Use of 8-Gy Radiotherapy Fractions for the Treatment of Lung Cancer in Fragile Patients

e17504 Background: The purpose of this study is to evaluate the tolerance and suitability of treatment with high dose radiotherapy (RT) fractions (fr) for fragile patients (pts) with lung cancer who are not candidates for surgery or chemotherapy (CT) in the daily clinical practice. Methods: 30 pts (29 males) were treated between April 2007 and December 2010. Median age was 73.5 (range 54-86). All of them except 2 were pts with severe limitations on pulmonary function, high surgical risk or bad physical condition; 2 pts had relapses of previous lung cancer that did not respond to CT. Curative-intent RT was administered twice weekly at doses of 56 Gy in 7 fr (24 pts), 48 Gy in 6 fr (2 pts), 40 Gy in 5 fr (3 pts) and 16 Gy in 2 fr (1 patient (pt) who could not complete RT). Median RT duration was 21 days (range 11-25). In one pt concurrent erlotinib was maintained. Stage of disease was I in 20 pts (67%), II in 4 pts (13%), III in 3 pts (10%) and IV in 3 pts (pulmonary or pleural metastases). Histology was squamous cell carcinoma in 14 pts, adenocarcinoma in 14 pts and undifferentiated carcinoma in 2 pts. Results: Local response was complete remission (CR) in 18 pts (60%), partial remission (PR) in 6 pts (20%), stable disease (SD) in 3 pts (10%), disease progression (DP) in 2 pts (7%) and non-evaluable in 1 pt (3%). With a median follow-up of 7 months (range 1-43), 14 pts are alive without DP (10 pts in CR, 1 pt in PR, 3 pts with SD), 3 pts are alive with DP, 1 pt developed metastases with local CR, 6 pts died of other causes (4 pts had CR of their tumors, 1 pt achieved a PR and 1 pt died of respiratory complications before completing RT), and 6 pts died of DP. 3-year overall survival (OS) is 51.6%, 3-year overall specific survival (OSS) is 73.7%, and 3-year disease free-progression survival (DFPS) is 53.1%. In the group of pts without advanced or metastatic disease, 3-year OS, OSS and DFPS are 80.2%, 60.5% and 50.4%, respectively. No treatment-related deaths were registered. Toxicity was limited to local radiologic pneumonitis in nearly all pts and dermatitis in some. Conclusions: Irradiation of localized lung tumors with high dose RT fractions in fragile pts who are not candidates to other types of therapy allow for good rates of both response and survival, with minimum toxicity and lower treatment period.