Simultaneous integrated boost intensity-modulated radiotherapy for treatment of locally advanced non-small-cell lung cancer: a retrospective clinical study

Objective: To evaluate the clinical efficacy and safety of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for patients with locally advanced non-small-cell lung cancer (LANSCLC). Methods: 48 patients with LANSCLC treated with SIB-IMRT from January 2010 to April 2012 were retrospectively analysed. A radiation dose of 45-63 Gy (median dose, 51.58 Gy) was delivered to the planning target volume (1.8-2.0 Gy daily fractions) simultaneously with 55.0-74.2 Gy (median dose, 63 Gy) to the planning gross tumour volume (2.00-2.25 Gy daily fractions). 45 patients received concurrent/sequential chemotherapy. The overall survival (OS), locoregional recurrence-free survival (LRFS) and progression-free survival (PFS) were estimated using the Kaplan-Meier method. Treatment-related pneumonitis and oesophagitis were graded according to the Common Terminology Criteria for Adverse Events v. 4.0. Results: By 1 July 2013, 29 of the 48 patients were dead. The median follow-up time for the survivors was 28 months (19-44 months). The median OS and PFS were 21 and 14 months, respectively. The median LRFS time was not reached. The 2-year LRFS, OS and PFS were 62.5%, 45.1% and 28.0%, respectively. Two patients experienced Grade 3 treatment-related pneumonitis, two patients experienced Grade 5 treatment-related pneumonitis and two patients had >= Grade 3 oesophagitis. Conclusion: SIB-IMRT appears to be an effective therapeutic option in patients with LANSCLC and warrants further evaluation with increased number of patients in prospective clinical trials. Advances in knowledge: This study explores the feasibility of delivering tumoricidal doses of radiation to primary lesions in non-small-cell lung cancer.