0% in group B (P > 0.1).

CONCLUSIONSConcurrent chemoradiotherapy is well tolerated in most unresectable stage IIIA-IIIB NSCLC patients. Its early response is better than sequential chemoradiotherapy.