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Accelerated Hypofractionated Image-Guided vs Conventional Radiotherapy for Patients With Stage II/III Non-Small Cell

Puneeth Iyengar1,2,3, Elizabeth Zhang-Velten1,2,3, Laurence Court4

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|August 12, 2021
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Hypofractionated image-guided radiotherapy (IGRT) did not improve survival compared to conventional radiotherapy (CFRT) for patients with stage II/III non-small cell lung cancer (NSCLC) ineligible for chemotherapy. Further research is needed to confirm equivalence between these lung cancer treatment options.

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Area of Science:

  • Oncology
  • Radiation Oncology
  • Clinical Trials

Background:

  • A significant subset of patients with stage II/III non-small cell lung cancer (NSCLC) cannot receive standard chemoradiotherapy due to toxicity risks.
  • Conventional radiotherapy (CFRT) efficacy is reduced in these patients without concurrent chemotherapy.
  • Hypofractionated image-guided radiotherapy (IGRT) is an alternative treatment approach.

Purpose of the Study:

  • To determine if hypofractionated IGRT improves overall survival in stage II/III NSCLC patients ineligible for concurrent chemoradiotherapy.
  • To compare hypofractionated IGRT with CFRT in this patient population.

Main Methods:

  • Phase 3 randomized clinical study involving 96 patients with stage II/III NSCLC.
  • Patients were ineligible for concurrent chemoradiotherapy.
  • Randomization to either hypofractionated IGRT (60 Gy in 15 fractions) or CFRT (60 Gy in 30 fractions).
  • Primary endpoint was 1-year overall survival.

Main Results:

  • No statistically significant difference in 1-year overall survival between hypofractionated IGRT (37.7%) and CFRT (44.6%).
  • No significant differences observed in median overall survival, progression-free survival, time to local failure, time to distant metastasis, or severe toxic effects.
  • Study closed early due to futility in reaching the primary endpoint.

Conclusions:

  • Hypofractionated IGRT is not superior to CFRT for stage II/III NSCLC patients ineligible for concurrent chemoradiotherapy.
  • Further studies are needed to verify equivalence between these radiotherapy regimens.
  • Hypofractionated radiotherapy may be a convenient option for well-selected NSCLC patients.