Outcomes of accelerated hypofractionated radiotherapy in stage I non-small-cell lung cancer

Purpose Outcomes after treatment with accelerated hypofractionated radiotherapy in stage I medically inoperable non-small-cell lung cancer (NSCLC) patients were determined. Methods Our single-institution retrospective review looked at medically inoperable patients with T1-2N0M0 NSCLC treated with accelerated hypofractionated curative-intent radiotherapy between 1999 and 2009. Patients were staged mainly by computed tomography imaging of chest and abdomen, bone scan, and computed tomography/magnetic resonance imaging of brain. Positron-emission tomography (PET) staging was performed in 6 patients. Medical charts were reviewed to determine demographics, radiotherapy details, sites of failure, toxicity (as defined by the Common Terminology Criteria for Adverse Events, version 3.0) and vital status. The cumulative incidence of local and distant failure was calculated. Overall (OS) and cause-specific (CSS) survival were estimated by the Kaplan-Meier method. Result In the 60 patients treated during the study period, the dose regimens were 50 Gy in 20 fractions (n = 6), 55 Gy in 20 fractions (n = 8), 60 Gy in 20 fractions (n = 42), and 60 Gy in 25 fractions (n = 4). All patients were treated once daily. The median follow-up was 27 months (range: 4-94 months). The os rates at 2 and 5 years were 61% [95% confidence interval (CI): 50% to 75%] and 19% (95% CI: 10% to 34%) respectively. The CSS rates at 2 and 5 years were 79% (95% CI: 68% to 91%) and 39% (95% CI: 24% to 63%) respectively. The cumulative incidence of local failure was 20% at 5 years. The cumulative incidence of distant failure was 28% at 5 years. No patients experienced grade 3 or greater pneumonitis or esophagitis. Conclusions Accelerated hypofractionated regimens are well tolerated and provide good local control in medically inoperable patients with stage I NSCLC. Such regimens may be a reasonable treatment alternative when stereotactic body radiation therapy is not feasible.