What is your preferred dose and fractionation schedule for a patient with a stage III non-small cell lung cancer, whose comorbidities preclude chemotherapy, but has good enough performance status to warrant an attempt at longer-term local control?

This is a very good question. I'd say the answer to this one is evolving! Typically the patients who cannot tolerate either sequential or concurrent chemotherapy for locally-advanced NSCLC are quite frail and/or have comorbidities that are significant. The results using radiation alone for Stage III...

There is really no practical standard of care in this situation. The vast majority of folks in our institution are able to get sensitizing doses of paclitaxel/carboplatin even if PS 2, so we don't treat many stage III patients with RT alone. I do use hypofractionated schedules, and the regimen depen...

An ideal regimen is 60 Gy in 15 fractions because it is well tolerated, more convenient—especially in patients who cannot tolerate chemotherapy—and generally better suited to those presumed fragile who would benefit from a shorter, more manageable course.

Moreover, it is safe to deliver to nearly any...

I employ the UT Southwestern model of 60 Gy in 15 fractions. I have been impressed with the efficacy and tolerance of this regimen. If from a planning standpoint 60 is not feasible, then I use the RTOG poor risk stage III dose of 45 Gy in 15 fractions.

RTOG's older study where 6960 was given at 120 BID has been used successfully to control locally advanced disease. We have seen excellent response and long term local control.

These are the constraints we derived from the UT Southwestern paper: