鼻咽癌外照射加腔内近距离超分割推量照射的远期疗效分析

背景与目的:鼻咽癌的后装治疗一般采用鼻咽腔内治疗的方法进行推量照射,适用于局部早期鼻咽癌.福建省肿瘤医院率先开展鼻咽旁插植技术,无颅底破坏的局部晚期鼻咽癌采用后装治疗推量照射.本文分析腔内后装推量照射的远期疗效,探讨常规外照射的合适剂量配合后程超分割后装推量照射的临床价值.方法:1998年1月～2002年12月体外照射加腔内后装超分割推量放射治疗鼻咽癌患者352例,体外常规放射治疗50～70 Gy后进行腔内近距离超分割推量照射,外照射后咽旁间隙肿瘤残留者配合咽旁区插植放疗.采用个体化鼻咽腔内施源器,超分割照射每次2.5～3.0 Gy,2次/天,间隔6 h,总剂量5～32 Gy,中位剂量17 Gy.结果:本组l、2、3、5年生存率分别为97.0%、91.3%、87.6%、84.7%.总体5年生存率Ⅰ、Ⅱ期88.2%,Ⅲ、Ⅳ期79.2%(log-rank检验,P=0.016);总体局控率Ⅰ、Ⅱ期94.1%,Ⅲ、Ⅳ期91.7%(log-rank检验,P＞0.05).后组颅神经损伤32例(9.4%).结论:鼻咽腔内后装联合咽旁间隙捅植近距离放射治疗鼻咽癌取得良好的局控率和生存率,局部晚期鼻咽癌取得与早期鼻咽癌类似的局控率,咽旁间隙受累者咽旁插植增加颈动脉鞘区照射剂量,后组颅神经损伤发生率较高.     

不同照射方式下非常规分割方案的生物效应对鼻咽癌疗效的影响

[目的]探讨不同照射方式（调强和普放）中采用非标准分割方案的疗程总剂量及分次剂量、总时间及分次数对鼻咽癌疗效的影响。[方法]回顾性分析2004年1～12月经病理确认并进行放射治疗且随访到2009年12月的资料完整的Ⅱ～Ⅳ期鼻咽癌病例162例,调强组57例,普放组105例;调强组和普放组给予肿瘤的总平均物理剂量分别为72Gy和76Gy,所对应的生物等效剂量（EQD2T）分别是75.5Gy和70Gy。调强组采用鼻咽加上下颈淋巴引流区同期加速推量动态调强放疗技术,普放组采用面颈联合野加颈部切线野常规放疗技术。[结果]调强组和普放组5年生存率分别为71.9%和70.5%,5年局控率分别为84.2%和78.1%,5年无瘤生存率分别为73.7%和71.4%,均无显著性差异。5年并发症发生率调强组低于普放组（65.9%vs85.1%,P=0.016）。[结论]调强和普放照射方式中采用72～76Gy物理剂量所反映的生物效应对鼻咽癌疗效影响不明显,两组的生存率和局控率接近。调强技术降低放疗损伤与晚反应组织生物剂量无关,但和物理优化技术有关。     

鼻咽癌适形和常规放疗的比较

目的：比较鼻咽癌立体定向适形放疗和常规放疗的效果及放疗反应。方法：共130例鼻咽癌患者，立体定向放疗组81例、普通放疗组49例，定向放疗组靶区为鼻咽肿瘤、咽旁间隙和颈部淋巴区，95％剂量曲线，分次剂量为3．0—3．5Gy／次，10—14次；普放组用面颈联合野照射D，36—40Gy／18—20次／3—4周，耳前野补量至鼻咽区DT 70Cy；颈部预防总量为DT50-55Gy。结果：立体定向放疗组和普放组1年局控率分别为91．36％（74／81例）、89．80％（44／49例）；1、3年生存率立体定向放疗组为96．30％（78／81）、91．35％（74／81），普放组95．92％（47／49），89．80％（44／49），两组比较局控率和生存率无显著差异。立体定向放疗组和普放组口干发生率分别为9．88％（8／81）和93．88％（46／49）；张口困难发生率分别为4．94％（4／81）和85．7％（42／49）；两组比较，差异均有显著性（P〈0．01）。结论：鼻咽癌立体定向放疗与单纯普放局控率无显著差异，但放疗反应明显降低。     

