Radiation dose and fractionation regimen for limited stage small cell lung cancer: a survey of current practice patterns of Chinese radiation oncologists / 中华放射肿瘤学杂志

Objective:To investigate the radiation dose and fractionation regimens for limited stage small cell lung cancer (LS-SCLC) in Chinese radiation oncologists.Methods:Over 500 radiation oncologists were surveyed through questionnaire for radiation dose and fractionation regimens for LS-SCLC and 216 valid samples were collected for further analysis. All data were collected by online questionnaire designed by WJX software. Data collection and statistical analysis were performed by SPSS 25.0 statistical software. The differences in categorical variables among different groups were analyzed by Chi-square test and Fisher's exact test. Results:Among 216 participants, 94.9% preferred early concurrent chemoradiotherapy, 69.4% recommended conventional fractionation, 70.8% preferred a total dose of 60 Gy when delivering conventional radiotherapy and 78.7% recommended 45 Gy when administering hyperfractionated radiotherapy.Conclusions:Despite differences in LS-SCLC treatment plans, most of Chinese radiation oncologists prefer to choose 60 Gy conventional fractionated radiotherapy as the main treatment strategy for LS-SCLC patients. Chinese Society of Clinical Oncology (CSCO), National Comprehensive Cancer Network (NCCN) and Chinese Medical Association guidelines or expert consensus play a critical role in guiding treatment decision-making.

A comparative study of concomitant boost radiation versus concomitant boost with concurrent chemoradiation versus standard fractionation chemoradiation in locally advanced head-and-neck cancer

Context: As the number of head-and-neck cancer (HNC) patients are high in our subcontinent, the study was designed to reduce the treatment time and increase efficacy. Aims: Comparative evaluation of the efficacy, toxicity, local control, and survival of concomitant boost radiotherapy (CBRT), CBRT with concurrent chemoradiation (CBRT + CCT) and conventionally fractionated radiotherapy with concomitant chemotherapy (CFRT + CCT) in locally advanced HNC (LAHNC). Materials and Methods: Patients with LAHNC were randomly assigned to 3-groups of 30-patients each. Group I (CBRT) received, 45 Gy/25#/5-weeks and 18 Gy/10# concomitant boost in the last 2-week of treatment, receiving a total dose of 63 Gy. Group II (CBRT + CCT) received CBRT with concomitant cisplatin 75 mg/m 2 on day 1, 17, and 34. Group III (CFRT + CCT) received 64 Gy/32#/6.2 weeks, concurrent with injection cisplatin 75 mg/m 2 on day 1, 22, and 42. Statistical Analysis Used: Stata 9.0 SPSS and Chi-square test were used for analysis and disease-free survival (DFS) rates were calculated using the Kaplan–Meier method. Results: The median follow-up period was 8.2 months. At last follow-up, locoregional control was 36%, 57%, and 40% and DFS was seen in 33%, 53%, and 40% of patients in Group I, II, and III, respectively. Grade-3 cutaneous reactions were significantly higher in Group-II as compared to that of Group-III (P = 0.033) and Group-I (P = 0.715). Conclusion: All three groups have similar response rates and DFS with manageable toxicity

Effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on prognosis of limited-stage small-cell lung cancer / 中华放射肿瘤学杂志

