title: Hypofractionated Image-guided Radiation Therapy (3Gy/fraction) in Patients Affected by Inoperable Advanced-stage Non-small Cell Lung Cancer After Long-term Follow-up.
abstract: BACKGROUND
  We conducted long-term follow-up analysis of the outcomes for patients affected by advanced-stage non-small cell lung cancer (NSCLC) treated with hypofractionated radiotherapy (RT).
  
  
  METHODS
  Sixty patients with advanced-stage NSCLC (IIIA-IV) treated with hypofractionated radiotherapy (60Gy/20 fractions) were analyzed. Radiation was delivered using an image-guided RT technique to verify the correct position. Toxicities were graded according to the Common Toxicity Criteria for Adverse Effects v4.0 scale.
  
  
  RESULTS
  Overall, six patients achieved a complete response and 46 patients had a partial response (tumor response rate 86%). After a median follow-up of 30 months, locoregional progression occurred in 23 patients and distant progression occurred in 38. The 1-year and 2-years overall survival were 57% and 40%, respectively. The 1-year and 2-years progression-free survival (PFS) were 47.1% and 33.5%, respectively. The median duration of OS and PFS was 13 months and 12 months, respectively. The 2-year local PFS and metastases-free survival (MFS) were 53% and 40.3%, respectively. On univariate analysis, the T-size (≥5 cm), and type of response to RT (non-response/progressive disease) were significantly associated with worse OS. Type of response was identified as significant prognostic factors for PFS (p<0.01) local PFS (p=0.015) and MFS (p<0.01). Acute grade 3 esophagitis and pneumonitis occurred in three patients (5%) and four patients (6%), respectively. Late grade 3 esophagitis and pneumonitis occurred in 2% (one patient) and 3% (two patients), respectively. No patient experienced grade 4 acute or late RT-related toxicities.
  
  
  CONCLUSIONS
  Hypofractionated RT offers good disease control for patients with advanced-stage NSCLC with acceptable toxicity rates. Phase III randomized trials are necessary to compare hypofractionated RT with conventional RT.
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy linda.agolli@gmail.com.
authors.forename: Linda
authors.initials: L
authors.lastname: Agolli
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bracci
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Nicosia
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Vitaliana
authors.initials: V
authors.lastname: DE Sanctis
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Riccardo Maurizi
authors.initials: RM
authors.lastname: Enrici
authors.affiliation: Institute of Radiation Oncology, Sapienza University, Sant'Andrea Hospital, Rome, Italy.
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D061089:Radiotherapy, Image-Guided / Q000401:mortality*; D015996:Survival Rate
keywords: Hypofractionated radiotherapy; advanced stage; image-guidance; non-small cell lung cancer; unresectable