Continuous Hyperfractionated Accelerated Radiotherapy Research Articles

147 - A retrospective evaluation of risk factors for and incidence of Pneumocystis jirovecii pneumonia (PJP) in Patients treated with continuous hyperfractionated accelerated radiotherapy (CHART) in the West of Scotland Cancer Centre

147 - A retrospective evaluation of risk factors for and incidence of Pneumocystis jirovecii pneumonia (PJP) in Patients treated with continuous hyperfractionated accelerated radiotherapy (CHART) in the West of Scotland Cancer Centre

Neo-adjuvant chemotherapy followed by either continuous hyper-fractionated accelerated radiation therapy week-end less or conventional chemo-radiotherapy in locally advanced NSCLC-A randomised prospective single institute study.

Better locoregional control and increased overall survival by continuous hyper fractionated accelerated radiotherapy have been shown in unresectable nonsmall cell lung carcinoma (NSCLC). Dose escalation and neoadjuvant chemotherapy (NACT) along with continuous hyperfractionated accelerated radiotherapy week end-less (CHARTWEL) were also tried for improved survival. In this present study, we compared the results of NACT followed by CHARTWEL against NACT followed by conventional concurrent chemo-radiation therapy. The aim of this study is to compare the locoregional control and toxicities in NSCLC Stage IIIA and B in both arms. Randomized, prospective single-institutional study with a study population comprising all locally advanced unresectable NSCLC patients enrolled in 2014 at our institute. All enrolled patients were randomized into two arms-CHARTWEL and concomitant chemo-radiotherapy (CCRT), after three weeks of the fourth cycle of NACT. In CHARTWEL arm 30 patients received two-dimensional radiotherapy (RT) 58.5 Gy/39 fr/2.5 weeks while in CCRT arm 30 received 66 Gy/33 fr/6.5 weeks. Disease response was evaluated at 6 months and toxicity assessment during and after treatment completion. Data were analyzed using tools such as percentage, mean, Chi-square test and P value. Chi-square and P value was calculated by statistical online software (http://quantpsy.org). 28% of patients in study arm and 20% in control arm had complete response at 6 months after RT. Locoregional disease control was observed in 44% in study arm and 32% in control arm of patients. There was no statistical difference in grades of toxicities or overall survival (OS)/disease-free survival except persistent esophagitis Grade III seen in two patients of study arm. Study suggests that CHARTWEL in combination with NACT is an effective strategy to treat patients with locally advanced lung cancer with the advantage of a smaller dose and shorter duration. Although large multivariate studies still needed.

Radiobiological modelling of clonogen distribution, hypoxic fraction and tumour size effects on local tumour control of non-small cell lung cancer

Published clinical data show that hypoxia in human lung tumours can impede the establishment of optimum local tumour control. However, the overall effect of hypoxia on the tumour control probability (TCP) model is not clear. The focus of this project was to assess the influence of radiobiological parameters (the number of clonogens and the hypoxic fraction), as well as some treatment parameters (i.e., the tumour size), on local tumour control of early stage non-small cell lung cancer (NSCLC). A TCP model, based on LQ cell survival concept combined with the Poisson statistic, was established to predict one, two and three years of local tumour control. This TCP model was created using data from seventeen publications of early-stage NSCLC treated using one of the three radiotherapy modalities: three-dimensional conformal radiation therapy (3D-CRT), continuous hyperfractionated accelerated radiotherapy (CHART) or stereotactic ablative body radiotherapy (SABR). The variations in the TCP with the gross tumour volume (GTV) size, clonogen number and hypoxic fraction were then investigated. This issue was approached by varying the clonogen densities values (between 10̂1 and 10̂7 cm̂3), the GTV volume (20–140 cc) and the hypoxic fraction (20–90%). The optimum values used to compute the TCP model were a clonogen density of 10̂7 cm̂3 and a hypoxic fraction of 20%, which were consistent with the clinical outcome values reported in the literature for NSCLC. This radiobiological model has demonstrated the proof of concept that poor local tumour control is strongly associated with the hypoxic fraction and large tumours.