Objective To investigate the effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on the prognosis of limited-stage small-cell lung cancer (SCLC).Methods A total of 188 patients with limited-stage SCLC were enrolled in this study and divided into hyperfractionated group (n=92) and hypofractionated group (n=96).The hyperfractionated group received thoracic radiotherapy at 45 Gy in 30 fractions twice a day, while the hypofractionated group received 55 Gy in 22 fractions once a day.The Kaplan-Meier method was used to calculate survival rates, and the Cox model was used for multivariate prognostic analysis.Results There were not significant differences in 1-, 2-, and 5-year progression-free survival (PFS) rates and 1-, 2-, and 5-year overall survival (OS) rates between the hyperfractionated group and the hypofractionated group (82% vs.85%, 61% vs.69%, 59% vs.69%, P=0.27;85% vs.77%, 41% vs.34%, 27% vs.27%, P=0.37).The multivariate analysis showed that the time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days was favorable prognostic factor for PFS (P=0.005).The time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days and prophylactic cranial irradiation were favorable prognostic factors for OS (P=0.044;P=0.000).There were significant differences in incidence rates of grade 2 and 3 acute radiation esophagitis between the two groups (28% vs.16%, 9% vs.2%, P=0.009).Conclusions Both hyperfractionated radiotherapy and hypofractionated radiotherapy combined with chemotherapy can improve the PFS and OS of patients with limited-stage SCLC.The time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days and the time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days are favorable prognostic factors for PFS and OS, respectively.However, the hyperfractionated group has significantly higher incidence rates of grade 2 and 3 acute radiation esophagitis than the hypofractionated group.

Tumor hypoxia and reoxygenation: the yin and yang for radiotherapy

Tumor hypoxia, a common feature occurring in nearly all human solid tumors is a major contributing factor for failures of anticancer therapies. Because ionizing radiation depends heavily on the presence of molecular oxygen to produce cytotoxic effect, the negative impact of tumor hypoxia had long been recognized. In this review, we will highlight some of the past attempts to overcome tumor hypoxia including hypoxic radiosensitizers and hypoxia-selective cytotoxin. Although they were (still are) a very clever idea, they lacked clinical efficacy largely because of ‘reoxygenation’ phenomenon occurring in the conventional low dose hyperfractionation radiotherapy prevented proper activation of these compounds. Recent meta-analysis and imaging studies do however indicate that there may be a significant clinical benefit in lowering the locoregional failures by using these compounds. Latest technological advancement in radiotherapy has allowed to deliver high doses of radiation conformally to the tumor volume. Although this technology has brought superb clinical responses for many types of cancer, recent modeling studies have predicted that tumor hypoxia is even more serious because ‘reoxygenation’ is low thereby leaving a large portion of hypoxic tumor cells behind. Wouldn’t it be then reasonable to combine hypoxic radiosensitizers and/or hypoxia-selective cytotoxin with the latest radiotherapy? We will provide some preclinical and clinical evidence to support this idea hoping to revamp an enthusiasm for hypoxic radiosensitizers or hypoxia-selective cytotoxins as an adjunct therapy for radiotherapy.

A Comparison between Simple Fractionation and Hyperfractionation in Advanced Cervical Cancer: Tumor Control and Radiation Complications / 고신대학교의과대학학술지

OBJECTIVES: To discern in advanced uterine cervical cancer whether the hyperfractionation is more effective in tumor control and in reducing radiation complication rates than the simple fractionation. METHODS: We retrospectively reviewed the medical records of 184 patients with advanced cervical cancer at our hospitals from January 2000 to December 2004. All patients were treated with radiation, 114 patients with simple fractionation, and 70 patients with hyperfractionation. RESULTS: Mean age was 55.4 years at baseline study. Complications were occurred in 90 patients of the 184 patients who treated with radiation therapy. Of these, 48 patients suffered from gastrointestinal complications, 24 patients suffered from genitourinary complications and 18 patients had both complications. Complications were occurred in 72 cases in simple fractionation group and 40 cases in hyperfractionation group. 77 patients had acute complications and 13 patients had chronic complications. There was no statistically significant difference between two groups (P = 0.772). Mild complication were occurred in 75 patients and severe complication were occurred in 15 patients, there was no statistically significant difference in two groups (P = 0.495). 66 patients had gastrointestinal complications and 42 patients had genitourinary complications, there was no statistical significance in two groups (P = 0.910). CONCLUSION: Many complications were occurred in patients who treated with radiation therapy, but there was no statistically significant survival and complication difference in two groups. Further research is needed.

