TY - JOUR
T1 - Long-Term Results of a Trial of Concurrent Chemotherapy and Escalating Doses of Radiation for Unresectable Non–Small Cell Lung Cancer
T2 - NCCTG N0028 (Alliance)
AU - Mayo Clinic, North Central Cancer Treatment Group
AU - Schild, Steven E.
AU - Hillman, Shauna L.
AU - Tan, Angelina D.
AU - Ross, Helen J.
AU - McGinnis, William L.
AU - Garces, Yolanda A.
AU - Graham, David L.
AU - Adjei, Alex A.
AU - Jett, James R.
N1 - Funding Information:
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of?Health under the award numbers U10CA180821 and?U10CA180882 (to the Alliance for Clinical Trials in Oncology) and by the following U.S. Public Health Service?grants: P30CA015083, CA025224, U10CA035101, U10CA035103, U10CA035415, U10CA037404, U10CA037417, U10CA060276, and U10CA180790. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The following institutions?participated in this study: Iowa-Wide Oncology Research?Coalition National Community Oncology Research Program, Des Moines, Iowa (Robert Behrens, UG1CA189816); Mayo Clinic Lead Academic Participant, Rochester, Minnesota (Steven Alberts, U10CA180790); Missouri Valley Cancer Consortium, Omaha, Nebraska (Gamini Soori); and Sanford National Cancer Institute Community Oncology Research Program of the North Central Plains, Sioux Falls, South Dakota (Preston Steen, UG1CA189825).
Publisher Copyright:
© 2017 International Association for the Study of Lung Cancer
PY - 2017/4/1
Y1 - 2017/4/1
N2 - Introduction This phase I/II trial was designed to determine the maximally tolerated dose of thoracic radiotherapy as part of a combined modality approach. This report includes the long-term outcomes of patients treated on this study. The phase II portion was never completed, as RTOG-0617 opened before it was concluded. Methods In this study, the maximally tolerated dose was defined as 74 Gy of radiation in 37 fractions. Twenty-five patients with unresectable NSCLC were treated with 2-Gy daily fractions and concurrent weekly carboplatin and paclitaxel. Of these patients, 20 had stage III disease and five had stage I or II disease. Results Patients were followed until death or for a minimum of 5 years in the case of survivors. The median and 5-year survivals were 42.5 months and 20% for all patients, 52.9 months and 40% in patients with stages I or II disease, and 39.8 months and 15% in patients with stage III disease. Conclusions The median survival of the stage III patients was quite favorable. We believe that this may have been due to a robust central review program of radiotherapy plans before treatment, ensuring compliance with protocol guidelines along with very low exposure of the heart to radiotherapy. Further improvements in 5-year survival will likely require research on both systemic therapy and thoracic radiotherapy. Potential therapeutic modalities that may aid in these efforts include immunotherapy, targeted therapy, improved imaging, adaptive radiotherapy, simultaneous integrated boost techniques, novel dose fractionation regimens, and charged particle therapy.
AB - Introduction This phase I/II trial was designed to determine the maximally tolerated dose of thoracic radiotherapy as part of a combined modality approach. This report includes the long-term outcomes of patients treated on this study. The phase II portion was never completed, as RTOG-0617 opened before it was concluded. Methods In this study, the maximally tolerated dose was defined as 74 Gy of radiation in 37 fractions. Twenty-five patients with unresectable NSCLC were treated with 2-Gy daily fractions and concurrent weekly carboplatin and paclitaxel. Of these patients, 20 had stage III disease and five had stage I or II disease. Results Patients were followed until death or for a minimum of 5 years in the case of survivors. The median and 5-year survivals were 42.5 months and 20% for all patients, 52.9 months and 40% in patients with stages I or II disease, and 39.8 months and 15% in patients with stage III disease. Conclusions The median survival of the stage III patients was quite favorable. We believe that this may have been due to a robust central review program of radiotherapy plans before treatment, ensuring compliance with protocol guidelines along with very low exposure of the heart to radiotherapy. Further improvements in 5-year survival will likely require research on both systemic therapy and thoracic radiotherapy. Potential therapeutic modalities that may aid in these efforts include immunotherapy, targeted therapy, improved imaging, adaptive radiotherapy, simultaneous integrated boost techniques, novel dose fractionation regimens, and charged particle therapy.
KW - 3D radiotherapy, Unresectable non–small cell lung cancer
KW - Chemoradiotherapy
KW - Dose escalation
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U2 - 10.1016/j.jtho.2016.12.021
DO - 10.1016/j.jtho.2016.12.021
M3 - Article
C2 - 28089762
AN - SCOPUS:85015945339
VL - 12
SP - 697
EP - 703
JO - Journal of Thoracic Oncology
JF - Journal of Thoracic Oncology
SN - 1556-0864
IS - 4
ER -