Radical Hypo-Fractionated Radiotherapy in Patient with Medically Inoperable or Refusal of Surgery Stage III/IV Non–Small Cell Lung Cancer

Abstract

Local control failure is an important factor of unsatisfactory efficacy of conventional radiotherapy for non-small cell lung cancer. Hypo-fractionated radiotherapy can minimize the negative effect of rapid tumor repopulation due to the overtime prolonged. We retrospectively analyzed the treatment outcomes and toxicities by hypofractionated radiotherapy in the patients with primary non–small-cell lung cancer (NSCLC). 86 patients with primary NSCLC received radical RT to the tumor at lung over 2.5 Gy per fraction for either medical comorbidity or refusal of surgery, between January 2006 and December 2013. The median total dose was 40–78Gy.Toxicities were graded according to CTCAE V4.0. Survival rates were estimated using the Kaplan-Meier method. The median follow-up was 25 months (range 3-84 months).Stage III 27.9%(24/86人), stage IV 72.1%(62/86人),both median total dose was 60Gy.BED of all patient was over 60Gy.The local control (LC) and overall survival (OS) at 1,2 and 3 years for stage III patient were 62.5%,20.8% and 12.5%; and 87.5%, 41.7%, and 12.5% respectively. The local control (LC) and overall survival (OS) at 1,2 and 3 years for stage IV patient were 67.7%,22.5% and 11.3%; and 77.4%, 35.5%, and 14.5% respectively. The LC and OS at 1, 2, 3-year were no significant difference between the two groups. There was no significant difference of grade 3 late adverse effects between the two groups. There was only 3/24 and 7/62 patient with 3+ radiation side effects. Radical hypofractionated RT regimen for medically inoperable or refusal of surgery stage III/IV NSCLC proved safe with minimal toxicity. Key Words: Non–small-cell lung cancer, hypo-fractionated radiotherapy