Vol 26, No 5 (2021)
Research paper
Published online: 2021-08-16

open access

Page views 5756
Article views/downloads 361
Get Citation

Connect on Social Media

Connect on Social Media

Short term clinical outcomes of accelerated hypofractionated radiotherapy in inoperable non-small cell lung cancer patients

Shoon Mya Aye1, Lin Lin Kyi1, Moe Hlaing1, Aye Aye Myint1, Khin Cho Win1
Rep Pract Oncol Radiother 2021;26(5):747-755.

Abstract

Background: This study aimed to evaluate short term clinical outcomes of accelerated hypofractionated radiotherapy (AHRT) regarding locoregional response (LRR), symptoms relief and acute toxicities in non-small cell lung cancer (NSCLC) patients.

The radical treatment for inoperable NSCLC is intolerable for some patients. An alternative RT regime should be considered for them.

Materials and methods: Inoperable NSCLC patients who could not tolerate radical treatment were treated with AHRT (45 Gy in 15 fractions over three weeks) by using the 3-dimensional conformal (RT) technique. The LRR was assessed by chest computed tomography (CT) performed before and 6 weeks after RT. Relief of symptoms such as cough, dyspnoea and chest pain was evaluated during RT and 6 and 12 weeks after RT, compared with the status before RT. Treatment-related acute toxicities such as dysphagia and radiation dermatitis were observed during and 6 and 12 weeks after RT.

Results: Total 65 patients (seven patients of stage II and fifty-eight patients of stage III) were included. Partial response was seen in 70.8% of patients, and stable disease was seen in 29.2% while there was neither complete response nor progressive disease after RT. Statistically significant associations were found between tumour response vs. pre-treatment tumour size and tumour response vs. performance status of the patients. Satisfactory symptom relief was found after RT, but severe acute dysphagia and radiation dermatitis (more than grade 3) were not observed.

Conclusion: Satisfactory LRR, symptom relief and acute toxicities were achieved by this regime. Long term studies are recommended to evaluate late toxicities and survival outcome further.

Trial registration no.: TCTR20200110001

 

 

