Hypofractionated radiation therapy in unresectable stage iii non-small cell lung cancer

Abstract

Background. Hypofractionation is the current choice for radiation therapy for patients with unresectable non‐small cell lung cancer (NSCLC) at the authors' institute. Methods. In this nonrandomized study, three hypofractionated radiation schedules (40‐Gy split course; 30–32 Gy in 6 fractions and 24 Gy in 3 fractions) are evaluated in 301 patients with unresectable Stage III NSCLC. Results. Patients with Stage IIIA disease treated with a 40‐Gy split course had longer survival (P < 0.005) and a lower local relapse rate (P < 0.01), but a higher distant failure rate (P < 0.01) than those receiving 24–32 Gy. Survival for patients with Stage IIIA disease treated with 40 Gy at 1, 2, and 5 years was 47%, 22%, and 7%, respectively. For patients with Stage IIIB disease, the radiation scheme used did not correlate with survival and relapse rates. Survival at 1, 2, and 5 years was 30%, 9%, and 2%, respectively. The hypofractionated radiation schemes were well tolerated, and no severe complications were recorded. Conclusions. In patients with Stage IIIA disease, 40‐Gy split‐course radiation therapy yields survival rates comparable to those achieved with conventional radiation therapy. In patients with Stages IIIB and IV NSCLC, 24 Gy in 3 weekly fractions yields survival rates comparable to those achieved with higher total doses given in more fractions.