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.
Highlights
Radiation therapy (RT), with concurrent or sequential chemotherapy, remains the mainstream for locally advanced non-small-cell lung cancer (NSCLC)
Our previous work revealed that hypofractionated radiotherapy (hypo-RT) was significantly associated with a decreased risk of severe lymphopenia; this may be another potential mechanism for the better prognosis achieved with hypo-RT [22]
E hypo-RT modality shows a trend of improved survival; there are concerns pertaining to RT toxicity [23]
Summary
Radiation therapy (RT), with concurrent or sequential chemotherapy, remains the mainstream for locally advanced non-small-cell lung cancer (NSCLC). The outcomes under such a treatment strategy are not optimistic. Local failure as the initial failure site occurs in approximately 35% to 40% of patients, indicating the need to intensify local-regional effects [1]. Improving the biologically effective dose (BED) received by patients is a potential treatment choice. A 1 Gy BED increase in the RT dose achieved an approximately 3% improvement in local control and a 4% improvement in survival [2]. A combination of several factors may contribute to this counterintuitive phenomenon, including accelerated tumor repopulation due to prolonged treatment time [4]
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