UNCONVENTIONAL FRACTIONATION RADIOTHERAPY REGIMENS IN TREATMENT OF INOPERABLE LUNG CANCER
https://doi.org/10.21294/1814-4861-2019-18-4-21-26
Abstract
The purpose of the study was to compare the efficacy and toxicity of hypofractionated versus hyperfractionated radiotherapy in patients with inoperable lung cancer.
Material and Methods. Patients with inoperable lung cancer, who were treated between 2014 and 2017, were assigned to undergo radiotherapy in two arms: accelerated hypofractionated conformal radiotherapy arm with 70 patients (60 Gy in 25 fractions, with 2.4 Gy per fraction) and accelerated hyperfractionated radiotherapy with 49 patients (60–70 Gy with 1–1.5 Gy per fraction). At the same time, platinum-based chemotherapy was applied.
Results. The rates of partial response, complete response, stable disease and progressive disease were 44.3, 7.2, 38.5 and 10.0 %, respectively in patients with hypofractionated conformal radiotherapy arm. The corresponding values were 71.4, 6.1, 16.4 and 6.1 %, respectively in patients with hyperfractionated radiotherapy arm. The 2-year overall survival rate was 62.8 % for the hypofractionated group and 58.1 % for the hyperfractionated group. Esophagitis III grade was observed in 4 (5.7 %) patients of the hypofractionated group and in 3 (6.5 %) patients of the hypofractionated group. Pneumonitis III grade was reported in 2 (2.9 %) patients in the hypofractionated radiotherapy arm and in 4 (8.7 %) patients in the hyperfractionated radiotherapy arm.
Conclusion. Results of the study showed that 3D-conformal hypofractionated radiotherapy combined with concurrent chemotherapy resulted no in severe radiation-induced complications, and demonstrated satisfactory short-and long-term treatment outcomes.
Keywords
About the Authors
D. V. GogolinRussian Federation
MD, PhD, Senior Researcher, Radiation Therapy Department,
4, Korolev Street, Obninsk-249036, Kaluga region
I. A. Gulidov
Russian Federation
MD, Professor, Head of Radiation Therapy Department,
4, Korolev Street, Obninsk-249036, Kaluga region
K. E. Medvedeva
Russian Federation
MD, Researcher, Proton and Photon Radiation Therapy Department,
4, Korolev Street, Obninsk-249036, Kaluga region
Y. A. Ragulin
Russian Federation
MD, PhD, Leading Researcher, Thoracic Surgery Department,
4, Korolev Street, Obninsk-249036, Kaluga region
Y. S. Mardinsky
Russian Federation
MD, Professor, Corresponding Member of the Russian Academy of Sciences, Principal Investigator, Proton and Photon Radiation Therapy Department,
4, Korolev Street, Obninsk-249036, Kaluga region
I. N. Ivanova
Russian Federation
MD, PhD, Proton and Photon Radiation Therapy Department,
4, Korolev Street, Obninsk-249036, Kaluga region
L. V. Kursova
Russian Federation
MD, PhD, Leading Research Fellow, Department of Surgical and Conservative Treatment of Radiation-Induced Damage,
4, Korolev Street, Obninsk-249036, Kaluga region
I. I. Kotuhov
Russian Federation
Principal Engineer, Proton and Photon Radiation Therapy Department,
A. Y. Buksha
Russian Federation
Engineer, Department of Clinical Topometry and Dosimetry,
4, Korolev Street, Obninsk-249036, Kaluga region
References
1. Trakhtenberg A.Kh., Frank G.A., Kolbanov K.I., Sedykh S.A., Pikin O.V. Lung tumors. Oncology manual. Moscow, 2008. 326. (in Russian).
2. Kaprin A.D., Starinskii V.V., Petrova G.V. Malignant neoplasms in Russia in 2015 (morbidity and mortality). Moscow, 2017. 250. (in Russian).
3. Ramroth J., Cutter D.J., Darby S.C., Higgins G.S., McGale P., Partridge M., Taylor C.W. Dose and Fractionation in Radiation Therapy of Curative Intent for Non-Small Cell Lung Cancer: Meta-Analysis of Randomized Trials. Int J Radiat Oncol Biol Phys. 2016 Nov 15; 96(4): 736–747. doi: 10.1016/j.ijrobp.2016.07.022.
4. O’Rourke N., Roqué I., Figuls M., Farré Bernadó N., Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev. 2010 Jun 16; (6): CD002140. doi: 10.1002/14651858. CD002140.pub3.
5. Rodrigues G., Choy H., Bradley J., Rosenzweig K.E., Bogart J., Curran W.J.Jr., Gore E., Langer C., Louie A.V., Lutz S., Machtay M., Puri V., Werner-Wasik M., Videtic G.M. Definitive radiotherapy in locally advanced non-small cell lung cancer: Executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based clinical practice guideline. Pract Radiat Oncol. 2015 May-Jun; 5(3): 141–8. doi: 10.1016/j. prro.2015.02.012.
6. Mardynsky Yu.S., Gulidov I.A., Ivanova I.N., Kursova L.V., Zolotkov A.G., Kudryavtsev D.V., Ragulin Yu.A., Gogolin D.V. Results of continuous hyperfractionated radiotherapy in treatment of non-small cell lung cancer. Siberian Journal of Oncology. 2010; 2: 11–14. (in Russian).
7. Westover K.D., Loo B.W.Jr., Gerber D.E., Iyengar P., Choy H., Diehn M., Hughes R., Schiller J., Dowell J., Wardak Z., Sher D., Christie A., Xie X.J., Corona I., Sharma A., Wadsworth M.E., Timmerman R. Precision Hypofractionated Radiation Therapy in poor perfoming patients with NCSLC: phase I dose escalation trial. Int J Radiat Oncol Biol Phys. 2015 Sep 1; 93(1): 72–81. doi: 10.1016/j.ijrobp.2015.05.004.
8. Bearz A., Minatel E., Rumeileh I.A., Borsatti E., Talamini R., Franchin G., Gobitti C., Del Conte A., Trovò M., Baresic T. Concurrent chemoradiotherapy with tomotherapy in locally advanced non-small cell lung cancer: a phase I, docetaxel dose-escalation study, with hypofractioneted regimen. BMC Cancer. 2013 Oct 31; 13: 513. doi: 10.1186/1471- 2407-13-513.
9. Ilin M.A., Baryshnikova D.V., Yadykov O.A., Ivashin A.V., Sotnikov V.M., Panshin G.A., Kotliarov P.M., Kharchenko V.P., Solodki V.A., Gvarishvili A. Results of radiation therapy of peripheral lung cancer with escalation of summary dose. Herald of the Russian Scientific Center of Roentgenoradiology of the Ministry of Healthcare of the Russian Federation. 2012; 4(12). (in Russian).
10. Kaprin A.D., Galkin V.N., Zhavoronkov L.P., Ivanov V.K., Ivanov S.A., Romanko Yu.S. Synthesis of basic and applied research is the basis of obtaining high-quality findings and translating them into clinical practice. 2017; 26(2): 26–40. (in Russian).
Review
For citations:
Gogolin D.V., Gulidov I.A., Medvedeva K.E., Ragulin Y.A., Mardinsky Y.S., Ivanova I.N., Kursova L.V., Kotuhov I.I., Buksha A.Y. UNCONVENTIONAL FRACTIONATION RADIOTHERAPY REGIMENS IN TREATMENT OF INOPERABLE LUNG CANCER. Siberian journal of oncology. 2019;18(4):21-26. (In Russ.) https://doi.org/10.21294/1814-4861-2019-18-4-21-26