Hypofractionated chemoradiotherapy for non-small-cell lung cancer in a real-world setting: a single-centre experience

This study aimed to evaluate tolerability and outcomes of hypofractionated radiotherapy for non-small cell lung cancer (NSCLC), with or without concomitant or prior chemotherapy, in a real-world single-centre setting.

Between August 2017 and September 2024, 117 consecutive NSCLC patients treated with hypofractionated radiotherapy were prospectively registered. The predominant regimen was 55 Gy in 20 fractions (94.1%), delivered either concurrently or after chemotherapy.

A total of 102 patients were analysed: 6 had stage II, 82 had stage III, and 14 had stage IV disease. Fifty-nine patients received concurrent chemoradiotherapy (conc-RChT) and 43 sequential chemotherapy followed by radiotherapy (seq-RChT). Median disease-free and overall survival were 18.3 and 22.0 months, respectively. Eastern Cooperative Oncology Group (ECOG) performance status was the only independent prognostic factor for overall survival (30.3 months for ECOG 0 vs. 18.9 months for ECOG 1-2; p = 0.012). Acute esophagitis occurred in 34% (grade 1), 16.7% (grade 2), and 3.9% (grade 3). Acute pneumonitis was reported in 12.7% (grade 1) and 8.8% (grade 2); late grade 1 pneumonitis in 4.9%.

To our knowledge, this is the first large real-world series from our country including unselected NSCLC patients treated with hypofractionated radiotherapy. Although 55 Gy in 20 fractions is standard in the UK, its use remains limited locally, particularly with conc-RChT. Our findings support hypofractionation as an effective and well-tolerated option, especially in high-volume centres.