Therapeutic management options for stage III non-small cell lung cancer

Table 4 Prospective trials for hypofractionation radiation schedules for non-small-cell lung cancer treatment

Ref.	Phase	Study design	Chemo regimen	RT	No. of patients	Stage	Median f/u (mo)	OS	Median OS (mo)	Response rate	Toxicity
RTOG 8312 Graham et al[116] (1995)	Pilot	HypoFRT	None	75 Gy in 2.68 fxns daily for 5.5 wk	59	IIIA/B		1-yr, 41% 2-yr, 25% 3-yr, 18% 5-yr, 4%	10		Most common was G1/2 pulmonary fibrosis and pneumonitits
Slawson et al[117] (1990)		Conv. RT vs HypoFRT		Conv. RT: 60 Gy in 2 Gy fxns (daily) HypoFRT: 60 Gy in 5Gy fxn (weekly)	150	Locally advanced, unresectable	36	1-yr, 49% vs 59% 2-yr, 23% vs 29%		CR, 17% vs 26%	No difference for later reactions
EORTC 08972-22973 Belderbos et al[61] (2007)	3	Sequential vs concurrent chemo + hypoFRT	Gemcitabine/cisplatin	66 Gy in 2.75 Gy fxns in 32 d	158	I-IIIB, Inoperable	39	2-yr, 34% vs 39% 3-yr, 22% vs 34%	16.2 vs 16.5		G3 hematological toxicity higher in sequential arm (30% vs 6%) Esophagitis more common in concurrent arm (5% vs 14%)
SOCCAR Maguire et al[101] (2014)	2	Sequential vs concurrent chemo + hypoFRT	Cisplatin/vinorelbine	55 Gy in 2.75 Gy fxns over 4 wk	130	III, inoperable	N/A	2-yr, 46% vs 50%	18.3 vs 24.3		G3+ esophagitis 8.5% vs 8.8% Tx-related mortality, 1.7% vs 2.9%
Liu et al[126] (2013)		Concurrent chemo + HypoFRT dose escalation	Carboplatin/vinorelbine	60-75 Gy in 3 Gy fxns for 5 wk	26	IIIA/B, unresectable	11.5	1-yr, 60.9%	13	CR, 26.9% Partial, 53.8% Stable, 19.2% ORR, 80.8%	Acute esophagitis, 88.5% (G3 = 15.4%) Pneumonitits, 42.3% (G3 = 77%)
Lin et al[127] (2013)	1	Concurrent chemo + hypoFRT dose escalation	Carboplatin/vinorelbine	60-72 Gy in 3Gy fxns for 5 wk	13	IIIA/B, unresectable	10			CR, 23.1% Partial, 15.4% Stable, 15.4% ORR, 84.6%	4 instances dose-limiting toxicities, all occurring in 72 Gy arm
Kim et al[128] (2013)		Concurrent chemo + hypoFRT IMRT dose escalation	Cisplatin/vinorelbine	48 Gy in 2.4 Gy fxns with boosts of 16.8 Gy/7, 20 Gy/7, or 22.7 Gy/7	12	II-IIIB, unresectable	22	1-yr, 58.3%	12.7	CR, 75% Partial, 33% Stable, 25%	No G3 acute or late radiation-toxicities

HypoFRT: Hypofractionation; IMRT: Intensity-modulated radiotherapy; CR: Complete response.