The purpose of this pilot study was to determine the safety and feasibility of accelerated fractionation (via concomitant boost) radiotherapy (XRT) with concurrent carboplatin/paclitaxel chemotherapy for locally advanced stage III non-small cell lung carcinoma. Radiotherapy consisted of 3-dimensional conformal techniques to 60 Gy continuous course, over 4 weeks, via 3-dimensional conformal techniques. Once-daily treatments were used; the large field (including gross tumor and selected regional nodes) was given a daily dose of 2.2 Gy (to 44 Gy), with a 0.8 Gy concomitant boost (field within a field) for an additional 16 Gy to the gross tumor volume. Weekly carboplatin at an area under the curve (AUC) of 2 plus paclitaxel 50 mg/m2 were given during XRT, followed by two cycles of systemic-dose carboplatin AUC 6, every 4 weeks plus paclitaxel 100 mg/m2 , 3 weeks out of 4, were planned. The nutritional supplement glutamine 10 mg 3 times per day was prescribed in an effort to decrease esophagitis. Before the early closure of this study, five patients were enrolled, of whom four were evaluable for toxicity/feasibility. No patient experienced grade 3+ acute nonhematologic toxicity during concurrent chemoradiotherapy. Hematologic toxicity was significant in the post-XRT consolidation phase, resulting in dose reduction and/or discontinuation in three of four patients. More notably, two patients experienced serious nonhematologic late toxicity. One patient developed a grade 4 tracheoesophageal fistula that probably contributed to her death 6 months after treatment, and one patient developed grade 3 pulmonary complications including severe oxygen-dependent radiation pneumonopathy. Three patients are alive without disease progression at 14, 20, and 21 months follow-up. Despite the use of 3-dimensional conformal technology, this regimen of concomitant boost accelerated hypofractionated XRT with concurrent and systemic chemotherapy was excessively toxic and not feasible. Extreme caution must be exercised in designing studies of XRT dose intensification with concurrent chemotherapy.

中文翻译：

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Ⅲ期非小细胞肺癌同时放化疗加速放疗的初步研究。

这项初步研究的目的是确定对于局部晚期III期非小细胞肺癌，同时进行卡铂/紫杉醇化疗的加速分级放疗（通过同时加强）放射治疗（XRT）的安全性和可行性。放射治疗包括3维保形技术，通过3维保形技术，可连续4周进行60 Gy连续疗程。每天使用一次治疗；大视野（包括大块肿瘤和选定的区域性结节）每天给予2.2 Gy（至44 Gy）的剂量，同时伴随0.8 Gy的增强（一个视野内的视野），使大块肿瘤的体积增加16 Gy。在XRT期间每周两次在曲线下面积（AUC）加上卡铂50 mg / m2的卡铂，然后进行两个周期的全身剂量卡铂AUC 6，计划每4周加100 mg / m2紫杉醇，每4周3周。为了减少食道炎，建议每天补充营养补充谷氨酰胺10毫克，每天3次。在该研究的早期结束之前，招募了五名患者，其中四名可评估其毒性/可行性。在同步放化疗期间，没有患者经历3级以上的急性非血液学毒性。在XRT合并后阶段，血液学毒性显着，导致四分之三的患者剂量减少和/或停药。更值得注意的是，两名患者出现了严重的非血液学晚期毒性。一名患者出现了4级气管食管瘘，可能在治疗6个月后导致了死亡，一名患者发生了3级肺部并发症，包括严重的氧依赖型放射性肺病。在随访的14、20和21个月中，有3例患者尚无疾病进展。尽管使用了3D保形技术，这种同时加用和全身化疗的联合加速加速超分割XRT的方案毒性太大，不可行。在设计同时进行化学疗法的XRT剂量增强研究时必须格外谨慎。