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Dose Escalation Study of Concurrent Chemoradiotherapy With the Use of Involved-field Conformal Radiotherapy and Accelerated Hyperfractionation in Combination With Cisplatin and Vinorelbine Chemotherapy for Stage III Non–small Cell Lung Cancer

The Final Report

Yoshimura, Naruo, MD, PhD*; Tada, Takuhito, MD, PhD†,‡; Matsumoto, Yoshiya, MD§; Sawa, Kenji, MD§; Yoshimoto, Naoki, MD, PhD§; Suzumura, Tomohiro, MD, PhD*; Tanaka, Hidenori, MD, PhD§; Mitsuoka, Shigeki, MD, PhD*; Kimura, Tatsuo, MD, PhD§,∥; Tamiya, Tomohiro, MD; Hirashima, Tomonori, MD, PhD; Kawaguchi, Tomoya, MD, PhD*,§; Kudoh, Shinzoh, MD, PhD*; Hosono, Masako, MD, PhD; Hirata, Kazuto, MD, PhD§

American Journal of Clinical Oncology: October 2018 - Volume 41 - Issue 10 - p 967–971
doi: 10.1097/COC.0000000000000412
Original Articles: Thoracic

Objectives: A phase I study to determine a recommended dose of thoracic radiotherapy using accelerated hyperfractionation for unresectable non–small cell lung cancer was conducted.

Materials and Methods: We used chemotherapy of a cisplatin doublet and 2 dose levels of radiation with accelerated hyperfractionation. The radiation dose levels were: a total dose of 60 Gy in 40 fractions at level 1, and 66 Gy in 44 fractions at level 2. Eligible patients with unresectable stage III non–small cell lung cancer received cisplatin and vinorelbine. Radiation therapy started on day 2 of chemotherapy and was delivered twice daily for 5 days a week.

Results: Total 12 patients were enrolled, with 6 patients each at dose levels 1 and 2. Dose-limiting toxicity was noted in 2 patients at level 1; one patient had grade 3 febrile neutropenia and the other patient had grade 3 esophagitis. No dose-limiting toxicity was noted in the 6 patients at level 2. Grade 3 to 4 leukopenia, neutropenia, and anemia were noted in 11 (92%), 9 (75%), and 8 (67%) of the total 12 patients, respectively. Grade 3 anorexia and infection were noted in 2 patients (17%) at each level. Grade 3 nausea, fatigue, esophagitis, and febrile neutropenia were noted in 1 patient (8%) at each level. The response rate in the total 12 patients was 83.3%. The median progression-free survival time and the median overall survival time were 10.7 and 24.2 months, respectively.

Conclusions: Sixty-six gray in 44 fractions is the recommended dose for the following phase II study.

Departments of *Clinical Oncology


§Respiratory Medicine

Premier Preventive Medicine, Graduate School of Medicine, Osaka City University

Department of Thoracic Malignancy, Osaka Prefectural Medical Center for Respiratory and Allergic Diseases, Osaka

Department of Radiology, Izumi Municipal Hospital, Izumi, Japan

Presented at 2013 ASCO Annual Meeting (General Poster Session; abstr 7564).

Clinical Trial Registration number: UMIN ID: UMIN000003769.

The authors declare no conflicts of interest.

Reprints: Naruo Yoshimura, MD, PhD, Department of Clinical Oncology, Graduate School of Medicine, Osaka City University, 1-4-3, Asahi-machi, Abeno-ku, Osaka 545-8585, Japan. E-mail:

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