鼻咽癌局部复发分次立体定向放射治疗

目的　探讨分次立体定向放射治疗技术 ,在局部复发晚期鼻咽癌再程放疗中的应用。方法　 1997年 7月到 2 0 0 0年12月 ,采用分次立体定向放射治疗局部复发鼻咽癌 2 3例。所有病例均采用 6MVX线照射 ,设 1～ 3个中心 ,80 %剂量曲线将靶区完全包含。总剂量DT2 4～ 64Gy(中位剂量 5 2 .2Gy) ,单次剂量DT4～ 8Gy(中位剂量 6.4Gy)。 结果　局部复发鼻咽癌经分次立体定向放射治疗后 ,1年生存率为 78.3 % (18/2 3 )、2年生存率为 69.6% (16/2 3 )。 3 9.1% (9/2 3 )的患者随访期内死亡 ,其中死于局部复发 1例 ,死于远处转移 5例 ,鼻咽大出血 3例。结论　分次立体定向放射治疗用于局部复发鼻咽癌的治疗是安全有效的 ,但单次剂量和总剂量值得进一步研究。     

后程三维适形放疗在鼻咽癌缩野放疗中的临床研究

目的：观察后程三维适形放疗在鼻咽癌缩野放疗中的近期疗效及副作用。方法：将84例初治无远处转移的鼻咽癌患者用信封法随机分为后程三维适形放疗组（观察组）和常规疗放疗组（对照组）。两组病例第一段采用面颈联合常规低熔点铅挡块野放疗36Gy／18次，加下颈前切线野放疗36Gy／18次；第二段采用双侧耳前野放疗10Gy／5次，第三段采用三维适形野放疗20Gy／10次；加全颈前切线野放疗14—4Gy／7—12次，颈淋巴结残局部补量10Gy／5次。鼻咽总剂量70Gy-74Gy；颈部剂量，淋巴结阴性50Gy；阳性70Gy。结果：两组病例完全缓解率、1年生存率分别为97．6％、100％和90．5％、92．9％。两组肿瘤的局控率差异有统计学意义（P〈0．05），生存率差异无统计学意义（P〉0．05）。结论：鼻咽癌后程三维适形放疗较常规放疗有较好的肿瘤局控率，且副反应较轻。     

PF方案化疗配合立体放疗加量治疗局部晚期鼻咽癌疗效观察

 目的 观察由顺铂联合氟尿嘧啶组成的PF方案化疗配合分次立体定向放射治疗（FSRT）推量治疗局部晚期鼻咽癌的疗效和毒副反应。方法 将61例局部晚期鼻咽癌分为两组，治疗组（30例）采用PF方案化疗配合FSRT推量至76～86 Gy，对照组（31例）采用常规放疗至70 Gy。结果 治疗组与对照组近期有效（CR+PR）率分别为96.6 ％、93.6 ％；1、3年肿瘤局部控制率分别为100.0 %、93.3 %和93.6 %、83.9 %，复发率分别为0和6.4 ％，远处转移率分别为13.3 ％和16.1 ％；1、3年生存率分别为100.0 %、96.7 %和96.7 %、87.1 %，治疗组近期有效率及1、3年局部控制率、生存率较高，复发率和远处转移率较低，但两组差异均无统计学意义（P＞0.05）。治疗组张口困难发生率较低，两组差异有统计学意义（P＜0.01），但口干、口腔黏膜反应较低，两组差异无统计学意义（P＞0.05），骨髓抑制较高，两组差异有统计学意义（P＜0.01）。结论 PF方案化疗配合FSRT推量治疗局部晚期鼻咽癌安全有效，值得推广。     

