Background: To establish the technique of 3-dimensional conformal radiation therapy (3DCRT) for non-small cell lung cancer (NSCLC) in stage II-IIIB,and to assess its acute side-effects and to obtain the maximum tolerance dose (MTD).
Methods: From June,1999 to June,2000,38 cases of NSCLC in stage II-IIIB were enrolled in this study.MTD was identified by dose escalation study.After 42Gy/21Fx/4.2wks by conventional fractionated irradiation through AP/PA fields,which covered the primary tumor and lymph nodes,the technique of 3DCRT was used as boost.The boost fields encompassed the clinical lesions showed on chest CT.The planning of total dose escalation depended on the percentage,i.e.,<25%,25%-37%,and >37% of normal lung volume irradiated to over 20Gy.The scheduled dose escalation ranged from 69 to 81Gy.The criteria for stopping dose escalation was grade III or more worse radiation pneumonitis (RTOG).The boost doses were delivered with 3Gy/fraction,once a day,5 fractions a week.
Results: Thirty-three cases had completed their treatments and could be evaluated by now.Acute radiation pneumonitis occurred in 26% of patients with grade I-II and 3% with grade III,and acute radiation esophagitis in 61% with grade I-II and 9% with grade III,and the hematopoietic toxicity in 58% with grade I-II and 9% with grade III.The current doses implemented were 78,78,and 75Gy respectively for patients with <25%,25%-37%,and >37% of normal lung volume irradiated.The overall immediate response rate of tumors was 88%(29/33).
Conclusions: Dose escalation in a volume-dependent organ as the lungs is acceptable and applicable.The immediate response is encouraging.MTD is to be determined.The long-term follow-up is needed to observe late complications and treatment efficacy.