Article available in PDF format

View PDF Download PDF file

References

  1. nternational Agency for Research On Cancer (IARC). GLOBOCAN 2018: Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2018. http://globocan.iarc.fr/old/FactSheets/cancers/lung-new.asp (20 July 2019).
  2. Bradley JD, Paulus R, Komaki R, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015; 16(2): 187–199.
  3. Curran WJ, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011; 103(19): 1452–1460.
  4. Steel G. Basic Clinical Radiobiology: Radiation response and tolerance of normal tissues. 3rd ed. Arnold, London 2002.
  5. Royal College of Radiologists (RCR). Radiotherapy Dose Fractionation. 3rd ed. London 2019.
  6. Lester JF, Macbeth FR, Toy E, et al. Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev. 2006(4): CD002143.
  7. Amini A, Lin SH, Wei C, et al. Accelerated hypofractionated radiation therapy compared to conventionally fractionated radiation therapy for the treatment of inoperable non-small cell lung cancer. Radiat Oncol. 2012; 7: 33.
  8. Nguyen L, Komaki R, Allen P, et al. Effectiveness of accelerated radiotherapy for patients with inoperable non-small cell lung cancer (NSCLC) and borderline prognostic factors without distant metastasis: a retrospective review. Int J Radiat Oncol Biol Phys. 1999; 44(5): 1053–1056.
  9. van Oorschot B, Assenbrunner B, Schuler M, et al. Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer. Strahlenther Onkol. 2014; 190(3): 270–275.
  10. Rami-Porta R, Asamura H, Travis WD, Rusch VW. Lung. In: Rami-Porta R, Asamura H, Travis WD, Rusch VW. American Joint Committee on Cancer (AJCC). ed. AJCC Cancer Staging manual. 8th ed. Springer, New York 2017: 431–456.
  11. Barette A, Dobbs J, Morris S, Roques T. Practical radiotherapy planning. 4th ed. Hodder Arnold, Italy 2009.
  12. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45(2): 228–247.
  13. National Cancer Institute (NCI). Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. US Department of Health and Human Services, National Institute of hHealth, National Cancer Institute 2009.
  14. Abratt RP, Shepherd LJ, Salton DG. Palliative radiation for stage 3 non-small cell lung cancer--a prospective study of two moderately high dose regimens. Lung Cancer. 1995; 13(2): 137–143.
  15. Teo P, Tai TH, Choy D, et al. A randomized study on palliative radiation therapy for inoperable non small cell carcinoma of the lung. Int J Radiat Oncol Biol Phys . 1988; 14(5): 867–871.
  16. Cagney DN, Thirion PG, Dunne MT, et al. A Phase II Toxicity End Point Trial (ICORG 99-09) of Accelerated Dose-escalated Hypofractionated Radiation in Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol). 2018; 30(1): 30–38.
  17. Din OS, Harden SV, Hudson E, et al. Accelerated hypo-fractionated radiotherapy for non small cell lung cancer: results from 4 UK centres. Radiother Oncol. 2013; 109(1): 8–12.
  18. Osti MF, Agolli L, Valeriani M, et al. Image guided hypofractionated 3-dimensional radiation therapy in patients with inoperable advanced stage non-small cell lung cancer. Int J Radiat Oncol Biol Phys. 2013; 85(3): e157–e163.
  19. Thida-Htun Y. Palliative effect of hypofractionated radiotherapy for advanced lung cancer. M.Med.Sc. Radiation Oncology) dissertation, University of Medicine 1, Yangon 2017.
  20. Thuzar-Pyone K. Locoregional response of sequential chemoradiation for inoperable non-small cell lung cancer. M.Med.Sc. (Radiation Oncology) dissertation. University of Medicine 1, Yangon 2016.
  21. Chiang A, Detterbeck FC, Stewart T, Decker RH, Tanoue L. Non-small-cell Lung Cancer . In: Devita VT VT, Lawrence TS, Rosenberg SA. ed. Cancer: Principles and Practice of Oncology. 11th ed. Wolters Kluwer, London 2019: 1135–1221.
  22. Trovó M, Minatel E, Veronesi A, et al. Combined radiotherapy and chemotherapy versus radiotherapy alone in locally advanced epidermoid bronchogenic carcinoma a randomized study. Cancer. 1990; 65(3): 400–404, doi: 10.1002/1097-0142(19900201)65:3<400::aid-cncr2820650304>3.0.co;2-h.
  23. Rowell NP, Williams CJ. Radical radiotherapy for stage I/II non-small cell lung cancer in patients not sufficiently fit for or declining surgery (medically inoperable): a systematic review. Thorax. 2001; 56(8): 628–638.
  24. Zhang J, Gold KA, Lin HY, et al. Relationship between tumor size and survival in non-small-cell lung cancer (NSCLC): an analysis of the surveillance, epidemiology, and end results (SEER) registry. J Thorac Oncol. 2015; 10(4): 682–690.
  25. Albain KS, Crowley JJ, LeBlanc M, et al. Survival determinants in extensive-stage non-small-cell lung cancer: the Southwest Oncology Group experience. J Clin Oncol. 1991; 9(9): 1618–1626.
  26. Espinosa E, Feliu J, Zamora P, et al. Serum albumin and other prognostic factors related to response and survival in patients with advanced non-small cell lung cancer. Lung Cancer. 1995; 12(1-2): 67–76.
  27. Koukourakis M, Hlouverakis G, Kosma L, et al. The impact of overall treatment time on the results of radiotherapy for nonsmall cell lung carcinoma. Int J Radiat Oncol Biol Phys. 1996; 34(2): 315–322.
  28. Valeriani M, Marinelli L, Reverberi C, et al. Inoperable early-stage primary and early recurrent non-small cell lung cancer: outcomes of a mono-institutional experience using a moderate hypofractionated schedule. Radiol Med. 2019; 124(1): 58–64.
  29. Ball D, Mitchell A, Giroux D, et al. IASLC Staging Committee and Participating Institutions. Effect of tumor size on prognosis in patients treated with radical radiotherapy or chemoradiotherapy for non-small cell lung cancer. An analysis of the staging project database of the International Association for the Study of Lung Cancer. J Thorac Oncol. 2013; 8(3): 315–321.