鼻咽癌复发与残存病变的分次立体定向放疗

背景与目的:鼻咽癌复发、残留患者采用常规技术推量,适应症局限,而应用分次立体定向放疗(FS-RT)能得到合理的剂量分布,保护高危器官,提高疗效.本研究旨在评价鼻咽癌患者放射治疗后局部残存、区域复发进行立体定向放射治疗的临床价值和毒副作用.方法:41例鼻咽癌放射治疗后局部残存、区域复发的患者,应用立体定向放射治疗系统,6 MV X线,60%～90%为参考剂量曲线,肿瘤边缘分次剂量为4 Gy,间隔1～2d,总剂量为12～28 Gy(中位数16 Gy)/3～7次(中位数4次)放疗.靶体积为3.56～35.75 cm3,中位靶体积11.02 cm3.患者分为2组:残存组35例为首程适形调强根治性放射治疗后;复发组6例为首程根治性放射治疗后6个月以上区域复发,二程IMRT后;全部病例1个月内经鼻咽镜、CT或MRI检查发现仍有较大肿块残存.结果:FSRT治疗后3个月,CR63.47%(26/41),PR22.0%(9/41),SD14.6%(6/41),全组病例中位随访时间为28个月(3～41个月),残留组1、2、3年总生存率分别为100%、97.1%和91.4%,局控率分别为97.1%、88.6%和88.6%,无瘤生存率分别为94.3%、85.7%和85.7%.复发组1、2年总生存率分别为83.3%和66.7%,局控率分别为66.7%和50.0%.无瘤生存率分别为66.7%和50.0%.结论:FSRT对局部残留或复发鼻咽癌有较好的局部控制效果和较高的安全性,区域复发仍是治疗失败的主要原因.     

三维适形放射治疗鼻咽癌后程大分割的剂量学研究

目的寻求1种较理想的鼻咽癌三维放疗的分割方式,从而提高局部控制率。方法对15例行三维适形放射治疗的鼻咽癌患者进行模拟的剂量学研究,将后程大分割（分次量2.5Gy和3.0Gy）与常规分割（2.0Gy）进行剂量学对比。结果大分割放疗可以较大幅度增加肿瘤区（GTV）的剂量。2.5组脊髓最大剂量、腮腺、颞颌关节、脑干平均剂量提高均不超过1.0Gy,脑干最大剂量增加2.3Gy。3.0组腮腺及颞颌关节的平均剂量增加幅度较大达3.4Gy和1.4Gy,脑干最大剂量增加4.5Gy。结论分次量2.5Gy的后程大分割放疗能够较大幅度地增加GTV剂量,且对正常器官的剂量增加幅度较小,并发症增加较少。     

放疗后残存、复发鼻咽癌的立体定向放射治疗

目的 评价对鼻咽癌患者放射治疗后局部残存。区域复发进行立体定向放射治疗的临床价值和毒副作用。方法 对33例鼻咽癌放射治疗后局部残存，区域复发的患者，应用大恒公司生产的立体定向放射治疗系统，6MVX线，60%-90%为参考剂量曲线，肿瘤边缘分次剂量为3-8Gy(中位数：6Gy)，间隔1-2天，总剂量为12-48Gy(中位数：31Gy)/3-13次（中位数：6或次），靶体积为4.2-45.0cm^3(中位数：18.7cm^3)。患者分为3个组；A组11例为首程根治性放射治疗后6个月内经鼻咽镜，CT或MRI检查发现仍有较大肿块残存；B组组13例为首程根治性放射治疗后6个月以上区域复发者；C组9例为根治性放射治疗后复发行二程放射治疗后6个月以上再次复发者。结果 全部33例患者CR为54.5%,PR为33.3%,NC为12.1%。A组CR为63.6%,PR为36.4%,NC为0，B组CR为61.5%,PR为23.1%,NC为15.4%。C组CR为33.3%,PR为44.4%,NC为22.2%,A,B,C组3年生存率分别为72.7%,32.3%,33.3%。鼻咽部大出血的发生率为12.1%(4/33)。结论 鼻咽癌放射治疗后局部残存。区域复发，采用立体定向放射治疗推量治疗或单一治疗是1种有效的方法。鼻咽部大出血是其严重的并发症。     

