Abstract: Objective To evaluate the safety and feasibility of concurrent chemotherapy with thoracic three-dimensional radiotherapy (TTDRT) on patients with non-small cell lung cancer (NSCLC) at stage IV.Methods  From Jan 2003 to July 2008，201 patients with NSCLC at stage IV entered the study.The median age of the patients was 60 years.All patients received platinum-based chemotherapy，with the median of 3 cycles.The median radiation dose to PTV of primary tumor was 60.3Gy，while 138 patients received TTDRT on metastatic foci.The treatment-related gastrointestinal and hematological toxicity were scored.Results  19 patients who received only one cycle of chemotherapy were not included in survival analysis but included in toxicity analysis.The rates of patients completed the full treatment，adequat radiotherapy，systemic chemotherapy，defect treatment and no treatment were 32%，14%，14.3%，30.3% and 9%，respectively.The median survival time of patients received 4 to 5 cycles of chemotherapy and DTPTV≥63Gy of TTDRT was 16.1 months，which was significantly longer than other treatments (χ²=25.369，P=0.000).45% of all patients had grade 2~3 gastrointestinal toxicity.The rates of grade 3~4 WBC，PLt and Hb toxicity were 35%，18% and 15%，respectively.The rates of grade 2~3 radiation pneumonitis and esophagitis were 9.5% and 13.4% respectively.The median survival times of patients with improved KPS and decreased KPS≥10 cases after treatment were 12 months and 4 months respectively (χ²=78.452，P=0.000).Cox regression analysis showed the improved KPS after treatment was an independent factor for survival (P=0.000).Conclusions  Concurrent chemotherapy with TTDRT on patients with NSCLC at stage IV is safe and tolerable.4 to 5 cycles of chemotherapy simultaneously with DTPTV ≥ 63Gy of TTDRT may improve survival time.

Key words: Non-small cell lung cancer at stage IV, Concurrent chemoradiotherapy, Thoracic three-dimensional radiotherapy, Survival time, KPS