Accelerated Hyperfractionated Radiotherapy for Locally Advanced Uterine Cervix Cancers / 대한방사선종양학회지

PURPOSE: To assess the efficacy of the use of accelerated hyperfractionated radiotherapy (AHRT) for locally advanced uterine cervix cancers. MATERIALS AND METHODS: Between May 2000 and September 2002, 179 patients were identified with FIGO stage IIB, IIIB, and IVA cancers. Of the 179 patients, 45 patients were treated with AHRT (AHRT group) and 134 patients were treated with conventional radiotherapy (CRT group), respectively. Patients undergoing the AHRT regimen received a dose of 30 Gy in 20 fractions (1.5 Gyx2 fractions/day) to the whole pelvis. Subsequently, with a midline block, we administered a parametrial boost with a dose of 20 Gy using 2 Gy fractions. Patients also received two courses of low-dose-rate brachytherapy, up to a total dose of 85~90 Gy to point A. In the CRT group of patients, the total dose to point A was 85~90 Gy. The overall treatment duration was a median of 37 and 66 days for patients that received AHRT and CRT, respectively. Statistical analysis was calculated by use of the Kaplan-Meier method, the log-rank test, and Chi-squared test. RESULTS: For patients that received cisplatin-based concurrent chemotherapy and radiotherapy, the local control rate at 5 years was 100% and 79.2% for the AHRT and CRT group of patients, respectively (p=0.028). The 5-year survival rate for patients with a stage IIB bulky tumor was 82.6% and 62.1% for the AHRT group and CRT group, respectively (p=0.040). There was no statistically significant difference for severe late toxicity between the two groups (p=0.561). CONCLUSION: In this study, we observed that treatment with AHRT with concurrent chemotherapy allows a significant advantage of local control and survival for locally advanced uterine cervix cancers.

Hyperfractionation Radiation Therapy in Advanced Head and Neck Cancer / 대한방사선종양학회지

PURPOSE: The effects of hyperfractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. MATERIALS AND METHODS: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7:1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 76.8 Gy). Follow-up periods ranged between 3 and 136 months, with the median of 52 months. RESULTS: The overall survival rates at 3 and 5 years in all patients were 66.7% and 52.4%. The disease-free survival rates at 3 and 5 years (3YDFS, 5YDFS) in all patients were 66.7% and 47.6%. The 3YDFS and 5YDFS in stage III patients were 81.8% and 63.6%, and those in stage IV patients were 53.8% and 32.3%. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25%) died due to distant metastasis and 12.5% died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. CONCLUSION: Although this study was performed on small patients group, we considered hyperfractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight increase in acute complications.

Results of Radiotherapy in Hypopharyngeal Cancer / 대한방사선종양학회지

PURPOSE: The aim of this study was to assess the effectiveness, survival rate and complications of radiation therapy and chemoradiation treatment in hypopharyngeal cancer. METHODS AND MATERIALS: From January 1984 to December 1999, 56 patients who had hypopharyngeal carcinoma treated with curative radiation therapy were retrospectively studied. Twenty four patients (42.9%) were treated with radiation therapy alone (Group I) and 32 (57.1%) treated with a combination of chemotherapy and radiation (Group II). Total radiation dose ranged from 40.5 to 83. 5 Gy (median 67.9 Gy). Radiotherapy was given with conventional technique in 9 patients (16.4%), with hyperfractionation I (1.15~1.2 Gy/fr., BID) in 26 (47.2%), hyperfractionation II (1.35 Gy/fr., BID) in 18 (32.7%), and accelerated fractionation (1.6 Gy/fr., BID) in 2 (3.6%). In chemotherapy, 5-FU (1,000 mg/m2 daily for 5 consecutive days) and cisplatin (100 mg/m2 on day 1) were administered in a cycle of 3 weeks interval, and a total of 1 to 3 cycles (average 2..3 cycles) were given prior to radiation therapy. Follow up duration was 1~195 months (median 28 months). RESULTS: Overall 2 and 5 year survival rates were 40.6% and 27.6%; 50.0% and 30.0% in Group I, and 36.4% and 26.3% in Group II, respectively. Complete local control rates in Group I and II were 70.0% and 67.7%, respectively. The response to radiotherapy and nodal stage were statistically significant prognostic factors. The complication rate was increased in Group II and was decreased in hyperfractionation. CONCLUSION: The response to radiotherapy and nodal stage were valid factors to indicate the degree of control over the hypopharyngeal cancer. The induction cisplatin, 5-Fu chemotherapy was not valid in terms of local control rate and survival rate, but did contribute to an increased complication rate. The use of hyperfractionation was valid to reduce the late radiation complications.