鼻咽癌初程调强放疗后残存病变分次立体定向放射治疗

 目的 初步评价分次立体定向放射治疗技术用于鼻咽癌三维适形调强放射治疗后残存病变推量治疗的临床价值。方法 31例鼻咽癌三维适形调强放射治疗后病变残存的患者，应用德国BrainLAB公司生产的立体定向放射治疗系统进行推量照射。6MVX射线中位剂量16Gy（12～20Gy）。1～3个中心，参考剂量曲线选定为70％～90％。分割方式：4Gy／次，间隔1～3d。结果 本组患者1、2、3年鼻咽局部控制率分别为97.0%，92．O％和86．O％；1、2、3年总生存率分别100％，94％和90％；1、2、3年无瘤生存率为97％，90％和82％。无其他特殊并发症发生。结论 鼻咽癌初治患者在三维适形调强放疗后残存病变给与立体定向加量照射，能够取得较好的局部控制率和生存率。     

Outcome of fractionated stereotactic radiotherapy for 90 patients with locally persistent and recurrent nasopharyngeal carcinoma

PURPOSE: Local recurrence remains one of the major causes of failure in nasopharyngeal carcinoma (NPC). Stereotactic radiosurgery and fractionated stereotactic radiation therapy (FSRT) have recently evolved as a salvage option of NPC. This study was conducted to review the treatment outcome after FSRT for NPC. METHODS AND MATERIALS: Between September 1999 and December 2005, 90 patients with persistent (Group 1: n = 34, relapse within 6 months of RT) or recurrent (Group 2: n = 56, relapse beyond 6 months) NPC received FSRT using multiple noncoplanar arcs of 8-MV photon to the target. Median FSRT dose was 18 Gy in three fractions (Group 1) or 48 Gy in six fractions (Group 2). Median follow-up was 20.3 months. RESULTS: Complete response rate after FSRT was 66% for Group 1 and 63% for Group 2. One-, 2-, and 3-year disease-specific survival (DSS) and progression-free survival (PFS) rates for all patients were 82.6%, 74.8%, 57.5%, and 72.9%, 60.4%, 54.5%, respectively. Three-year local failure-free survival, DSS, and PFS rates were 89.4%, 80.7%, and 72.3% for Group 1, and 75.1%, 45.9%, and 42.9% for Group 2, respectively. Multivariate analysis showed that recurrent disease and large tumor volume were independent factors that predicted poorer DSS and PFS. Seventeen patients developed late complications, including 2 with fatal hemorrhage. CONCLUSIONS: Our results indicate that FSRT is effective for patients with persistent and recurrent NPC. Compared with reported results of radiosurgery, FSRT provides satisfactory tumor control and survival with a lower risk of complications and it may be a better treatment for local failures of NPC.     

Fractionated stereotactic radiotherapy of optic pathway gliomas: tolerance and long-term outcome

PURPOSE: To evaluate the effectiveness and toxicity of fractionated stereotactically guided radiotherapy (FSRT) in the management of optic glioma. METHODS AND MATERIALS: Fifteen patients with optic pathway gliomas were treated with FSRT at our institution between 1990 and 2003. A median target dose of 52.2 Gy (range, 45.2-57.6 Gy) was applied using a median fractionation of 5 fractions of 1.8 Gy weekly using a linear accelerator. RESULTS: The median follow-up time was 97 months (range, 8-151 months). Of the 15 patients, 1 died of tumor progression during the follow-up period. The progression-free survival rate at 3 and 5 years was 92% and 72%, respectively. The median overall survival after FSRT was 90 months (range, 8-151 months). The 5-year survival rate after FSRT was 90%. We did not observe secondary malignancies. CONCLUSION: Fractionated stereotactic radiotherapy was safe and well tolerated in all patients. The good tumor control and the potential of sparing normal brain tissue, especially the pituitary gland in lesions involving the optic chiasm, permit effective treatment of patients with optic nerve gliomas. Longer follow-up is needed to assess the incidence of late effects fully.     