Optimal tumour control for early-stage non-small-cell lung cancer: A radiobiological modelling perspective

A fully heterogeneous population tumour control probability (TCP) model, based on the linear-quadratic (LQ) cell survival concept combined with the Poisson statistic, was established to predict local tumour control after one, two and three years. This TCP model was created using data from 16 publications that reported on early-stage non–small-cell lung cancer (NSCLC) treated using either three-dimensional conformal radiation therapy (3D-CRT), continuous hyperfractionated accelerated radiotherapy (CHART) or stereotactic ablative body radiotherapy (SABR). The TCP model was fitted to the clinical outcome data using optimised radiosensitivity values produced by the Nelder-Mead simplex algorithm. The statistical analysis resulted in R2 values of 0.96, 0.96 and 0.97 and wRMSE values of 3.9%, 5.2% and 5.9% for one-, two- and three-year local tumour control rates, respectively. The TCP models for one, two and three years were internally validated using a bootstrap resampling approach. The mean R2 and 95% CI for the bootstrap samples were 0.98 (0.93–0.99), 0.98 (0.95–0.99) and 0.98 (0.96–0.99) for the one-, two- and three-year local tumour control rates, respectively. Variations in the TCP with clonogenic density were then further investigated by introducing a new mathematical model to vary the clonogenic cell and radiation dose distribution across the treated volume. Based on the above model, it was estimated that 60% of the dose was sufficient to maintain the TCP after two years for the areas with lower clonogenic cell density. If externally validated, this lower-dose treatment plan could have beneficial effects on the surrounding healthy tissue without negatively affecting tumour control.

Radiation dose intensity and local tumour control of non-small cell lung cancer: A radiobiological modelling perspective

Several clinical situations call for the use of radiobiological principles as powerful clinical tools. The aim of this project is to examine the effect of radiotherapy dose intensity on local tumour control for non-small cell lung cancer (NSCLC) using the biological effective dose (BED) concept. A two-year tumour control probability (TCP) model was developed based on the linear-quadratic cell concept combined with Poisson statistics. The two-year local control outcome was analysed for the radiotherapy dose using the BEDs. The BED calculations and the TCP model were fitted to a series of NSCLC patients drawn from the literature. The investigation is based on the two-year local tumour control rate for stage I-II NSCLC for a dose fractionation size that varied from 1.5-20 Gy per fraction delivered via three radiotherapy treatments: 3D-conformal radiation therapy (3D-CRT), continuous hyperfractionated accelerated radiotherapy (CHART) and stereotactic ablative body radiotherapy (SABR). The BED values of 2,280 patients were computed and analysed as a function of local tumour control. To quantitatively assess the correlation between the BED and local tumour control, a residuals analysis and linear regression were performed. Higher radiotherapy doses were associated with improved local tumour control and survival rates for NSCLC, as suggested by the coefficient of the correlation R2 statistical test: 0.83 for the 3D-CRT and 0.91 for the SABR treatment.

Continuous Hyperfractionated Accelerated Radiotherapy (CHART) for Non-small Cell Lung Cancer (NSCLC): 7 Years' Experience From Nine UK Centres

AimContinuous hyperfractionated accelerated radiotherapy (CHART) remains an option to treat non-small cell lung cancer (NSCLC; NICE, 2011). We have previously published treatment outcomes from 1998–2003 across five UK centres. Here we update the UK CHART experience, reporting outcomes and toxicities for patients treated between 2003 and 2009. Materials and methodsUK CHART centres were invited to participate in a retrospective data analysis of NSCLC patients treated with CHART from 2003 to 2009. Nine (of 14) centres were able to submit their data into a standard database. The Kaplan–Meier method estimated survival and the Log-rank test analysed the significance. ResultsIn total, 849 patients had CHART treatment, with a median age of 71 years (range 31–91), 534 (63%) were men, 55% had undergone positron emission tomography-computed tomography (PET-CT) and 26% had prior chemotherapy; 839 (99%) patients received all the prescribed treatment. The median overall survival was 22 months with 2 and 3 year survival of 47% and 32%, respectively. Statistically significant differences in survival were noted for stage IA versus IB (33.2 months versus 25 months; P = 0.032) and IIIA versus IIIB (20 months versus 16 months; P = 0.018). Response at 3 months and outcomes were significantly linked; complete response showing survival of 34 months against 19 months, 15 months and 8 months for partial response, stable and progressive disease, respectively (P < 0.001). Age, gender, performance status, prior chemotherapy and PET-CT did not affect the survival outcomes. Treatment was well tolerated with <5% reporting ≥grade 3 toxicity. ConclusionIn routine practice, CHART results for NSCLC remain encouraging and we have been able to show an improvement in survival compared with the original trial cohort. We have confirmed that CHART remains deliverable with low toxicity rates and we are taking a dose-escalated CHART regimen forward in a randomised phase II study of sequential chemoradiotherapy against other accelerated dose-escalated schedules.

