Purpose/Objective(s)RTOG 0617, raising the dose from 60 Gy to 74 Gy in a concurrent mode with chemotherapy, failed to improve the results for patients with locoregionally advanced non-small cell lung cancer (NSCLC). Thereafter the potential capacity of concurrent approaches in this entity is challenged. In a prospective study we combined chemotherapy sequentially with accelerated radiation therapy, correlating tumor volume to radiation doses. Primary end point is locoregional tumor control, secondary end points are survival and toxicity. With a median follow-up time of 62.1 months for patients alive, mature results are presented.Materials/MethodsRadiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5-4.5 cm/4.5-6.0 cm/ >6.0 cm; mean number of three perpendicular diameters). ICRU-doses of 73.8 Gy/79.2 Gy/84.6 Gy/90.0 Gy, respectively, were applied. Macroscopically involved nodes were treated with a median dose of 59.4 Gy, nodal sites about 6 cm cranial to involved nodes electively with 45 Gy. Fractional doses were 1.8 Gy twice daily (bid). Tight margins of only 7 mm from GTV (ITV) to PTV were used. 77% of the patients received 2 cycles chemotherapy before radiation therapy, keeping the interval between chemotherapy and radiation therapy preferentially < 8 days.ResultsBetween 2004 and 2009,123 continuously referred, unselected patients with 127 histologically/cytologically proven NSCLC were enrolled; Stage II: 6 pts.; IIIA: 70 pts.; IIIB: 47 pts. Weight loss >5%/ 3 months: 26%; Karnofsky Index ≤ 70%: 46% of the patients. 28 local recurrences occurred, distributed within the above described tumor size groups as follows: 2/20, 18/ 75, 6/24 and 2/8. Ten patients failed regionally only. The local tumor control rate at 2-/ 5 years is 73%/ 70%, respectively; the regional tumor control rate 91%/ 89%, respectively. The median overall survival time is 24.6 months, the 2- and 5-year overall survival rates are 52% and 19%, respectively. 2 treatment-related deaths (progressive pulmonary fibrosis) occurred in patients with pre-existing pulmonary fibrosis. Further toxicity was mild or moderate: Pneumonitis grade 2/ 3 (n = 10/ 6); esophagitis grade 2/ 3 (n = 16/ 7). Lung late grade 2 (n = 13), esophagus late grade 3 (n = 1).ConclusionsLocoregional tumor control is high; as are survival times for this unselected patient cohort; toxicity in general is low. All outcome parameters seem to compare favorably with concurrent chemo-radiotherapies, at present considered 'state of the art'; additionally DART-bid is applicable to an unselected patient population. Our results could contribute to consider research of approaches with more appropriate, because differentiated elevated and accelerated radiotherapeutic components. Purpose/Objective(s)RTOG 0617, raising the dose from 60 Gy to 74 Gy in a concurrent mode with chemotherapy, failed to improve the results for patients with locoregionally advanced non-small cell lung cancer (NSCLC). Thereafter the potential capacity of concurrent approaches in this entity is challenged. In a prospective study we combined chemotherapy sequentially with accelerated radiation therapy, correlating tumor volume to radiation doses. Primary end point is locoregional tumor control, secondary end points are survival and toxicity. With a median follow-up time of 62.1 months for patients alive, mature results are presented. RTOG 0617, raising the dose from 60 Gy to 74 Gy in a concurrent mode with chemotherapy, failed to improve the results for patients with locoregionally advanced non-small cell lung cancer (NSCLC). Thereafter the potential capacity of concurrent approaches in this entity is challenged. In a prospective study we combined chemotherapy sequentially with accelerated radiation therapy, correlating tumor volume to radiation doses. Primary end point is locoregional tumor control, secondary end points are survival and toxicity. With a median follow-up time of 62.1 months for patients alive, mature results are presented. Materials/MethodsRadiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5-4.5 cm/4.5-6.0 cm/ >6.0 cm; mean number