Conservative treatment of stage III lung cancer using chemoradiotherapy in hypofractionation mode, case report

Lung cancer is a leader in the world in terms of morbidity and mortality. Moreover, the number of patients with locally advanced forms of non-small cell lung cancer exceeds 30% of all newly diagnosed cases. The standard of treatment for patients with inoperable stage III lung cancer is chemoradiotherapy. Currently, ways to increase the effectiveness of chemoradiotherapy are being considered, in particular, local escalation of the radiation dose to the tumor, which allows personalizing approaches in the treatment of this category of patients. One of the most common complications of chemoradiotherapy is post-radiation pulmonitis, which requires timely diagnosis and treatment with glucocorticosteroids in severe cases.
We present a case report of a patient with locally advanced non-small cell lung cancer who received treatment as part of simultaneous chemoradiotherapy in the hypofraction mode, complicated by post-radiation pulmonitis.
Successful treatment of complications led to the restoration of the general condition of the patient; during the follow-up examination, a complete response to the specific treatment was recorded.
Thus, a promising method of treating patients with inoperable stage III non-small cell lung cancer is the option of simultaneous chemoradiotherapy with local escalation of the radiation dose to the tumor, while being wary of complications such as pulmonitis, allows for timely diagnosis and treatment of the condition.

1. Tessen H.W., Hutzschenreuter U., Steffens C.C., Nusch A., Spirik J., Marschner N. The treatment of lung cancer in German outpatient centres. Data from a clinical registry – TLK Registry. Onkologie. 2011;34 (Suppl. 6) (Poster P533):153. Available at: https://www.karger.com/Article/Pdf/333301.

2. Howlader N., Noone A.M., Krapcho M., Miller D., Bishop K., Kosary C.L. et al. SEER Cancer Statistics Review, 1975–2010, National Cancer Institute. Bethesda, MD; 2013. Vol 20, 2015 p. Available at: http://seer.cancer.gov/csr/1975_2010.

3. Wakelee H., Kelly K., Edelman M.J. 50 Years of Progressin the Systemic Therapy of Non-Small Cell Lung Cancer. Am Soc Clin Oncol Educ Book. 2014;34:177–189. doi: 10.14694/EdBook_AM.2014.34.177.

4. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. Non-small Cell Lung Cancer Collaborative Group. BMJ. 1995;311(7010):899–909. doi: 10.1136/bmj.311.7010.899.

5. Aupérin A., Le Péchoux C., Rolland E., Curran W.J., Furuse K., Fournel P. et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2181–2190. doi: 10.1200/JCO.2009.26.2543.

6. O’Rourke N., Roqué I., Figuls M., Farré Bernadó N., Macbeth F. Concurrent chemoradiotherapy in non-small cell lung cancer. Cochrane Database Syst Rev. 2010;(6):50–53. doi: 10.1002/14651858.CD002140.pub3.

7. Сhen C.P., Weinberg V.K., Jahan T.M., Jablons D.M., Yom S.S. Implication of delayed initiation of radiotherapy accelerated repopulation after induction chemotherapy for stage III non-small cell lung cancer. Thorac. Oncol. 2011;6(11):1857–1864. doi: 10.1097/JTO.0b013e318229a41e.

8. Machtay M., Bae K., Movsas B., Paulus R., Gore E.M., Komaki R. et al. Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: an analysis of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 2012;82(1):425–434. doi: 10.1016/j.ijrobp.2010.09.004.

9. Bradley J.D., Paulus R., Komaki R., Masters G., Blumenschein G., Schild S. et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015;2(16):187–199. doi: 10.1016/S1470-2045(14)71207-0.

10. Dess R.T., Sun Y., Matuszak M.M., Sun G., Soni P.D., Bazzi L. et al. Cardiac events after radiation therapy: combined analysis of prospective multicenter trials for locally advanced non-small-cell lung cancer. J Clin Oncol. 2017;35(13):1395–1402. doi: 10.1200/JCO.2016.71.6142.

11. Семищева Н.Л., Карапетян Е.И., Мальцева Т.А., Авдеева Н.В., Одиреев А.Н. Постлучевой пневмонит в практике пульмонолога. Бюллетень физиологии и патологии дыхания. 2014;(53):137–142. Режим доступа: https:// cfpd.elpub.ru/jour/article/view/733. Semishcheva N.L., Karapetian E.I., Maltseva T.A., Avdeeva N.V., Odireev A.N. Postradiation pneumonitis in the practice of a pulmonologist. Byulleten fiziologii i patologii dykhaniya = Bulletin Physiology and Pathology of Respiration. 2014;(53):137–142. (In Russ.) Available at: https://cfpd.elpub.ru/jour/article/view/733.

12. Turner L.M., Howard J.A., Dehghanpour P., Barrett R.D., Rebueno N., Palmer M. et al. Exploring the feasibility of dose escalation positron emission tomography-positive disease with intensity-modulated radiation therapy and the effects on normal tissue structures for thoracic malignancies. Med Dosim. 2011;4(36):383–388. doi: 10.1016/j.meddos.2010.09.007.

13. Marino P., Preatoni A., Cantoni A. Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb nonsmall cell lung cancer. A meta-analysis. Cancer. 1995;76(4):593–601. doi: 10.1002/1097-0142(19950815)76:4<593::aid-cncr2820760409>3.0.co;2-n.

14. Aupérin A., Pechoux C.L., Pignon J.P., Koning C., Jeremic B., Glamon G. Concomitant radio-chemotherapy based on platin compounds in patients with locally advanced non-smallcell lung cancer (NSCLC): a meta-analysis of individual data from 1764 patients. Ann Oncol. 2006;17(3):473–483. doi: 10.1093/annonc/mdj117.

15. Деньгина Н.В. Оптимальные схемы химиолучевого лечения немелкоклеточного рака легкого III стадии (обзор литературы). Поволжский онкологический вестник. 2015;(2):74–79. Режим доступа: http:// oncovestnik.ru/index.php/khimioterapiya/item/994-optimalnye-skhemykhimioluchevogo-lecheniya-nemelkokletochnogo-raka-legkogo-iii-stadiiobzor-literatury. Dengina N.V. Optimal regimens for chemoradiotherapy of stage III nonsmall cell lung cancer (literature review). Povolzhskiy onkologicheskiy vestnik = Oncology Bulletin of the Volga Region. 2015(2):74–79. (In Russ.) Available at: http://oncovestnik.ru/index.php/khimioterapiya/item/994-optimalnye-skhemy-khimioluchevogo-lecheniya-nemelkokletochnogoraka-legkogo-iii-stadii-obzor-literatury.