164 - Continuous hyperfractionated accelerated radiotherapy (CHART) for non-small cell lung cancer (NSCLC) in patients age 80 and above

164 - Continuous hyperfractionated accelerated radiotherapy (CHART) for non-small cell lung cancer (NSCLC) in patients age 80 and above

The Elderly are Less Likely to Receive Recommended Radical Radiotherapy for Non-small Cell Lung Cancer

AimsThe National Institute for Healthcare Excellence recommends continuous hyperfractionated, accelerated radiotherapy (CHART), concurrent chemoradiation (cCRT) and stereotactic ablative radiotherapy (SABR) for appropriate patients with non-small cell lung cancer (NSCLC), but these are not universally available in all UK radiotherapy centres. Reduced access to these treatments may be contributing to reduced survival, with the concern that elderly patients are less likely to receive guideline-recommended therapy (GRT). Materials and methodsWe report a prospective, UK national study of patients treated with curative-intent radiotherapy for NSCLC over a 2 month period. Clinical oncologists in all UK radiotherapy centres were contacted and asked to complete a proforma on all patients treated with curative-intent radiotherapy. ResultsThree hundred and seventeen records were returned from 82% of centres. Only 49% (95% confidence interval 43–55%) of patients received the GRT for their tumour type. Patients aged 70 years or over were less likely to access GRT than those under 70 years (40% compared with 60%, P = 0.001), both as a result of clinicians offering therapy less frequently (52% compared with 65%, P = 0.03) and a higher refusal of therapy (22% versus 8%, P = 0.02). A reluctance to travel to a different centre was a key component of these decisions. SABR was delivered to only 52% of suitable patients, mainly because it was not available in the local centre. ConclusionsIn this study of UK curative-intent radiotherapy practice, a lack of local access seems to limit uptake of advanced radiotherapy techniques such as SABR, especially for patients aged over 70 years.

ED10.03 New Developments in Radiotherapy of Stage III NSCLC

ED10.03 New Developments in Radiotherapy of Stage III NSCLC

5: What is the relationship between F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) characteristics and outcomes in continuous hyperfractionated accelerated radiotherapy (CHART) for non-small cell lung cancer (NSCLC)?

5: What is the relationship between F-18-fluorodeoxyglucose positron emission tomography (FDG-PET) characteristics and outcomes in continuous hyperfractionated accelerated radiotherapy (CHART) for non-small cell lung cancer (NSCLC)?

