Toxicity of concurrent hyperfractionated radiation therapy and chemotherapy in locally advanced (stage III) non-small cell lung cancer (NSCLC): single institution experience in 600 patients

to investigate toxicity of hyperfractionated radiation therapy (Hfx RT) with or without concurrent chemotherapy (CHT) in patients with locally advanced non-small cell lung cancer (NSCLC) and factors independently influencing it.

Of a total of 600 patients treated during five prospective studies Hfx RT alone was given in 127 and Hfx RT-CHT was given in 473 patients. Hfx RT doses were 64.8 and 69.6 Gy (1.2 Gy bid) and 67.6 Gy (1.3 Gy bid). CHT administration consisted of concurrent carboplatin and etoposide in 409 patients and concurrent carboplatin and paclitaxel in 64 patients.

Acute oesophageal toxicity was significantly increased with concurrent CHT (p = 0.034), as well as bronchopulmonary (p = 0.044) and haematological toxicity (p < 0.001). Only late high-grade bronchopulmonary (p = 0.007) toxicity was significantly more frequent in the RT-CHT group. Only acute high-grade haematological toxicity was significantly more frequent in split CHT than in daily CHT and Hfx RT alone (p < 0.001). Only late high-grade bronchopulmonary toxicity remained significantly more frequent in both Hxf RT-CHT groups than in Hfx RT alone. No variable influenced acute high-grade bronchopulmonary, gastric or skin toxicity. Pronounced weight loss influenced increased acute high-grade oesophageal toxicity. Increased weight loss and lower KPS influenced increased haematological toxicity. Pronounced weight loss and concurrent CHT influenced increased late high-grade bronchopulmonary toxicity.

This study reconfirmed low acute and late high-grade toxicity in stage III NSCLC treated with concurrent RT-CHT and identified factors influencing it.