High-dose fractionated radiotherapy to 80 Gy for stage I-II medically inoperable non-small-cell lung cancer

Introduction: Management of medically inoperable non-small-cell lung cancer (NSCLC) has been historically challenging, with poor rates of local control and disease-specific survival. Nearly all published series of standard fractionation radiotherapy have utilised doses <70 Gy. The present investigation describes disease control and survival outcomes for a large series of patients prescribed high-dose radiotherapy for early-stage NSCLC. Methods: Retrospective analysis of disease control and survival outcomes for stages I–II NSCLC patients prescribed ≥70 Gy at 1.8–2.5 Gy per fraction. Results: Between May 1997 and August 2008, 100 primary lung tumours in 98 patients (two metachronous) were eligible for analysis. The median age was 71 years (range 49–93), and 92 patients were considered medically inoperable. Nearly all cases were clinical stage cT1N0 (51 patients) or cT2N0 (35). The median radiotherapy dose prescribed was 80.5 Gy (range 70–90). At a median follow-up of 18 months, 72 patients died (44 of/with disease) and 50 experienced recurrence. The estimated 3-year in-field control, progression-free survival, disease-specific, and overall survival rates were 50, 29, 30 and 24%, respectively. Univariate analyses demonstrated an inverse association between local control and tumour size. Medical inoperability was associated with decreased disease-specific and overall survivals. Patient age and biologically equivalent dose were also associated with overall survival. Conclusions: Disease control and survival of fractionated radiotherapy for early-stage NSCLC remain suboptimal. Medical inoperability is associated with worse overall survival; however, local control remains a predominant pattern of failure despite 80 Gy in standard fractionation, particularly in patients with larger tumour size.