Fractionation Didn't Affect Overall Survival for Inoperable Non-small Cell Lung Cancer in Small Cleveland Clinic Study

In comparing two stereotactic body radiation fractionation schedules used to treat medically inoperable stage I non-small cell carcinoma, researchers at the Cleveland Clinic Foundation found that varying the doses didn't affect tumor control or toxicity.

Kevin L. Stephans, et al, reviewed the cases of 86 patients with medically inoperable stage I non-small cell lung cancer who received either radiation therapy in 50 Gy in five fractions or 60 Gy in three fractions. The institutional practice in the radiation oncology department at the Cleveland Clinic was 10 Gy x 5 before the institution adopted a 20 Gy x 3 regimen in 2006 that conformed to Radiation Therapy Oncology Group 0236.

The researchers found that local control was 97.3 percent for the 50-Gy cohort versus 100 percent for 60 Gy, nodal failure was 7.3 percent versus 3.4 percent, the distant metastasis rate was 21.8 percent versus 29.5 percent and overall survival was 83.1 percent versus 76.9 percent.

Mild late chest wall toxicity of grade 1 or 2 was seen in nine patients at a median of 8.4 months after treatment and proved more common in the 60-Gy group.

The authors concluded that fractionation did not affect local control, overall survival, nodal failure and distant failure. However, "chest wall toxicity was more common with 60-Gy group."

These findings were published in the August 2009 Journal of Thoracic Oncology in the article, "A Comparison of Two Stereotactic Body Radiation Fractionation Schedules for Medically Inoperable Stage I Non-small Cell Lung Cancer: the Cleveland Clinic Experience," published in the August 2009 Journal of Thoracic Oncology.