Hypofractionated Radiotherapy as Definitive Treatment of Stage I Non-Small Cell Lung Cancer in Older Patients

Abstract

We report our experience using hypofractionated radiotherapy in older patients. This analysis includes patients aged 60 years and older at our institution with inoperable Stage I (T1/T2 N0 M0) non--small-cell lung cancer that completed a curative course of radiotherapy alone using a hypofractionated schedule. Between 1991 and 2006, 75 such patients were identified with median age of 74 years (range, 60-86). Patient characteristics were as follows: male, 65/75 (86.7%); stage IA (T1N0), 47/75 (62.7%); stage IB (T2N0), 28/75 (37.3%). Patients received a median total dose of 6500 cGy using median daily dose fractions of 250 cGy. The following outcomes were analyzed: local failure free survival (time to local failure or death from any cause), time to distal failure as first event, and overall survival. Toxicities were evaluated using Common Terminology Criteria for Adverse Events v 3.0. The median follow-up was 19.6 months (range: 4.0-128.8 months). Median local failure free survival was 19.6 months (95% confidence interval [CI]: 14.4-28.8 months); and median overall survival was 21.2 months (95% CI: 14.9-29.3 months). Analysis of competing risks showed that at 5 years, the probability of local failure as the first detected event was 22.1% (95% CI: 12.8%-32.9%); the probability of distal failure as the first detected event was 14.5% (95% CI: 7.3%-24.0%); and the probability of death without recording a failure was 48.6% (95% CI: 36.1%-60.1%). Radiation-related toxicity of grade 3 or greater was seen in 3 patients and there were no treatment-related deaths. Hypofractionated radiotherapy is an effective, safe treatment for older patients with stage I non--small-cell lung cancer.