Involved-field Irradiation Intensity Modulated Radiation Therapy with Concurrent Chemotherapy for Locally Advanced Non-small Cell Lung Cancer

Objective To compare toxicities and clinical outcomes of involved field irradiation (IFI)and with elective nodal irradiation (ENI)intensity modulated radiation therapy (IMRT)with concurrent chemotherapy for locally advanced non-small cell lung cancer (LA-NSCLC). Methods 49 patients with of LA-NSCLC were prospectively randomized into IFI group and ENI group，receiving 2 cycles of concurrent chemotherapy and radical IMRT. Results ≥grade 2 radiation pneumonitis developed in 8.0% of the patients in IFI group and 37.5% in ENI group (P=0.01).The mean prescription doses to grass tumor volumes with IFI and ENI were (66.2±6.5)Gy and (61.3±6.3)Gy (P=0.01).The responsive rates were 92.0% and 66.7% (P=0.03)，and the elective nodal failure (ENF)rates were 4.2%and 4.0% (P=0.49)，respectively.The 1-year local-failure rates were 8.0% and 16.7% (P=0.62)，while the 1-year survival rates were72.0% and 62.5% (P=0.48)，respectively. Conclusion IFI IMRT with concurrent chemotherapy for LA-NSCLC could reduce the probability of normal tissue complications and improve the target dose and tumor control rate without increasing incidence of elective nodal failure.It might further prolong patients' survival.