Treatment of stage Ⅲ-Ⅳa nasopharyngeal carcinoma with late course accelerated hyperfractionation radiotherapy / 肿瘤研究与临床

0.05). There was no significant difference in radiation reaction and squeal between two groups. Conclusions The clinical results of LCAH radiotherapy may be improve the three year of local control rate than conventional CF in stage Ⅲ~Ⅳa but do not improve the survival rate of three years.The radiation reaction and sequela was similar,is worth further study.

Hyperfractionated re-irradiation using a 3-dimensional conformal technique for locally recurrent carcinoma of the nasopharynx; preliminary results

To evaluate the efficacy of hyperfractionated re-irradiation using a three-dimensional conformal radiotherapy (3-D CRT) technique in patients with locally recurrent carcinoma of the nasopharynx. Four patients with locally recurrent nasopharyngeal cancer were retreated with a hyperfractionated schedule using a 3-D CRT technique. Re-irradiation was delivered in 1.1-1.2 Gy fractions twice per day (BID), with interfraction intervals of more than 6 hours. The total dose ranged from 59.4 to 69.2 Gy. A 3-D CRT technique with 5- or 6-field coplanar and/or non-coplanar beams were employed during the entire treatment procedure. All four patients achieved complete remission of locally recurrent lesions, with marked improvement of subjective symptoms, immediately after re-irradiation. All are alive and well without evidence of disease after limited follow-up periods, which range from 7 to 20 months. So far, there have been no radiation-induced neurologic complications. Four patients with locally recurrent carcinoma of the nasopharynx were successfully treated by hyperfractionated re-irradiation using a 3-D CRT technique. A relatively high re-irradiation dose of more than 60 Gy may be safely delivered with no serious acute or late radiation-induced complications in patients with local recurrences and who were initially treated with doses greater than 70 Gy.

The Results of Hyperfractionated Radiation Therapy Combined with Taxol for Paraaortic Node Recurrence in Cervix Cancer / 대한방사선종양학회지

