Abstract
BackgroundWhile conventionally fractionated radiation therapy alone is an acceptable option for poor prognostic patients with unresectable stage III NSCLC, we hypothesized that accelerated hypofractionated radiotherapy will have similar efficacy without increasing toxicity.MethodsThis is a retrospective analysis of 300 patients diagnosed with stage III NSCLC treated between 1993 and 2009. Patients included in the study were medically or surgically inoperable, were free of metastatic disease at initial workup and did not receive concurrent chemotherapy. Patients were categorized into three groups. Group 1 received 45 Gy in 15 fractions over 3 weeks (Accelerated Radiotherapy (ACRT)) while group 2 received 60-63 Gy (Standard Radiation Therapy 1 (STRT1)) and group 3 received > 63 Gy (Standard Radiation Therapy (STRT2)).ResultsThere were 119 (39.7%) patients in the ACRT group, 90 (30.0%) in STRT1 and 91 (30.3%) in STRT2. More patients in the ACRT group had KPS ≤ 60 (p < 0.001), more commonly presented with weight loss > 5% (p = 0.002), and had stage 3B disease (p < 0.001). After adjusting for clinical variables, there were no differences in the radiation groups in terms of the patterns of local or distant tumor control or overall survival. Some benefit in relapse free survival was seen in the STRT1 group as compared to ACRT (HR = 0.65, p = 0.011). Acute toxicity profiles in the ACRT were significantly lower for grade ≥ 2 radiation dermatitis (p = 0.002), nausea/vomiting (p = 0.022), and weight loss during treatment (p = 0.020).ConclusionsDespite the limitations of a retrospective analysis, our experience of accelerated hypofractionated radiation therapy with 45 Gy in 15 fractions appears to be an acceptable treatment option for poor performance status patients with stage III inoperable tumors. Such a treatment regimen (or higher doses in 15 fractions) should be prospectively evaluated using modern radiation technologies with the addition of sequential high dose chemotherapy in stage III NSCLC.
Highlights
While conventionally fractionated radiation therapy alone is an acceptable option for poor prognostic patients with unresectable stage III non-small cell lung cancer (NSCLC), we hypothesized that accelerated hypofractionated radiotherapy will have similar efficacy without increasing toxicity
We report our updated experience in stage III NSCLC patients treated with 45 Gy in 15 fractions and compared to patients who received 60 Gy or higher conventionally fractionated radiation therapy
We found treatment to be well tolerated in the accelerated hypofractionated radiotherapy (ACRT) cohort, even though these patients presented with worse prognostic factors
Summary
While conventionally fractionated radiation therapy alone is an acceptable option for poor prognostic patients with unresectable stage III NSCLC, we hypothesized that accelerated hypofractionated radiotherapy will have similar efficacy without increasing toxicity. Several studies have identified initial performance status and weight loss to be important prognostic factors in predicting survival in NSCLC [4]. As such, these factors become important in assessing treatment options for these patients. Concurrent chemoradiation given for six weeks may be difficult for these patients to tolerate, especially those presenting with poor performance status and significant weight loss from their cancers. Several studies have demonstrated significant rates of increased toxicity and overall poorer survival in elderly patients with poor prognostic factors, raising the need for alternative treatment management in patients who cannot tolerate standard therapy [5]
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