Dose Escalation by Boosting Radiation Dose Within the Primary Tumor Using FDG-PET-CT Scan in Stage IB, II and III NSCLC

Inclusion Criteria

• •1. Patients \> 18 years with any subtype of pathologically proven (biopsy or cytology), non-small cell lung cancer. The diagnosis may be established from biopsy or cytology obtained from the primary tumor and/ or from metastatic lymph nodes.
• •2. Minimal diameter of the primary tumor 4 cm, this to allow for boosting of sub-volumes.
• •3. UICC TNM Stage T2-4, N0-3, M0 disease (TNM definition see appendix 2).
• •4. Only stage IB-II patients who are nog candidates for surgery are study candidates.
• •5. Measurable disease at registration.
• •6. ECOG-performance status ≤ 2 (see appendix 6)
• •7. Lung function: FEV1 and DLCO at least 40 % of the age-adjusted normal value
• •8. Willing and able to give a written informed consent.
• •9. Patients with locoregional recurrent lung tumor following surgery or a second primary cancer (at least 3 years after treatment) are eligible, unless a pneumonectomy was performed.
• •10. SUVmax in the pre-treatment FDG-PET scan ≥ 5 for the primary tumor.
• •11. Adequate organ function, including the following:
• •* Adequate bone marrow reserve: absolute neutrophil (segmented and bands) count (ANC) ≥ 1.5 x 109/L, platelets ≥ 100 x 109/L, and hemoglobin ≥ 9 g/dL.
• •* Hepatic: bilirubin ≤ 1.5 times the upper limit of normal (x ULN); alkaline phosphatase (AP), aspartate aminotransferase (ASAT), and alanine aminotransferase (ALAT) ≤ 3.0 x ULN (AP, AST, and ALT ≤ 5 x ULN is acceptable if liver has tumor involvement).
• •* Renal: calculated creatinine clearance (CrCl) ≥ 45 ml/min based on the original weight based Cockcroft and Gault formula
• •12. For women: Must be surgically sterile, postmenopausal, or compliant with a highly reliable contraceptive method (failure rate \<1%) during and for 6 months after the treatment period; must have a negative serum or urine pregnancy test within 7 days before study enrollment and must not be breast-feeding.
• •13. For men: Must during chemotherapy take adequate contraceptive measures.