Locally recurrent nasopharyngeal carcinoma.

PURPOSE: To assess the outcome of and determine prognostic factors for locally recurrent nasopharyngeal carcinoma (NPC) in patients treated with a second course of radiotherapy (RT). MATERIALS AND METHODS: From 1982 to 1995, 186 NPC patients, who had initially been treated in the Department of Radiation Oncology, Chang Gung Memorial Hospital-Linkou, developed local recurrence in the nasopharynx and were re-treated with RT (>/=20 Gy). The time from the initial RT to re-treatment ranged from 8 to 136 months (median: 23 months). All patients were treated with external RT and conformal radiotherapy was used in 35 patients after 1993. Fifteen received radiosurgery as a boost treatment. The RT dose at the nasopharyngeal tumor area ranged from 20 to 67.2 Gy (median 50 Gy). Eighty-two patients received one to eight courses of cisplatin-based chemotherapy in addition to RT. RESULTS: The 1-, 3- and 5-year survival was 54.9, 22. 1 and 12.4%, respectively. Patients whose tumor relapsed later than 2 years after the first treatment had a better survival than those with earlier relapse (3-year survival: 30.1 vs. 10.8%; P=0.015), but the difference became insignificant in patients who received >/=50 Gy. Patients without evidence of intracranial invasion or cranial nerve palsy had better survival than those with such lesions (3-year survival: 30.9 vs. 3.7%; P=0.006). A re-treatment dose >/=50 Gy yielded better survival (3-year survival: 22.8 vs. 18.5%; P=0.003). Addition use of radiosurgery may improve survival. The use of chemotherapy did not improve survival. Conformal radiotherapy resulted in significantly fewer severe complications than conventional RT. CONCLUSIONS: A repeat course of RT for locally recurrent NPC successfully prolongs survival in a significant number of patients. Intracranial invasion and/or cranial nerve palsy and re-treatment dose affect the prognosis, with a dose of >/=50 Gy significantly improving survival. Radiosurgery boost may also improve survival. Our preliminary data indicates that conformal radiotherapy may decrease the severity of radiation-induced complications. However; longer follow-up and larger sample size is necessary to document the findings.     

T3～T4N0～N3期鼻咽癌单纯放疗疗效分析

目的 探讨不同T分期与N分期对局部晚期鼻咽癌单纯放疗疗效的影响。方法 回顾分析556例T3～T4N0～N3期（1992年福州分期）鼻咽癌初治患者临床资料。全组病例均采用面颈联合野照射技术给予单纯常规放疗。原发灶照射总剂量66～80Gy（6.5～8．0周完成），颈淋巴结转移灶照射总剂量60～70Gy（6～7周完成）。结果 全组病例5年总生存率为66．4％。T3期5年总生存率为69．1％，T4期的为59.0％（P〈0．05）；两者局部控制率、无瘤生存率、无复发生存率以及无转移生存率均无差别。N0、N1、N2、N3期的5年总生存率分别为74．0％、66．0％、57．6％、29．4％（P〈0．01），N分期越高复发率和远处转移率越高。结论 单纯常规放疗的局部晚期鼻咽癌患者中。N分期是影响疗效及预后的主要因素，T分期为次要因素。对不同N分期的局部晚期鼻咽癌患者进行分层放化疗，对于解决治疗失败的原因——复发与远处转移也许会起到积极和有效的作用。     