PL05.03: Radio-Oncology

When I commenced training in radiation oncology in 1973, there were no CT scanners, calculations were done with slide rules, and chemotherapy, let alone combined modality therapy, had no established role in the treatment of non-small cell lung cancer. An influential trial published in the Lancet in 19711 had shown no difference in survival whether patients were randomized to radiotherapy, chemotherapy, a combination of the two or a policy of wait-and–see. Yet within 30 years, the standard of care for patients with inoperable lung cancer being treated for cure, both small cell and non-small cell, had, ironically, become, and remains, concomitant chemotherapy and radiotherapy. The outlook for patients generally regarded as incurable at the outset of my career is that up to one in three selected patients can now expect to live five years as a result of chemoradiation. Patients with stage I non-small cell lung cancer can have their cancer successfully ablated by non-invasive stereotactic radiotherapy in 90% of cases. The developments which led to these changes can be grouped according to three main themes: the impact of the computer revolution; a better understanding of the natural history and biology of the disease, and the introduction of mutimodality therapy. Better identification and delineation of the tumor are critical to the success of radiotherapy, in particular avoidance of the catastrophic “geographic miss.” Without computers, the CT and hybrid PET/CT scanners could not have been possible. These dramatically improved the accuracy of staging as well as providing 3D information on the relationship of the soft tissue target to the nearby dose-limiting organs at risk. As computing power increased it became possible to create 4D images of moving tumors, and to image the target with on-board CT scanners attached to the linac immediately before treatment, so making image guided stereotactic ablative radiotherapy possible. Powerful computerized treatment planning systems are now able to create complex dose distributions conforming to the irregularities of any target volume, and to provide dose-volume metrics predictive of risks of normal tissue damage. The recognition that the central nervous system is a sanctuary site which can harbor metastatic disease leading to treatment failure in spite of successful chemotherapeutic eradication of extracranial disease, particularly in small cell lung cancer, led to the introduction of prophylactic cranial irradiation. The British study of continuous hyperfractionated accelerated radiotherapy (CHART) which was given over 12 days to patients with inoperable non-small cell lung cancer resulted in better survival than treatment given over six weeks, even though the total dose was lower. This trial provided clinical support for the notion of treatment induced accelerated repopulation, and reinforced the principle that total treatment times should be kept short in both small cell and non-small cell lung cancer, both when radiotherapy is used alone, and when in combination with chemotherapy. The limitations of single modality therapy for a disease with a high propensity for developing genetically determined resistance have long been recognized, and have stimulated the development of strategies simultaneously employing non-cross resistant therapies to maximize tumor cell kill, in line with the principles espoused by Goldie and Coldman.2 The use of concomitant platinum based chemotherapy with high dose radiotherapy is now well established by meta-analysis as improving survival of both non-small cell and small cell lung cancers, but it is also more toxic. Amelioration of these toxicities represents a major challenge for the future. It is likely that the technical progress in radiation treatment planning and delivery is close to a plateau, and that future progress will depend more on understanding the biology of the disease and its response, and that of the normal tissues, to radiation damage. Biomarkers of response and toxicity, so spectacularly harnessed to advantage by our medical oncology colleagues, are desperately needed to tailor the radiotherapy prescription to the needs of each individual and their cancer. Finally, it is evident that in many jurisdictions, including industrialized wealthy nations, that many patients are either receiving substandard radiotherapy that might increase their chances of cure, or are not receiving treatment at all.3 Unless these problems can be addressed, the benefits of the remarkable advances in technology and biology documented above will shamefully be restricted to only a fraction of those afflicted with locoregional disease. 1. Durrant KR, Berry RJ, Ellis F, Ridehalgh FR, Black JM, Hamilton WS. Comparison of treatment policies in inoperable bronchial carcinoma. Lancet. 1971;1(7702):715-9. 2. Goldie JH, Coldman AJ, Gudauskas GA. Rationale for the use of alternating non-cross-resistant chemotherapy. Cancer Treat Rep. 1982;66(3):439-49. 3. Vinod SK. International patterns of radiotherapy practice for non-small cell lung cancer. Semin Radiat Oncol. 2015;25(2):143-50. lung cancer, radiation oncology, history

137: Is there still a role for continuous hyperfractionated accelerated radiotherapy (CHART) in the management of NSCLC?

137: Is there still a role for continuous hyperfractionated accelerated radiotherapy (CHART) in the management of NSCLC?

P2.05-041 Accelerated Radical Radiotherapy for Non Small Cell Lung Cancer: Single Centre Experience of Two Fractionations: Topic: RT Techniques

