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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

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Abstract

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.

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Authors and Affiliations

  1. Department of Radiation Oncology, Azienda Sanitaria Universitaria Integrata UD, P.le Santa Maria della Misericordia 15, 33100, Udine, Italy

    Giuseppe Parisi & Marco Trovo

  2. Department of Radiation Oncology, Sacro Cuore Don Calabria Cancer Care Center, Negrar-Verona, Italy

    Rosario Mazzola, Niccolò Giaj-Levra & Filippo Alongi

  3. Department of Oncology and Advanced Technology, Arcispedale S Maria Nuova-IRCCS of Reggio Emilia, Reggio Emilia, Italy

    Patrizia Ciammella & Giorgia Timon

  4. Department of Radiation Oncology, SS.Antonio e Biagio e C.Arrigo Hospital Alessandria, Alessandria, Italy

    Alessandra Fozza

  5. Department of Radiotherapy and Radiosurgery, Humanitas Cancer Center and Research Hospital, Rozzano, Milan, Italy

    Davide Franceschini

  6. Department of Radiation Oncology, CRO IRCCS, Aviano, Italy

    Federico Navarria

  7. Radiotherapy Unit - Department of Oncology and Hematology, University Hospital of Modena Italy, Modena, Italy

    Alessio Bruni

  8. Department of Radiation Oncology, Azienda Ospedaliero Universitaria Careggi, University of Florence, Florence, Italy

    Marco Perna & Vieri Scotti

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Contributions

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.

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Correspondence to Giuseppe Parisi.

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Parisi, G., Mazzola, R., Ciammella, P. et al. 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. Radiol med 124, 136–144 (2019). https://doi.org/10.1007/s11547-018-0950-z

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