两种非常规分割放疗治疗鼻咽癌的疗效分析

目的 对比观察两种放疗方式治疗鼻咽癌的局部控制率及急性反应和晚期损伤。方法 60例NO-2患者随机分为两组,一组采用标准超分割(HFR)方式放疗,总量DT 76.8 Gy;另一组采用前后程加速超分割(AHFR)方式放疗,总量DT72～75 Gy。结果 (1)两组的5年总生存率和5年无病生存率分别为69.84％、65.86％和62.86％、55.35％。两组的局部控制率均为93.33％。(2)AHFR组与HFR组的急性黏膜反应程度相似,AHRF组略高于HFR组。晚期反应两组无明显差异。(3)放疗结束时局部肿瘤的近期消退率AHFR组低于HFR组。半年时两者CT消退率相同。结论 两种放疗方式无明显差异,标准超分割放疗方式更简便易行。     

934例鼻咽癌单纯放疗远期疗效分析

目的 分析鼻咽癌患者单纯根治性放疗的远期疗效.方法 回顾分析1999年全年934例鼻咽癌初治患者临床资料及其主要预后影响因素.934例中男676例,女258例.按1992年福州分期标准分期,Ⅰ、Ⅱ、Ⅲ、Ⅳ.期分别为35、215、488和196例.全组病例均采用低熔点铅挡块而颈联合野等中心照射技术给予单纯常规分割放疗,原发灶总剂量66～88 Gy,颈淋巴结转移灶总剂量60～70 Gy,颈预防照射剂量50～56 Gy.结果 随访3.0～94.2个月,中位随访期67.1个月.全组病例5和8年总生存率、无瘤牛存率、无复发牛存率、无转移牛存率分别为68.3%、67.3%、64.4%、72.4%和48.0%、66.6%、50.8%、68.0%(χ2=49.74,P=0.000).无论是5和8年总牛存率、无瘤牛存率、无复发生存率或无转移生存率,N1期患者均显著低于N0期患者[66.0%:77.4%和50.3%:59.8%(χ2=33.34.P=0.000)、66.8%:76.1%和66.1%:76.1%(χ2=29.08,P=0.000)、63.4%:72.9%和48.9%:58.7%(χ2=27.65,P=0.000)、71.0%:80.8%和63.4%:68.0%(χ2=26.13,P=0.000)],N1与N2期的相似,N1～2期的显著高于N3期的.多因素分析表明性别、年龄、T分期及N分期是影响总牛存的独立预后因素.结论 早期鼻咽癌患者单纯根治性放疗可取得较好远期疗效,但局部晚期患者的总牛存率则仍未理想,主要火败丁局部区域复发和远处转移.临床分期及N期不同期别是影响顶后的主要因素.     

A phase II trial of accelerated radiotherapy using weekly stereotactic conformal boost for supratentorial glioblastoma multiforme: RTOG 0023

PURPOSE: This phase II trial was performed to assess the feasibility, toxicity, and efficacy of dose-intense accelerated radiation therapy using weekly fractionated stereotactic radiotherapy (FSRT) boost for patients with glioblastoma multiforme (GBM). METHODS AND MATERIALS: Patients with histologically confirmed GBM with postoperative enhancing tumor plus tumor cavity diameter <60 mm were enrolled. A 50-Gy dose of standard radiation therapy (RT) was given in daily 2-Gy fractions. In addition, patients received four FSRT treatments, once weekly, during Weeks 3 to 6. FSRT dosing of either 5 Gy or 7 Gy per fraction was given for a cumulative dose of 70 or 78 Gy in 29 (25 standard RT + 4 FSRT) treatments over 6 weeks. After the RT course, carmustine (BCNU) at 80 mg/m(2) was given for 3 days, every 8 weeks, for 6 cycles. RESULTS: A total of 76 patients were analyzed. Toxicity included: 3 Grade 4 chemotherapy, 3 acute Grade 4 radiotherapy, and 1 Grade 3 late. The median survival time was 12.5 months. No survival difference is seen when compared with the RTOG historical database. Patients with gross total resection (41%) had a median survival time of 16.6 months vs. 12.0 months for historic controls with gross total resection (p = 0.14). CONCLUSION: This first, multi-institutional FSRT boost trial for GBM was feasible and well tolerated. There is no significant survival benefit using this dose-intense RT regimen. Subset analysis revealed a trend toward improved outcome for GTR patients suggesting that patients with minimal disease burden may benefit from this form of accelerated RT.     