PURPOSE: The aim of this study was to investigate treatment results, toxicity and efficacy of hyperfractionated radiation therapy combined with paclitaxel for paraaortic node recurrence in cervix cancer. MATERIALS AND METHODS: Between September 1997 to March 1999, 12 patients with paraaortic node recurrence in cervix cancer who previously received radical or postoperative radiotherapy were treated with hyperfractionated radiation therapy combined with paclitaxel. Of these, 2 patients who irradiated less than 30 Gy were excluded, 10 patients were eligible for this study. Median age was 5 1 years. Initial FlGO stage was 1 stage IB1, 2 stage IIA, 7 stage IIB. For initial treatment, 7 patients received radical radiotherapy and 3 received postoperative radiotherapy. The paraaortic field encompassed the gross recur rent disease with superior margin at T 12, and inferior margin was between L5 and S 1 with gap for previously pelvic radiation field. The radiation field was initially anterior and posterior opposed field followed by both lateral field. The daily dose was 1.2 Gy, twice daily fractions, and total radiotherapy dose was between 50.4 and 60 Gy(median, 58.8 Gy). Concurrent chemotherapy was done with paclitaxel as a radiosensitizer. Dose range was from 20 mg/m to 30 mg/m (median, 25 mg/m'), and cycle of chemotherapy was from 3 to 6 (median, 4.5 cycle). Follow-up period ranged from 3 to 21 months. RESULTS: Interval between initial diagnosis and paraaortic node recurrence was range from 2 to 63 months (median, 8 months). The 1 year overall survival rate and median survival were 75% and 9.5 months, respectively. The 1 year disease free survival rate and median disease free survival were 30% and 3 7 months, respectively. At 1 month after treatment, 4 (40%) achieved a complete response and 6 (63%) experienced a partial response and all patients showed response above the partial response. There was distant metastasis in 6 patients and pelvic node recurrence in 2 patients after paraaortic node irradialion. There was 2 patients with grade 3 to 4 leukopenia and 8 patients with grade 1 to 2 nausea/ vom ting which was usually tolerable with antiemetic drug. There was no chronic complication in abdomen and pelvis during follow up period. CONCLUSION: Hyperfractionated radiation therapy combined with paclitaxel as a radiosensitizer showed high response rate and few complication rate in paraaortic node recurrence in cervix cancer. Therefore, present results suggest that hyperfractionated radiation therapy combined with paclitaxel chemotherapy can be used as optimal treatment modality in this patients.

Results of Hyperfractionated Radiation Therapy in Bulky Stage Ib, IIa, and IIb Uterine Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb. METHODS AND MATERIAl: Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University, School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO staging system, there were stage Ib (3 patients), IIa (6 patients) with exophytic (> or = 5cm in diameter) and huge endophytic mass, and IIb (32 patients) with median age of 55 years old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield (4x10cm), and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively. RESULTS: Five year local control rate was 78% and the actuarial overall five year survival rate was 66.1% for all patients, 44.4% for stage Ib, IIa and 71.4% for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five year survival rate was 88.9%, 73% respectively. Pelvic lymph node status (negative : 74%, positive:25%, P= 0.0015) was significant prognostic factor affecting to five year survival rate. There was marginally significant survival difference by total dose to A point (>84Gy : 70%, ; or =grade 3) and Three patients developed grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. CONCLUSION: We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophytic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.

The analysis of esophageal cancer patients treated by late course hyperfractionation radiotherapy / 中华放射肿瘤学杂志

Objective To evaluate the effect and the radiation reaction of esophageal cancer patients treated by LCHR.Methods 96 patients of esophageal cancer were treated by LCHR. 76 patients had pathology evidence. There were 65 males and 31 females. The ages ranged from 41 to 70 years with median 57.5 years. The patients with lesion in upper thoracic segment 21 cases, Middle thoracic segment 63 cases, lower thoracic segment 12 cases. The length of lesions: 7.0?cm 10 cases. They were randomly divided into two groups, The conventional radiation group (48 cases). And late course hyperfractionation (48 cases).Both groups were treated by 60Co ?- ray external radiation 2.0?Gy every time each day, five times in each week in conventional group, the total dose 64?Gy/32 fractions/44d; in the late course hyperfractionation group. 40?Gy in four weeks at first and then two times each day with 1.15～1.25?Gy every time and with 6～8 hours, interval, from the fifth week, ten times in each week, ale total dose 68～70?Gy/44～45d. Results All patients were followed at more then five years. The follow-up rate was 96.9%. The survival rate of 1,3,5-year in late course hyperactionation group were 81.1%, 44.1%, 26.8% and 61.7%, 25.1%, 16.9% in conventional group respectively. The survival rate of late course hyperactionation group is better than conventional group. Between the two groups , there was significant difference in the survival rate of 1,3-year (P0.05). Conclusions The result showed that the 1,3,5-year survival rate of LCHR of esophageal cancer is better than conventional radiotherapy. Between the two groups , there was significant difference in the survival rate of 1,3-year ,However there is no significant difference in the survival rate of 5-year. It is well tolerated, without late reactions in long term survivors.

