Combined stereotactic body radiotherapy with conventionally fractionated radiotherapy successfully managing a locoregionally advanced lung cancer patient: a case report

This report describes the case of a 55-year-old man, heavy smoker, with a history of adenocarcinoma of the right upper lung lobe (cT1bN2M0, stage IIIA; 2015/08, AJCC 7e) with wild-type epithelial growth factor receptor. Because of the co-morbidity and high risk associated with operation, he received definitive concurrent vinorelbine-cisplatin-based chemoradiotherapy. Conventional fractionated radiotherapy (RT) (total dose, 6,200 cGy) was administered in 31 fractions targeting the mediastinum. Concurrently, stereotactic body radiation therapy (SBRT) with a total dose of 6,000 cGy was delivered in 3 fractions to the primary lung tumor (once per week in the first 3 weeks of mediastinum RT). The normal organ doses met the constraint criteria. No severe acute toxicities (i.e., ≥ grade 3) were observed during and after the treatment course, and until a 2.5-year follow-up period. Durable complete response of the primary lung tumor and mediastinal lymph nodes were documented at 2.5 years after RT. Combined SBRT to the primary lung tumor and conventional fractionated RT to the mediastinum are an attractive approach for irradiation in locoregionally advanced patients with non-small cell lung cancer (NSCLC). Good tumor control and limited toxicities were observed. However, further prospective studies are warranted to define its clinical significance.