of three perpendicular diameters). ICRU-doses of 73.8 Gy/79.2 Gy/84.6 Gy/90.0 Gy, respectively, were applied. Macroscopically involved nodes were treated with a median dose of 59.4 Gy, nodal sites about 6 cm cranial to involved nodes electively with 45 Gy. Fractional doses were 1.8 Gy twice daily (bid). Tight margins of only 7 mm from GTV (ITV) to PTV were used. 77% of the patients received 2 cycles chemotherapy before radiation therapy, keeping the interval between chemotherapy and radiation therapy preferentially < 8 days. Radiation doses to primary tumors were aligned along increasing tumor size within 4 groups (<2.5 cm/2.5-4.5 cm/4.5-6.0 cm/ >6.0 cm; mean number of three perpendicular diameters). ICRU-doses of 73.8 Gy/79.2 Gy/84.6 Gy/90.0 Gy, respectively, were applied. Macroscopically involved nodes were treated with a median dose of 59.4 Gy, nodal sites about 6 cm cranial to involved nodes electively with 45 Gy. Fractional doses were 1.8 Gy twice daily (bid). Tight margins of only 7 mm from GTV (ITV) to PTV were used. 77% of the patients received 2 cycles chemotherapy before radiation therapy, keeping the interval between chemotherapy and radiation therapy preferentially < 8 days. ResultsBetween 2004 and 2009,123 continuously referred, unselected patients with 127 histologically/cytologically proven NSCLC were enrolled; Stage II: 6 pts.; IIIA: 70 pts.; IIIB: 47 pts. Weight loss >5%/ 3 months: 26%; Karnofsky Index ≤ 70%: 46% of the patients. 28 local recurrences occurred, distributed within the above described tumor size groups as follows: 2/20, 18/ 75, 6/24 and 2/8. Ten patients failed regionally only. The local tumor control rate at 2-/ 5 years is 73%/ 70%, respectively; the regional tumor control rate 91%/ 89%, respectively. The median overall survival time is 24.6 months, the 2- and 5-year overall survival rates are 52% and 19%, respectively. 2 treatment-related deaths (progressive pulmonary fibrosis) occurred in patients with pre-existing pulmonary fibrosis. Further toxicity was mild or moderate: Pneumonitis grade 2/ 3 (n = 10/ 6); esophagitis grade 2/ 3 (n = 16/ 7). Lung late grade 2 (n = 13), esophagus late grade 3 (n = 1). Between 2004 and 2009,123 continuously referred, unselected patients with 127 histologically/cytologically proven NSCLC were enrolled; Stage II: 6 pts.; IIIA: 70 pts.; IIIB: 47 pts. Weight loss >5%/ 3 months: 26%; Karnofsky Index ≤ 70%: 46% of the patients. 28 local recurrences occurred, distributed within the above described tumor size groups as follows: 2/20, 18/ 75, 6/24 and 2/8. Ten patients failed regionally only. The local tumor control rate at 2-/ 5 years is 73%/ 70%, respectively; the regional tumor control rate 91%/ 89%, respectively. The median overall survival time is 24.6 months, the 2- and 5-year overall survival rates are 52% and 19%, respectively. 2 treatment-related deaths (progressive pulmonary fibrosis) occurred in patients with pre-existing pulmonary fibrosis. Further toxicity was mild or moderate: Pneumonitis grade 2/ 3 (n = 10/ 6); esophagitis grade 2/ 3 (n = 16/ 7). Lung late grade 2 (n = 13), esophagus late grade 3 (n = 1). ConclusionsLocoregional tumor control is high; as are survival times for this unselected patient cohort; toxicity in general is low. All outcome parameters seem to compare favorably with concurrent chemo-radiotherapies, at present considered 'state of the art'; additionally DART-bid is applicable to an unselected patient population. Our results could contribute to consider research of approaches with more appropriate, because differentiated elevated and accelerated radiotherapeutic components. Locoregional tumor control is high; as are survival times for this unselected patient cohort; toxicity in general is low. All outcome parameters seem to compare favorably with concurrent chemo-radiotherapies, at present considered 'state of the art'; additionally DART-bid is applicable to an unselected patient population. Our results could contribute to consider research of approaches with more appropriate, because differentiated elevated and accelerated radiotherapeutic components.