Purpose: Chemoradiotherapy is the standard treatment of inoperable and/or non-resectable IIIA/B non-small-cell lung cancer (NSCLC). Aware of the necessity to increase local control in locally advanced NSCLC, we analyzed the feasibility of high-dose three-dimensional conformal radiation therapy (3D-CRT) in the treatment of localised NSCLC.
Patients and methods: We undertook a retrospective analysis of consecutive patients with non-resectable NSCLC treated with high-dose (74Gy) standard-fractionation 3D-CRT, with particular attention to the relationship between lung and heart radiation-induced toxicities.
Results: Fifty patients (41 males, 9 females) were included. A total of 35 (70%) patients received the planned total dose of 74Gy. Patients irradiated to inferior doses interrupted the treatment because of limiting toxicities. Induction and concurrent chemotherapy was delivered to 39 (78%) and 14 (28%) patients, respectively. Eight (16%) patients experienced grade 3-4 acute lung toxicity, all of them having a history of pulmonary disease, a FEV1 below 1.6 L, and a lung V(20) of at least 25%. Three (6%) patients were deemed to experience radiation-induced cardiac toxicity.
Conclusions: This study assesses the feasibility of delivering a total dose of 74 Gy combined with chemotherapy in locally advanced NSCLC. High lung and heart V(20) increases the risk of radiation-induced lung and cardiac toxicity, the later being highly difficult to precisely assess, as late deaths are rarely documented, and responsibility of the treatment might be often underestimated. The precise evaluation of cardiac condition may be helpful to spare fragile patients from potentially toxic effects of high-dose radiation, especially in controlled trials.