A retrospective study of shrinking field radiation therapy during chemoradiotherapy in stage III non-small cell lung cancer

// Chenxue Jiang 1, 2, * , Shuiyun Han 2, * , Wucheng Chen 1, 2 , Xiaozhen Ying 1, 2 , He Wu 1, 2 , Yaoyao Zhu 1, 2 , Guodong Shi 2 , Xiaojiang Sun 2 and Yaping Xu 1, 2 1 First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China 2 Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China * These authors contributed equally to this work Correspondence to: Yaping Xu, email: xuyaping1207@163.com Keywords: lung cancer; chemoradiation therapy; dose escalation; adaptive radiotherapy Received: April 04, 2017 Accepted: October 26, 2017 Published: January 03, 2018 ABSTRACT Background and purpose: This retrospective study aimed to investigate the feasibility of shrinking field radiotherapy during chemoradiotherapy in non-small cell lung cancer (NSCLC). Patients and methods: Ninety-seven patients with stage III NSCLC who achieved a good response to chemoradiation were analyzed. Computed tomography was performed after 40-50 Gy dose radiation to evaluate curative effect. Patients in the shrinking field group underwent resimulation CT scans and shrinking field radiotherapy. Acute symptomatic irradiation-induced pneumonia (ASIP), progression patterns and survival were assessed. Results: Of the 97 patients who achieved response after a median total dose of 60 Gy, fifty patients received shrinking field radiotherapy. The incidence of acute symptomatic irradiation-induced pneumonia tended to be lower for the shrinking field group (18.0% vs. 23.4%, P = 0.51). The rate of disease progression was significantly higher in the non-shrinking than shrinking field group (95.7% vs. 66.0%, P < 0.001). Compared to the non-shrinking field group, the shrinking field group had similar overall survival (30.0 vs. 30.0 months, P = 0.58) but significantly better median progression-free survival (14.0 vs. 11.0 months, P = 0.006). Conclusions: Shrinking field radiotherapy during chemoradiotherapy in stage III non-small cell lung cancer seems safe with acceptable toxicities and relapse, and potentially spares normal tissues and enables dose escalation. Prospective trials are warranted.