Meta-analysis of the effect of late course accelerated hyperfractionation radiotherapy for esophageal carcinoma / 中华放射肿瘤学杂志

Objective To evaluate the effect of late course accelerated hyperfractionation radiotherapy(LCAHR) for esophageal carcinoma. Methods Six clinical trials on LCAHR for esophageal carcinoma were reviewed by means of Meta analysis . Results The 1 and 3 year survival rates in the LCAHR group derived from the fixed effect model were 2.39 (1.58～3.62) and 3.05(1.96～4.74) times higher than the conventional fractionation group. With the random effect model,the 1 and 3 year survival rates in the LCAHR group were 2.43(1.54～3.82) and 2.99(2.08～4.30) times higher than the conventional fractionation group.Conclusion For esophageal carcinoma,the better outcome of LCAHR makes it advisable in extensive clinical practice.

Brainstem Tumors : Results of 20 Patients Treated with Radiation Therapy / 대한치료방사선과학회지

A total of 20 patients(male : female=10:10, adult : children=8:12) with brainstem tumors had been received radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between 1980 and 1990. Thirteen of 20 patients were treated with conventional radiation therapy (before 1989, 180~200 cGy per fraction, 5 days a week, total dose 4680~5400 cGy), and seven patients were treated with hypefractionated radiation therapy(in 1990, 100 cGy per fraction, twice daily 10 fractions a week, total dose 7200 cGy). Median follow up periods for conventional radiation therapy group and hyperfractionated radiation therapy group were 39 months and 10 months, respectively. Four of 20 Patients had histopathologic diagnosis prior to treatment ; 3 cases were low grade astrocytoma and 1 case was high grade astrocytoma. Overall 2-year actuarial survival rate was 30%. The prognosis of patients with a longer duration of symptom and sign was better(60% vs 12%), and the adult(52%) was better than children(14%). There was no significant difference between the focal(29%) and diffuse(20%) type. The initial clinical response was better in the hyperfractionated radiation therapy group. Because of the relatively small number of Patients and short follow up Period in hyPerFractionated radiation therapy group, there was no comparison between two group.

Hyperfractionated Radiotherapy with Concomitant Boost Technique for Unresectable Non-Small Cell Carcinoma of the Lung / 대한치료방사선과학회지

Twenty five patients with unresectable non-small cell carcinoma of the lung have been treated with hyperfractionated radiotherapy with concomitant boost technique since September, 1989. Those patients with history of previous surgery or chemotherapy, pleural effusion or significant weight loss (greater than 10% of body weight) were excluded from the study. Initially, 27 Gy were delivered in 15 fractions in 3 weeks to the large field. Thereafter, large field received 1.8 Gy and cone downboost field received 1.4Gy with twice a day fractinations up to 49.4Gy. After 49.4Gy, only boost field was treated twice a day with 1.8 and 1.4 Gy. Total tumor doses were 62.2Gy for 12 patients and 65.4Gy for remaining 13 patients. Follow up period was ranged from 6 to 24 month. Actuarial survival rates at 6, 12, and 18 month were 88%, 62%, and 38%, respectively. Corresponding disease free survival rates were 88%, 41%, and 21%, respectively. Actuarial cumulative local failure rates at 9,12 and 15 month were 36%, 42%, and 59%, respectively. No significant increase of acute or late complications including radiation pneumonitis was noted with maximum follow up of 24 month. Although the longer follow up is needed, it is worthwhile to try the prospective randomized study to evaluate the efficacy of hyperfractionated radiotherapy with concomitant boost technique for unresectable non-small cell lung cancers in view of excellent tolerance of this treatment. In the future, further increase of total radiation dose might be necessary to improve local control for non-small cell lung cancer.