"Purpose/Objective: Concurrent chemoradiotherapy (CRT) is a standard of care in the treatment of unresectable locally advanced non-small-cell lung cancer (NSCLC). Many trials investigating multimodality treatment of unresectable NSCLC restrict enrollment to relatively good risk patients. Consequently, limited data is available regarding the multimodality treatment of poor risk patients. At Rush University Medical Center, patients with locally advanced NSCLC are treated with a unique regimen of split course thoracic radiotherapy with concurrent chemotherapy. We sought to review the Rush experience in treating locally advanced NSCLC since 1999 with an emphasis on poor risk patients.""Methods: All patients with a diagnosis of stage IIIA/IIIB NSCLC and treated with definitive split course CRT between 1/1999 and 12/2008 were included in this retrospective study. The primary endpoint was overall survival (OS). Poor risk patients were defined in sccordance with published southwest oncology group (SWOG) reports with minor modification. We defined poor risk as a patient with any of the following: performance status 2 with albumin "Results: 138 patients were identified, 34% stage IIIA and 64% stage IIIB. There were 51 poor risk patients and 87 average risk patients. Median survival for all patients was 22.1 months with an actuarial 33.5% 3 year OS rate. Poor risk patients demonstrated a median survival of 22.3 months that was not statistically different from the median survival of the remainder of the cohort (p=0.36). Acute esophagitis was mild, with a 3% rate of grade 3 esophagitis and no cases of grade 4 or 5. There was a 3% rate of treatment related mortality. Radiotherapy technique appeared significantly related to the development of radiation pneumonitis; the 1 year actuarial rate of pneumonitis was 26.2% in patients treated using traditional opposed methods versus 7.2% in those treated using multifield techniques with all fields treated on all days (p"Conclusions: Split course CRT was effective in the treatment of locally advanced NSCLC, with poor risk patients demonstrating encouraging survival rates versus published reports (median survival 22.3 months in this study versus 10.2 months in SWOG 9712). Esophagitis was minimal in comparison to rates experienced with conventional daily RT and concurrent chemotherapy. Modern multifield 3D conformal techniques decreased the risk of radiation pneumonitis. "
Gielda, B,
Fidler, M,
Definitive Split-Course Concurrent Chemoradiation Results in Encouraging Outcomes in Poor Risk Patients with Locally Advanced NSCLC. Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL.
http://archive.rsna.org/2010/9020127.html
