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Gregory J. Riely, MD, PhD


Concurrent Chemoradiation With Dose-Escalation Ablative Radiotherapy for Unresectable NSCLC

By: Joshua D. Madera, MD
Posted: Thursday, February 1, 2024

For patients with locally advanced, unresectable non–small cell lung cancer (NSCLC), the use of hypofractionated concurrent chemoradiation with an adaptive stereotactic ablative radiotherapy (SABR) boost may be an efficacious treatment option, according to an early-stage, single-institution study published in JAMA Oncology. Additional studies are needed to further explore its clinical benefit and potential integration with immunotherapy as a therapeutic alternative, suggested Percy Lee, MD, of the University of California, Los Angeles, and colleagues.

“Intrathoracic [disease] progression remains the predominant pattern of failure in patients treated with concurrent chemoradiation followed by a consolidation immune checkpoint inhibitor for locally advanced, unresectable NSCLC,” the investigators noted.

From 2011 to 2018, a total of 28 patients with clinical stage II or III NSCLC were recruited for the study. All patients received an initial 10 fractions of 4 Gy of hypofractionated radiation. This was followed by an adaptive SABR boost of 25 Gy (low-dose cohort, n = 10), 30 Gy (intermediate-dose cohort, n = 9), or 35 Gy (high-dose cohort, n = 9) with concurrent paclitaxel or carboplatin. Patients were monitored regularly to assess for the development of dose-limiting toxicities.

The study authors reported the maximum tolerated dose as 70 Gy in 15 fractions. In addition, the local control rate at the 2-year interval was 74.1% in the low-dose cohort, 85.7% in the intermediate-dose cohort, and 100.0% in the high-dose cohort. Furthermore, the overall survival rates at the 2-year interval for the low-, intermediate-, and high-dose cohorts were 30.0%, 76.2%, and 55.6%, respectively. Acute and late treatment-related nonhematologic effects were observed in 11% and 7% of patients, respectively.

Disclosure: For full disclosures of the study authors, visit

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