La radiologia medica

, Volume 124, Issue 2, pp 136–144 | Cite as

Hypofractionated radiation therapy in the management of locally advanced NSCLC: a narrative review of the literature on behalf of the Italian Association of Radiation Oncology (AIRO)—Lung Working Group

  • Giuseppe ParisiEmail author
  • Rosario Mazzola
  • Patrizia Ciammella
  • Giorgia Timon
  • Alessandra Fozza
  • Davide Franceschini
  • Federico Navarria
  • Alessio Bruni
  • Marco Perna
  • Niccolò Giaj-Levra
  • Filippo Alongi
  • Vieri Scotti
  • Marco Trovo


A systematic literature was performed to assess the benefit in terms of effectiveness and feasibility of hypofractionated radiotherapy (HypoRT), with or without chemotherapy (CT), in the treatment of locally advanced non-small cell lung cancer (NSCLC). We have identified all studies, published from 2007 onwards, on patients with locally advanced NSCLC treated with HypoRT with radical intent, with a minimal dose per fraction of 2.4 Gy, with or without concurrent chemotherapy. Twenty-nine studies were identified, for a total of 2614 patients. Patients were divided in the concurrent chemo-radiation therapy group (CT-RT) and radiotherapy alone (RT). In RT group, the delivered dose ranged from 45 to 85.5 Gy, with a dose/fraction from 2.4 to 4 Gy. Actuarial 2-year PFS ranged from 13 to 57.8%, and 1, 2- and 3-year overall survival (OS) ranged from 51.3 to 95%, from 22 to 68.7%, and from 7 to 32%, respectively. Acute Grade ≥ 3 esophagitis occurred in 0–15%, while late esophageal toxicity was 0–16%. Acute pneumonitis occured in 0–44%, whereas late pneumonitis occured in 0–47%, most commonly grade ≤ G3. In CT-RT group, the delivered dose ranged from 52.5 to 75 Gy, with a dose/fraction ranging from 2.4 to 3.5 Gy. Actuarial 2-year PFS ranged from 19 to 57.8%, and OS at 1, 2 and 3 years ranged from 28 to 95%, 38.6 to 68.7%, and 31 to 44%, respectively. Acute Grade 2 and 3 esophagitis occurred in 3–41.7%, while late esophageal toxicity occurred in 0–8.3%. Acute pneumonitis ranged from 0 to 23%, whereas late pneumonitis occured 0–47%. HypoRT seems to be safe in patients with locally advanced NSCLC. The encouraging survival results of several studies analyzed suggest that hypofractionated radiation schemes should be further investigated in the future.


Hypofractionated radiotherapy Chemotherapy NSCLC Treatment Toxicity 


Author contribution statements

In our review are listed 13 authors. The authors’ contribution is listed: GP and MT wrote the article independently reviewed the citations and were responsible for analyzing and interpreting the data. RM wrote the manuscript in consultation with GP and MT. PC, GT, AF, DF, FN, AB, MP NJL, FA, VS contributed to design, bibliographic search and implementation of the review. FN drafted the article. All authors contributed to the analysis of the results, discussed the results and commented the manuscript. GP and MT revised its content to its final version. All authors approved the final manuscript.

Compliance with ethical Standards

Conflict of interest

All authors declare no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  • Giuseppe Parisi
    • 1
    Email author
  • Rosario Mazzola
    • 2
  • Patrizia Ciammella
    • 3
  • Giorgia Timon
    • 3
  • Alessandra Fozza
    • 4
  • Davide Franceschini
    • 5
  • Federico Navarria
    • 6
  • Alessio Bruni
    • 7
  • Marco Perna
    • 8
  • Niccolò Giaj-Levra
    • 2
  • Filippo Alongi
    • 2
  • Vieri Scotti
    • 8
  • Marco Trovo
    • 1
  1. 1.Department of Radiation OncologyAzienda Sanitaria Universitaria Integrata UDUdineItaly
  2. 2.Department of Radiation OncologySacro Cuore Don Calabria Cancer Care CenterNegrar-VeronaItaly
  3. 3.Department of Oncology and Advanced TechnologyArcispedale S Maria Nuova-IRCCS of Reggio EmiliaReggio EmiliaItaly
  4. 4.Department of Radiation OncologySS.Antonio e Biagio e C.Arrigo Hospital AlessandriaAlessandriaItaly
  5. 5.Department of Radiotherapy and RadiosurgeryHumanitas Cancer Center and Research HospitalMilanItaly
  6. 6.Department of Radiation OncologyCRO IRCCSAvianoItaly
  7. 7.Radiotherapy Unit - Department of Oncology and HematologyUniversity Hospital of Modena ItalyModenaItaly
  8. 8.Department of Radiation Oncology, Azienda Ospedaliero Universitaria CareggiUniversity of FlorenceFlorenceItaly

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