HYPOFRACTIONATED RADIATION-THERAPY IN UNRESECTABLE STAGE-III NONSMALLCELL LUNG-CANCER

Background. Hypofractionation is the current choice for radiation ther apy 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 w ith unresectable Stage III NSCLC. Results. Patients with Stage IIIA di sease 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 fail ure rate (P < 0.01) than those receiving 24-32 Gy. Survival for patien ts 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%, respectivel y. The hypofractionated radiation schemes were well tolerated, and no severe complications were recorded. Conclusions. In patients with Stag e IIIA disease, 40-Gy split-course radiation therapy yields survival r ates comparable to those achieved with conventional radiation therapy. In patients with Stages IIIB and IV NSCLC, 24 Gy in 3 weekly fraction s yields survival rates comparable to those achieved with higher total doses given in more fractions.