Gated Intensity Modulated Radiation Therapy and Concurrent Chemotherapy for Inoperable NSCLC

Inclusion Criteria:

• Patients with histologically-proven, by biopsy or cytology, unresectable lung cancer of the following histologic types: squamous cell carcinoma, adenocarcinoma, large cell carcinoma, non-small cell carcinoma, not otherwise specified.
• Patient with AJCC Stage IIIA-IIIB, if all detectable tumor can be encompassed by radiation therapy fields, including both the primary tumor and the involved regional lymph nodes.
• 18-fluoro-2-deoxyglucose positron emission tomography required for staging and image fusion for treatment planning.
• Atelectasis, if present, must be less than one lung.
• Patients must have granulocytes >1500/µl; platelets >100,000/µl; bilirubin < 1.5 mg/dl; AST(SGOT) < 2 ULN; serum creatinine < 2.0 mg/dl.
• Zubrod Score 0-1.
• FEV1 must be >1.0 L.
• Patients must sign a study-specific informed consent form prior to study entry
• Patients must have measurable disease on the planning CT.
• Patient must have a completed the IMRT plan and the attending physician must have reviewed and approved the dose volume histograms as follows (based on treatment planning to the Phase 4 dose level): total lung V20 < 30%, mean esophageal dose < 34 Gy, the esophageal V55 < 30%, the heart V40 < 50%.
• No prior or concurrent malignancy except non-melanomatous skin cancer unless disease-free for one year or more; no prior lung cancer within last two years.
• No prior RT to thorax.
• No previous chemotherapy or previous biologic response modifiers for current lung cancer or within the past five (5) years.
• No distant metastases or supraclavicular lymph node involvement or significant atelectasis.
• No clinically significant pleural effusions, pericardial effusions or superior vena cava syndrome.

Exclusion Criteria:

• Undifferentiated small cell (oat cell or high grade neuroendocrine) carcinoma, any stage.
• Stage I, II or IV NSCLC.
• Complete tumor resection, recurrent disease, or those patients eligible for definitive surgery.
• Concurrent malignancy except non-melanomatous skin cancer or prior cancer unless disease-free for one year or more.
• Prior radiation therapy to the thorax.
• Previous chemotherapy or previous biologic response modifiers for current lung cancer or within the past five (5) years.
• Distant metastases or supraclavicular lymph node involvement, or atelectasis of an entire lung.
• Patients who have not had the pre-treatment evaluations in Section 4.0 or evaluations performed > 8 weeks prior to study entry.
• Patients with clinically significant pleural effusions, pericardial effusions or superior vena cava syndrome.
• Prior lung cancer within the last two years.
• Patients who have significant atelectasis and in whom the CT definition of the gross tumor volume(GTV) is difficult to determine.
• Pregnant or lactating females. It is not known what effects this treatment may have on the developing fetus.