Radical radiotherapy (RT) regimens for NSCLC vary considerably. In routine practice our centre has predominantly used continuous hyperfractionated accelerated radiotherapy (CHART, 54Gy in 36 fractions over 12 days) and accelerated hypofractionated RT (55 Gy in 20 fractions over 4 weeks) since 1997. This report updates previous data presentation [1] including patients treated between 2005 and 2011. Case notes and radiotherapy records for all patients receiving radical radiotherapy were retrospectively reviewed. Patient demographics, tumor characteristics, RT and survival data were collected. Descriptive statistical analysis and Cox regression analysis was performed using SSPS. 516 patients received radical radiotherapy, over 95% received CHART (237 patients) or hypofractionated RT (257). Median age was 70 yrs, and 60% percent were male. PET staging was performed in 81%, and 26%, 17% and 51% were stage 1, 2, 3 respectively. 81% were WHO performance status 0-1. 44% were squamous carcinomas, 21% non-squamous, 20% not otherwise specified, with 14% without histological diagnosis. Prior chemotherapy was given to 36%, of whom 84% had stage III disease. 99.6% completed their prescribed radiotherapy treatment. 2 year survival was 47.5% and median overall survival from time of diagnosis was 23 months. Univariate analysis showed statistically significant association of survival with gender, stage and histology, but not age, PS or RT regime. Discussion: This single centre experience reflects the outcome of unselected consecutively treated NSCLC patients. Patient selection for the two radiotherapy regimens was largely down to patient preference for in- or out-patient treatment. Encouragingly, CHART outcomes seem a little better than those reported in the original CHART paper [2] and our previous cohort [1]. We feel this probably reflects improved patient selection following the introduction of PET staging into routine practice. Conclusions: The outcome for patients treated with accelerated radiotherapy fractionations in routine practice remains encouraging, and randomised trials comparing these approaches with conventionally fractionated chemoradiotherapy regimes are needed. 1. Pemberton LS, Din OS, Fisher PM, Hatton MQ. Accelerated radical radiotherapy for non-small cell lung cancer (NSCLC) using two common regimens: a single centre audit of outcome. Clinical Oncology 2009;21:161-7 2. Saunders M et.al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet. 1997 Jul 19;350(9072):161-5

P2.05-045 Accelerated Radical Radiotherapy for Non-Small Cell Lung Cancer: Single Centre Experience of Two Schedules in the Treatment of Elderly Patients: Topic: RT Techniques

Radical radiotherapy (RT) regimens for NSCLC vary considerably and there is little data on outcomes for elderly patients, who are underrepresented in clinical trials. Our center has routinely used continuous hyperfractionated accelerated radiotherapy (CHART, 54Gy in 36 fractions over 12 days) and accelerated hypofractionated RT (55 Gy in 20 fractions over 4 weeks) since 1997. We have examined outcomes for patients over the age of 80 treated between 2005 and 2011. Case notes and radiotherapy records for all patients receiving radical radiotherapy were retrospectively reviewed. Patient demographics, tumor characteristics, RT and survival data were collected. Descriptive statistical analysis and Cox regression analysis was performed using SSPS. 516 patients received radical radiotherapy: 73 were over 80 years old; 71 % were male; and 85% WHO performance status 0-1. PET staging was performed in 87%, with 41%, 22% and 32% being stage 1, 2, 3 respectively. 51% were squamous carcinomas, 18% non-squamous, 12% unspecified, and 19% without a confirmed histological diagnosis. 2 patients received primary chemotherapy. 40% received CHART, and 56% hypofractionated RT. All patients completed their prescribed radiotherapy treatment. 2 year survival was 67% and median overall survival from time of diagnosis was 22 months. Univariate analysis suggested stage was the only statistically significant variable associated with survival. Discussion: Our results confirm that accelerated radiotherapy schedules are deliverable in elderly populations with NSCLC who are generally not considered suitable for standard treatment with chemo-radiotherapy. The outcomes are similar to those reported in our younger patient cohorts [1] and appear to be as good as those reported in the original CHART paper [2]. Conclusions: The use of accelerated radiotherapy fractionations for the radical treatment of elderly patients with NSCLC is a feasible and well tolerated treatment for those patients not suitable for a chemo-radiotherapy approach. Outcomes are encouraging, but trials specific to this population are needed to define the optimal radiotherapy regimen. Ref: Pemberton LS, Din OS, Fisher PM, Hatton MQ. Accelerated radical radiotherapy for non-small cell lung cancer (NSCLC) using two common regimens: a single centre audit of outcome. Clinical Oncology 2009; 21:161-7 2. Saunders M et.al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial. CHART Steering Committee. Lancet. 1997 Jul 19; 350(9072):161-5.

