Cancer Res Treat.  2016 Oct;48(4):1187-1195. 10.4143/crt.2015.391.

Radiation Therapy Alone in cT1-3N0 Non-small Cell Lung Cancer Patients Who Are Unfit for Surgical Resection or Stereotactic Radiation Therapy: Comparison of Risk-Adaptive Dose Schedules

• Cho WK
• Noh JM
• Ahn YC
• Oh D
• Pyo H

• KMID: 2356221
• DOI: http://doi.org/10.4143/crt.2015.391

Abstract

PURPOSE
High dose definitive radiation therapy (RT) alone is recommended to patients with cT1-3N0 non-small cell lung cancer, who are unfit for surgery or stereotactic RT. This study was conducted to evaluate the clinical outcomes and cost-effectiveness following RT alone using two different modest hypofractionation dose schemes.
MATERIALS AND METHODS
Between 2001 and 2014, 124 patients underwent RT alone. From 2001 till 2010, 60 Gy in 20 fractions was delivered to 79 patients (group 1). Since 2011, 60 Gy in 20 fractions (group 2, 20 patients), and 60 Gy in 15 fractions (group 3, 25 patients) were selectively chosen depending on estimated risk of esophagitis.
RESULTS
At follow-up of 16.7 months, 2-year rates of local control, progression-free survival, and overall survival were 62.6%, 39.1%, and 59.1%, respectively. Overall survival was significantly better in group 3 (p=0.002). In multivariate analyses, cT3 was the most powerful adverse factor affecting clinical outcomes. Incidence and severity of radiation pneumonitis were not different among groups, while no patients developed grade 2 esophagitis in group 3 (p=0.003). Under current Korean Health Insurance Policy, RT cost per person was 22.5% less in group 3 compared with others.
CONCLUSION
The current study demonstrated that 60 Gy in 15 fractions instead of 60 Gy in 20 fractions resulted in comparable clinical outcomes with excellent safety, direct cost saving, and improved convenience to the patients with tumors located at ≥ 1.5 cm from the esophagus.

Keyword

Non-small cell lung carcinoma; Radiotherapy; Dose fractionation

MeSH Terms

Appointments and Schedules*
Carcinoma, Non-Small-Cell Lung*
Cost Savings
Disease-Free Survival
Dose Fractionation
Esophagitis
Esophagus
Follow-Up Studies
Humans
Incidence
Insurance, Health
Multivariate Analysis
Radiation Pneumonitis
Radiotherapy

Figure

• 

  Fig. 1. Illustration of selection criteria of fractionation scheme in the current study. SBRT, stereotactic body radiation therapy.

Reference

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