Hypofractionated radiation therapy for inoperable advanced stage non-smallcell lung cancer

Aims and background: Inoperable advanced stage lung cancer is usually treat ed by radiation therapy. Although a minority of patients may achieve prolon ged survival with aggressive therapeutic approaches, most patients present with adverse prognostic factors that do not allow curative treatment. For t hese cases palliation of symptoms becomes the main treatment purpose, and s hort treatment schedules are commonly employed. Methods: Fifty-two inoperable patients with stage IIIB or IV non-small cell lung cancer (NSCLC) were treated with a hypofractionated schedule of radio therapy. Initially all patients received 20 Gy in five fractions, and appro ximately one month after irradiation completion patients underwent clinical and radiological evaluation, Those that achieved a >50% reduction In tumor load and respiratory symptoms were submitted to a second similar short cou rse of radiotherapy. Results: Thirty-three (63%) patients received only one course of radiothera py. After the first evaluation, 19 patients (37%), all stage IIIB, fulfille d the criteria to receive a total dose of 40 Gy. Survival rates at one and two years were 33% and 0%, respectively, in the group of patients that rece ived 20 Gy, and 52% and 21% respectively, in the group treated with 40 Gy. Two-year survival rates were 10% for stage IIIB and 0% for stage IV patient s. Among the patients that were Irradiated with a dose of 20 Gy, a subjecti ve reduction of dyspnea and cough and remission of hemoptysis were observed in 97%, 82% and 80% cases, respectively. Complete remission of dyspnea and coughing was observed in 17 (89%) and 14 (74%) patients treated with two i rradiation courses. Only mild toxicity was recorded. Conclusions: Our treatment schedule achieved symptom control in the majorit y of patients. Early evaluation after 20 Gy allowed selection of responsive patients that could benefit from more prolonged treatment.