120P Neoadjuvant chemotherapy followed by either continuous hyper-fractionated accelerated radiation therapy week-end less or conventional chemo-radiotherapy in locally advanced non small cell lung cancer

120P Neoadjuvant chemotherapy followed by either continuous hyper-fractionated accelerated radiation therapy week-end less or conventional chemo-radiotherapy in locally advanced non small cell lung cancer

121P Survival following treatment of non-small cell lung cancer (NSCLC) using continuous hyperfractionated accelerated radiotherapy (CHART): A single-centre retrospective analysis

121P Survival following treatment of non-small cell lung cancer (NSCLC) using continuous hyperfractionated accelerated radiotherapy (CHART): A single-centre retrospective analysis

137 10 years of CHART (continuous hyperfractionated accelerated radiotherapy) for non-small cell lung cancer (NSCLC) at NCCC

137 10 years of CHART (continuous hyperfractionated accelerated radiotherapy) for non-small cell lung cancer (NSCLC) at NCCC

121 Continuous hyperfractionated accelerated radiotherapy (CHART) using volumetric modulated arc therapy (VMAT) for locally advanced non-small cell lung cancer (NSCLC) – the clinical experience

121 Continuous hyperfractionated accelerated radiotherapy (CHART) using volumetric modulated arc therapy (VMAT) for locally advanced non-small cell lung cancer (NSCLC) – the clinical experience

The Quality of Curative-intent Radiotherapy for Non-small Cell Lung Cancer in the UK

AimsLung cancer is the leading cause of cancer-related death in the UK. The quality of curative-intent radiotherapy is associated with better outcomes. National quality standards from the National Institute for Health and Care Excellence (NICE) on patient work-up and treatment selection were used, with guidance from the Royal College of Radiologists on the technical delivery of radiotherapy, to assess the quality of curative-intent non-small cell lung cancer radiotherapy and to describe current UK practice. Materials and methodsRadiotherapy departments completed one questionnaire for each patient started on curative-intent radiotherapy for 8 weeks in 2013. ResultsEighty-two per cent of centres returned a total of 317 proformas. Patient selection with positron emission tomography/computed tomography, performance status and Forced Expiratory Volume in 1 second (FEV1) was usually undertaken. Fifty-six per cent had pathological confirmation of mediastinal lymph nodes and 22% staging brain scans; 20% were treated with concurrent chemoradiation, 12% with Stereotactic Ablative Radiotherapy (SABR) and 8% with Continuous Hyperfractionated Accelerated Radiotherapy (CHART). Sixty-three per cent of patients received 55 Gy/20 fractions. Although respiratory compensation was routinely undertaken, only 33% used four-dimensional computed tomography. Seventy per cent of patients were verified with cone beam computed tomography. There was consistency of practice in dosimetric constraints for organs at risk and follow-up. ConclusionsThis audit has described current UK practice. The latest recommendations for patient selection with pathological confirmation of mediastinal lymph nodes, brain staging and respiratory function testing are not universally followed. Although there is evidence of increasing use of newer techniques such as four-dimensional computed tomography and cone beam image-guided radiotherapy, there is still variability in access. Efforts should be made to improve access to modern technologies and quality assurance of radiotherapy plans.

A meta-analysis comparing hyperfractionated vs. conventional fractionated radiotherapy in non-small cell lung cancer.

Lung cancer is the leading cause of cancer-related mortality. Non-small cell lung cancer (NSCLC) accounts for most lung cancer and carries a 5-year survival rate of 15%. The squamous cell carcinoma, large cell carcinoma, and adenocarcinoma are the most common types of NSCLC. The data on long term use of hyperfractionated radiotherapy (HRT) in NSCLC treatment is lacking. We performed a meta-analysis, based on published randomized trials to compare HRT [continuous hyperfractionated accelerated radiotherapy (CHART)/continuous hyperfractionated accelerated radiotherapy weekend less (CHARTWEL)] vs. conventional fractionated (CF) radiotherapy in the treatment of NSCLC. A systematic search through the bibliographic databases, PubMed, Google Scholar and Cochrane Library was performed till December 2013. Of 63 studies identified, 3 studies were analyzed. All were randomized studies and included 1,005 patients in total. The pooled results of the studies showed that HRT did not improve overall survival (OS) of patients suffering from NSCLC compared to CF after 2 years (OR, 1.29; 95% CI, 0.98-1.71; P=0.16) and 3 years (OR, 0.55; 95% CI, 0.34-0.87; P=0.22) which was statistically significant. HRT was no better than CF in controlling tumour (OR, 1.40; 95% CI, 1.03-1.91). No significant difference in metastasis free survival (OR, 1.08; 95% CI, 0.83-1.39) and late dysphagia (OR, 1.48; 95% CI, 0.75-2.92) were observed between the two groups. The results of the present meta-analysis showed that HRT was not significantly better to conventional radiotherapy in NSCLC treatment.