Role of chemoradiotherapy in intermediate prognosis nasopharyngeal carcinoma

To evaluate the long term impact of concurrent chemoradiotherapy (CCRT) compared to radiotherapy (RT) alone in patients with T2N1M0 nasopharyngeal carcinoma (NPC) retrospectively. Three hundred and ninety-two patients with T2N1M0 NPC according to the AJCC 2002 stage classification system were analyzed. Among them, 211 patients were treated with RT alone and the rest of 181 patients were treated with CCRT. A planned dose of 70 Gy was delivered in 2.0 Gy per fraction over 7 weeks to the primary tumor with 6-MV photons or (60)Cobalt γ-ray. The chemotherapy regimen of cisplatin with a dose of 100mg/m(2) was delivered for 2-3 cycles. With a median follow-up of 66 months (range 2.4-117.1 months), the 5-year overall survival (OS) and disease-free survival (DFS) rates was higher in CCRT group compared to RT alone group, though they failed to reach statistical significance (80.2% vs. 76.6%, P=0.778 and 70.5% vs. 64.2%, P=0.413, respectively). A significant improvement was detected in 5-year relapse-free survival (RFS) rate in CCRT group than RT alone group (91.5% vs. 77.3%, P=0.008). Moreover, chemotherapy was the only independent prognostic factor for the 5-year RFS (P=0.007). Concurrent chemoradiotherapy appeared to improve the 5-year RFS rate for patients with T2N1M0 NPC. Large prospective, randomized clinical studies are needed to confirm its therapeutic gain.     

Routine use of approximately 60 Gy once-daily thoracic irradiation for patients with limited-stage small-cell lung cancer

PURPOSE: To review the outcome of patients with limited-stage small-cell lung cancer receiving daily thoracic irradiation (RT) to approximately 60 Gy. METHODS AND MATERIALS: The records of patients treated with RT for limited-stage small-cell lung cancer between 1991 and 1999 at Duke University were retrospectively reviewed. Sixty-five patients were identified who had received continuous course once-daily 1.8-2 Gy fractions to approximately 60 Gy (range 58-66). All patients received chemotherapy (CHT); 32 received concurrent RT/CHT and 33 sequential CHT and then RT. Prophylactic cranial RT was administered to 17 patients. The time from diagnosis to local failure, tumor progression, and death was assessed using actuarial methods. The median follow-up for all patients was 16.7 months and for surviving patients was 29.6 months. The median age was 64 years (range 36-83), and the median Karnofsky performance status was 80 (range 50-100). RESULTS: The 3-year actuarial rate of local failure, progression-free survival, and overall survival was 40%, 25%, and 23%, respectively. One case of acute Grade 3 esophagitis developed. Ten late complications occurred: four pulmonary, two esophageal, two infectious, one leukemia, and one retinal toxicity with prophylactic cranial RT. Six were mild and resolved with treatment. CONCLUSION:CHT plus approximately 60 Gy of once-daily RT for limited-stage small-cell lung cancer was generally well tolerated. The survival rates were less than have been reported using 45 Gy in 1.5-Gy twice-daily fractions (2-year overall survival rate 47% compared with 30% in this study), but may be comparable because fewer than one-half our patients received concurrent CHT/RT and only 26% received prophylactic cranial RT. The relatively low rate of normal tissue morbidity in our patients supports the use of conventional once-daily fractionation to > or = 60 Gy. A randomized trial would be required to compare the outcomes after maximally tolerated dose twice-daily RT vs. maximally tolerated dose daily RT.