Hypofractionated radiation therapy in unresectable stage iii non-small cell lung cancer

Abstract

Background. Hypofractionation is the current choice for radiation therapy for patients with unresectable non‐small cell lung cancer (NSCLC) at the authors' institute. Methods. In this nonrandomized study, three hypofractionated radiation schedules (40‐Gy split course; 30–32 Gy in 6 fractions and 24 Gy in 3 fractions) are evaluated in 301 patients with unresectable Stage III NSCLC. Results. Patients with Stage IIIA disease treated with a 40‐Gy split course had longer survival (P < 0.005) and a lower local relapse rate (P < 0.01), but a higher distant failure rate (P < 0.01) than those receiving 24–32 Gy. Survival for patients with Stage IIIA disease treated with 40 Gy at 1, 2, and 5 years was 47%, 22%, and 7%, respectively. For patients with Stage IIIB disease, the radiation scheme used did not correlate with survival and relapse rates. Survival at 1, 2, and 5 years was 30%, 9%, and 2%, respectively. The hypofractionated radiation schemes were well tolerated, and no severe complications were recorded. Conclusions. In patients with Stage IIIA disease, 40‐Gy split‐course radiation therapy yields survival rates comparable to those achieved with conventional radiation therapy. In patients with Stages IIIB and IV NSCLC, 24 Gy in 3 weekly fractions yields survival rates comparable to those achieved with higher total doses given in more fractions.

Double-flash, large-fraction radiation therapy as palliative treatment of malignant superior vena cava syndrome in the elderly

“…These schemes have been found equivalent to more conventional palliative schedules as far as symptom control and clinical benefit are concerned [14,20,30,31] state that "local symptoms from primary or metastatic non-small-cell lung cancer can be relieved by a variety of doses and fractionations of external-beam radiation therapy. In appropriately selected patients, hypofractionated palliative radiotherapy (of one to five fractions instead of 10) may provide symptomatic relief with acceptable toxicity in a more time efficient and less costly manner" [2].…”

“…In two trials conducted by the Medical Research Council in the United Kingdom, a two-fraction (8.5 Gy ×2) RT schedule was shown to be feasible and an alternative to multifractionated regimens in terms of both survival and toxicity in advanced lung cancer patients [4,21]. More recently, other studies have confirmed the feasibility and effectiveness of hypofractionated RT regimens in the palliative setting, with doses up to 24 Gy in three fractions [8,14,15,16,20,31]. In order to maximize symptom control and minimize treatment-related discomfort, a policy of short-course, largefraction RT has been adopted in our centre for the treatment of older patients affected with solid malignancyrelated SVCS.…”

A Systematic Overview of Radiation Therapy Effects in Non-Small Cell Lung Cancer

“…The same investigators designed hypofractionated RT schedules for unresectable, stage III NSCLC. The results of a large phase II study using three different schedules show very low overall survival (55). In only one subgroup were the results comparable to those obtained with conventional RT.…”

Palliative percutaneous radiotherapy in non-small-cell lung cancer

“…Oesophagitis is increasingly more common at total doses 30 Gy [7,10], but usually does not occur in hypofractionated regimens [11,12] like 1 × 10 Gy or 2 × 8.5 Gy (one week apart). Nausea, fever, acute chest pain and episodes of rigor have been reported in up to 50% of patients [13][14][15][16][17][18] from series using high single doses (1 × 10 Gy and 2 × 8.5 Gy). At lower doses per fraction, these side effects are rarely observed.…”