Results of irradiation of inoperable stage III non-small cell lung cancer with 25 Gy in 5 fractions

Background: Patients with advanced Stage III inoperable non-small cell lung cancer who were not suitable for irradiation with curative doses, were tre ated at the Department of Radiotherapy of the University Hospital of Dresde n with 25 Gy in 5 fractions over 1 to 2 weeks. Survival of these patients w as compared in this retrospective study to the survival of patients treated during the same period with 60 Gy in 30 fractions. Patients and Method: Between 1985 and 1994 298 patients were treated for a histologically or cytologically proven nonsmall cell lung carcinoma with 60 Gy in 30 fractions (n = 80), with 40 Gy in 20 fractions (n = 26) or with 2 5 Gy in 5 fractions (n = 192). Overall survival was determined using actuar ial methods. Prognostic parameters were analyzed using uni- and multivariat e tests. Results: Median overall survival for all patients was 6 months (95% confide nce interval 5; 7). In univariate analysis, survival of the patients treate d with 60 Gy was significantly better than survival in the other groups. Me dian survival was 11 months (9; 13) after 60 Gy, 6 months (4; 8) after 40 G y and 5 months (4; 6) after 25 Gy. In multivariate analysis the treatment s chedule lost its significant influence on outcome of the therapy. The most important prognostic parameter was the performance status of the patients. Conclusions: When stratified for performance status as the most important p rognostic parameter the survival time after hypofractionated irradiation to 25 Gy given in 5 fractions in 1 to 2 weeks was not significantly different from the results after conventional fractionation to 60 Gy. Hypofractionat ed radiation schedules are often more convenient for the patient, economica l, and have been shown to be effective in symptom control. Thus, in clear p alliative situations hypofractionated treatment with 25 Gy in 5 fractions o r a comparable schedule appears to be a reasonable therapeutic option.