Outcomes of Image-Guided Moderately Hypofractionated Radiotherapy for Stage III Non-Small-Cell Lung Cancer

Abstract

Objective. To evaluate the efficacy and toxicity of hypofractionated radiotherapy (hypo-RT) for stage III non-small-cell lung cancer (NSCLC) in the Chinese population. Methods. Eighty-six stage III NSCLC patients who received hypo-RT (60 Gy/20 fractions, BED = 78.00 Gy: 73 patients; 62.5 Gy/25 fractions, BED = 78.13 Gy: 13 patients) were recruited. Fifty-seven patients who received conventional radiotherapy (60 Gy/30 fractions, BED = 72.00 Gy) during the same period were enrolled as the control group. All hypo-RT treatments were conducted using image-guided technology. The efficacy and toxicity of the treatment were compared between the two groups. Results. The median duration of follow-up was 23.0 months (range: 4.0–82.0 months). Univariate and multivariate analyses of all 143 stage III NSCLC patients revealed that hypo-RT was an independent factor for progression-free survival (PFS) and overall survival (OS). The median PFS and OS of hypo-RT were significantly higher than in the conventional RT group (PFS: 14.30, 11.00 months, p = 0.035 ; OS: 43.30, 31.50 months, p = 0.045 ). The incidence rates of symptomatic radiation pneumonitis and radiation esophagitis (≥grade 2) were 17.77% and 27.91%, respectively, in the hypo-RT group. Compared to the conventional radiation therapy group (22.81% and 19.30%, respectively), no significant differences were found between the two common side effects ( p = 0.662 and p = 0.241 , respectively). Conclusion. For Chinese stage III NSCLC patients, image-guided hypo-RT offers favorable prognosis, and the treatment toxicity was totally acceptable. This radiation modality deserves further prospective clinical trials.

Development and validation of a random forest model for predicting radiation pneumonitis in lung cancer patients receiving moderately hypofractionated radiotherapy: a retrospective cohort study

“…Moreover, with the advent of image-guided radiation therapy (IGRT), RT has entered a new era of precision. Our previous studies demonstrated that moderately hypo-RT delivered by IGRT provided a superior prognosis and tolerable toxicity than did conventional RT in Chinese patients with locally advanced NSCLC (5,6). In line with our results, moderately hypo-RT is also being increasingly used to treat unresectable NSCLC worldwide (7,8), particularly in the United Kingdom (9).…”

Comparison of post-chemoradiotherapy pneumonitis between Asian and non-Asian patients with locally advanced non-small cell lung cancer: a systematic review and meta-analysis

“…1 . Among the 248 studies, 174 studies (85 Asian and 89 non-Asian) with 20,999 patients examined definitive CRT without immunotherapy, 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 70 , 71 , 72 , 73 , 74 , 75 , 76 ,…”

Is immunotherapy at reduced dose and radiotherapy for older patients with locally advanced non-small lung cancer feasible?—a narrative review by the international geriatric radiotherapy group

“…Grade 3–4 esophagitis and pneumonitis remained the limiting factor for dose escalation with hypofractionated radiotherapy ( 80 ). However, preliminary results from hypofractionated IGRT for locally advanced NSCLC reported a higher survival and progression-free survival compared to the conventional radiotherapy technique with comparable toxicity most likely due to the higher biologic equivalent dose (BED) ( 81 ). Median survival, local control, and grade 3–4 toxicity were 42 months, 43%, 42.1% and 32 months, 31%, and 47.6% for the hypofractionated group and conventional fractionated group, respectively.…”