Impact of irradiation protocol deviations on the outcome of unresectable stage III NSCLC patients receiving concurrent chemoradiotherapy: Quality-assurance results of the GFPC-IFCT 02.01 trial

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LIED RADIATION ONC LOGY ww.appliedradiology.com March I I I . li r i l . OL GY © w .appliedradiology.c m July 4 A dose-effect relationship of exclusive radiotherapy (RT) is likely to exist in non-small cell lung cancer (NSCLC) with lower doses providing poorer local control.1,2 However, high doses result in more severe toxicity. Based on 3D conformal RT, thresholds have been established for pulmonary dose-volume histograms (DVH), with the aim of avoiding severe radio-induced pneumonitis.3 In selected patients with unresectable stage III NSCLC, concomitant chemoradiation has proven superior to sequential combination therapy,4,5 but causes more frequent acute esophagitis.6-9 Therefore, RT quality control is useful for reducing treatment toxicity and improving tumor control. In some other malignancies, both toxicity and overall survival (OS) correlate with the quality of RT.10 Very few data on RT quality are available for NSCLC, as quality assurance usually focuses on technical and physical assessment of linear accelerators.11-12 We analyzed RT quality in a phase II randomized trial of concurrent chemoradiation for unresectable stage III NSCLC. The main objectives were to assess compliance with the trial’s protocol and the impact of observed deviations on survival and toxicity.

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