Evaluation of Hypofractionated Radiotherapy in Advanced Non-Small Cell Lung Cancer

Background: Hypofractionated chest radiotherapy regimens have provided excellent palliation of pulmonary symptoms in patients with inoperable and advanced non-small cell lung cancer (NSCLC). Purpose: To evaluate prospectively the efficacy, toxicity, duration of palliation of pulmonary symptoms and survival after different hypofractionated radiotherapy regimens in symptomatic patients with advanced non small cell lung cancer. Also, to determine which radiotherapy regimens were required for better palliation of thoracic symptoms and whether more intensive radiotherapy regimen is required with the aim of prolonging survival. Methods: Between January 2000 and June 2003, fiftyfour patients with symptomatic, inoperable and advanced NSCLC were enrolled in our prospective study and were received palliative hypofractionated radiotherapy regimens using involved fields. Sixteen patients (group I) received 17 Gy/2 fractions, one week apart, eighteen patients (group II) received 20 Gy/5 fractions/a week and twenty patients (group III) received 39 Gy/13 fractions/17 days. Results: The median follow-up was 20 months. The most common presenting pulmonary symptoms were cough (81.5%), dyspnea (51.9%), chest pain (44.4%) and haemoptysis (35.2%). Clinical palliation of symptoms was achieved in 75.9%. Palliation of symptoms were better in group III, especially for chest pain and dyspnea. For all symptoms caused by lung cancer, the median duration in palliation ranged from 48-175 days. Performance status improved in 70.4%. The median survival of the whole treatment groups was 225 days. The one-year and 2-year survival were better in group III 30% and 10% versus 22.2% and 5.6% in group II and 18.8% and 0% in group I. Performance status, size of tumor and weight loss had an influence on survival. Dysphagia is the main transient treatment related side effect, which was higher 25% in group III versus 16.6% in group II and 12.5% in group I, Lasting for a median 8 days in group I, 9 days in group II and 15 days in group III. Conclusion: Hypofractionated palliative radiotherapy regimens gave a high level of palliation of pulmonary symptoms with minimal toxicity. Very short hypofractionated radiotherapy regimen was preferred in patients with poor performance status and short expected survival time while more intensive radiotherapy regimen may be considered for patients with good performance status, locally advanced disease and long expected survival time.