Dose-Escalation Radiation for Locally Advanced NSCLC

Background: Concurrent radiotherapy and chemotherapy for locally advanced non–small-cell lung cancer (NSCLC) results in 2-year local control of only 60%. Two studies have demonstrated that dose-escalation radiation induced increased toxicities. Objective: To evaluate heterogeneous fluorodeoxyglucose (FDG)-PET–driven dose escalation in unselected, inoperable NSCLC. Design: Multi-institutional, randomized dose-escalation study. Participants: Adults with Eastern Cooperative Oncology Group performance status scores from 0 to 1, stages IIB to IIIB NSCLC. Methods: Patients were randomized between 66 Gy in 33 fractions, 5 fractions/week and heterogeneous dose escalation, up to 95 Gy in 33 fractions, again in 5 fractions/week. Prior to randomization, 2 treatment plans were generated for each patient. Patients were stratified by treating center and squamous versus nonsquamous histology. Induction chemotherapy with platinum doublet was permitted. Concurrent chemotherapy was oral vinorelbine an more...