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Improving Outcomes in NSCLC: Optimum Dose Fractionation in Radical Radiotherapy Matters.

Michael Brada1, Helen Forbes2, Susan Ashley3

  • 1Department of Radiation Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom; Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.

Journal of Thoracic Oncology : Official Publication of the International Association for the Study of Lung Cancer
|January 29, 2022
PubMed
Summary

Conventional radiotherapy (60-66 Gy in 30-33 fractions) improved survival for non-small cell lung cancer (NSCLC) patients compared to moderate hypofractionation (55 Gy in 20 fractions). Conventional fractionation remains the standard of care.

Keywords:
Hypofractionated radiotherapyLocalized and locally advanced non–small cell lung cancerPrognosis by dose fractionationRadical radiotherapy fractionation

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Area of Science:

  • Oncology
  • Radiotherapy
  • Clinical Trials

Background:

  • Moderate hypofractionation is a common radiotherapy regimen for non-small cell lung cancer (NSCLC).
  • Conventional fractionation is another widely used regimen for NSCLC treatment.

Purpose of the Study:

  • To compare the outcomes of moderate hypofractionation (55 Gy in 20 fractions) versus conventional fractionation (60-66 Gy in 30-33 fractions) for NSCLC.
  • To determine the standard of care for NSCLC radiotherapy based on survival data.

Main Methods:

  • Analysis of a national radiotherapy dataset of 169,863 NSCLC cases in England (2012-2016).
  • Patients with stages I-III NSCLC (73,186) were divided into training (2012-2013) and validation (2014-2016) cohorts.
  • Overall survival was analyzed using a proportional hazards model, adjusted for prognostic factors.

Main Results:

  • Patients receiving conventional fractionation (2 Gy/fraction) had improved median survival compared to moderate hypofractionation (2.75 Gy/fraction).
  • Cohort 1: 29 months (conventional) vs. 25 months (hypofractionation), HR=1.16, p=0.001.
  • Cohort 2: 28 months (conventional) vs. 25 months (hypofractionation), HR=1.10, p=0.02.

Conclusions:

  • Conventional fractionation regimens are associated with a survival benefit in NSCLC patients compared to moderate hypofractionation.
  • Conventional fractionation should remain the standard of care for NSCLC, pending randomized trial data.