Efficacy and safety of high-dose hypofractionated palliative radiotherapy (40 Gy in 10 daily fractions) for non-small cell lung cancer.

PURPOSE: Palliative thoracic radiotherapy plays a crucial role in the management of patients with non-small cell lung cancer (NSCLC). Conventional dose-fractionation schemes often yield modest and short-lived tumor responses. This study aims to evaluate the efficacy and safety of a high-dose hypofractionated radiotherapy regimen of 40 Gy in 10 daily fractions in NSCLC.

MATERIALS AND

METHODS

Consecutive NSCLC patients who underwent palliative thoracic radiotherapy using the 40 Gy in 10 daily fractions regimen between January 2017 and December 2022 were identified from institutional databases of two tertiary oncology centers. Treatment responses were assessed using the Response Evaluation Criteria in Solid Tumor criteria. Local tumor control rate was estimated using cumulative incidence function, considering death as a competing event. The rates of radiation pneumonitis and esophagitis were assessed.

RESULTS

Sixty-two eligible patients were included. Median age was 72.6 years, with 52 patients (83.4%) having Eastern Cooperative Oncology Group performance status of ≥2. Radiotherapy was given to 33 patients (53%) with locally advanced primary NSCLC and 29 patients (47%) with oligopersistent or oligoprogressive NSCLC. Fifty-three tumors (85.4%) were considered unsuitable for stereotactic radiotherapy by location or size. With a median follow-up of 4.1 years, the overall response rate was 69.3%. Local control rates at 1 and 3 years were 96.7% and 76.9%, respectively. Grade 1-2 radiation pneumonitis and esophagitis occurred in 46.7% and 8.1% of patients. One case of grade 3 esophagitis was observed.

CONCLUSION

The 40 Gy in 10 daily fractions regimen demonstrates high local tumor control rate and a favorable safety profile, representing an effective and safe palliative option for NSCLC patients.