Title: A Comparative Study of Palliative Hypofractionated vs Conventional Fractionated Radiotherapy in Locally Advanced non Small Cell Lung Cancer
Authors: Dr Guman Singh, Dr Saroj Dhaka, Dr Neeti Sharma, Dr H.S.Kumar
Purpose: To compare the compliance, tumor response, quality of life and survival between a hypofractionated & a conventional fractionated RT schedule in locally advanced NSCLC patients.
Materials & Methods: Total 50 patients with unresectable stage III NSCLC were given 3 cycle of neoadjuvant chemotherapy. After 3-4 weeks of completion of 3rd cycle, 25 patients received a total 17Gy in 2 fr (8.5Gy/fr) on day1 & day8 in study arm , 25 patients received a total 50 Gy in 25 fr (2Gy/fr) administered daily(5days/week) for 5 weeks. Disease response was evaluated by RECIST criteria at 1, 3 &6 month. Then follow up was done after 1yr, 2yr & 3yr to evaluate the overall survival.
Result: none of patients in both arms had complete response at any follow up. Locoregional disease contol was observed in 18% & 27% in study & control arm respectively (p value>0.05). Median survival was 10 months &12.5 months in study & control arm respectively which was not statistically significant. There was no statistically difference in grade of toxicities. OS rates at 1, 2& 3years were 40%, 10% &0% in study arm and 50%, 20% &5% in control arm but difference in OS was not statistically significant.
Conclusion: Many patients were lost to follow up in our study; although among the patients followed, we found to concluded that for improvement of quality of life in locally advanced NSCLC patients with poor PS & short life span, the palliative hypofractionated regimen of short duration (17Gy/2fr) could be considered as a reasonable alternative and also economically feasible & required shorter duration of stay in the hospital. In conclusion, large number of patients with strict follow up need to be done to ascertain the need and benefits of this palliative TRT.
Keyword: Unresectable stage III non small cell lung cancer, conventional radiation, hypofractionated radiation, neoadjuvant CT.