BACKGROUND AND PURPOSE We aimed to investigate the potential of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer (NSCLC). MATERIALS AND METHODS Individually prescribed radiation doses were calculated based on NTC. Patients with total tumour radiation doses ≥66 Gy were assigned to the high dose (HD, ≥66 Gy) group, and all other patients were assigned to the standard-dose (SD, <66 Gy) group. Each patient was retrospectively assigned an Eighth edition of American Joint Committee on Cancer disease stage based on the imaging data of initial diagnosis to avoid over- and under-staging. Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival. RESULTS From March 2006 to September 2012, 140 patients were enrolled and assigned to two groups: 71 patients into the HD group and 69 patients into the SD group. The median survival time (MST) was significantly higher in the HD group (33.5 months) than in the SD group (21 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the HD group than in the SD group (37.8% vs 16.7%). Median progression-free survival was 19 months in the HD group and 11 months in the SD group (p < 0.0001). No difference in severe (grade 3-5) toxic effects was noted between the two groups. CONCLUSIONS The significant positive association observed between prescribed dose and survival suggests that individualized isotoxic dose-escalated radiation based on NTC might improve survival in this cohort of stage III NSCLC Chinese patients.

中文翻译：

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基于正常组织约束的高剂量放疗联合同步化疗实现了不可切除的 III 期非小细胞肺癌患者的有希望的生存期

背景和目的 我们旨在研究基于正常组织约束 (NTC) 的个体等毒剂量递增的可能性，假设在不可切除的 III 期非小细胞肺癌的同步放化疗中，高剂量放疗优于标准剂量。非小细胞肺癌）。材料和方法 根据 NTC 计算单独规定的辐射剂量。肿瘤总辐射剂量≥66 Gy的患者被分配到高剂量（HD，≥66 Gy）组，所有其他患者被分配到标准剂量（SD，<66 Gy）组。根据初步诊断的影像资料，每位患者被回顾性分配到美国癌症联合委员会第八版疾病分期，以避免分期过度和分期不足。对调强放射治疗计划进行了优化，以最大限度地减少暴露于辐射的风险器官的体积。主要终点是总生存期。结果 2006年3月至2012年9月共纳入140例患者，分为两组：HD组71例，SD组69例。HD 组（33.5 个月）的中位生存时间（MST）明显高于 SD 组（21 个月），（p < 0.0001）。HD 组的总体 5 年生存率显着高于 SD 组（37.8% 对 16.7%）。HD 组的中位无进展生存期为 19 个月，SD 组为 11 个月（p < 0.0001）。两组之间没有发现严重（3-5 级）毒性作用的差异。