International Journal of Scientific Research in Dental and Medical Sciences

International Journal of Scientific Research in Dental and Medical Sciences

Comparing the Effectiveness and Safety Profiles of Accelerated Fractionation Radiotherapy with Concomitant Boost and Conventional Fractionation Radiotherapy for the Treatment of Inoperable Locally Advanced Non-Small Cell Lung Cancer

Document Type : Original Article

Authors
Ningthoujam Dinita Devi 1
Rahul Mahawar 1
Nongmaithem Nilima Devi 1
Silchang Koknal Marak 2
Yumkhaibam Sobita Devi 1
Irom Ibungo Singh 3
1 Department of Radiation Oncology, RIMS, Imphal, Manipur, 795001, India
2 Department of Oncology, Tura Civil Hospital, Meghalaya, 794101, India
3 Department of Respiratory Medicine, RIMS, Imphal, Manipur, 795001, India
10.30485/ijsrdms.2024.476078.1603
Abstract
Background and aim: Non-small cell lung cancer (NSCLC) has aggressive tumor growth and requires high radiation doses for effective tumor control. The purpose of this study was to compare the therapeutic efficacy and toxicity profiles of accelerated fractionation radiotherapy with a concurrent boost to standard radiotherapy protocols in patients with inoperable locally advanced non-small cell lung cancer (LA-NSCLC).
Material and methods: This randomized controlled trial was conducted in the Radiation Oncology Department, RIMS, among 118 patients of LA-NSCLC distributed in two study arms during the period November 2020 to October 2022.  In Arms A (n=59), patients received conventional radiotherapy consisting of 60 Gy delivered in 30 fractions over six weeks. This regimen comprised 25 initial fractions of 2 Gy each, followed by a 5-fraction boost. Arm B (n=59) employed an accelerated fractionation schedule. Patients initially received 19 fractions of 2 Gy each. Subsequently, they underwent twice-daily irradiation: 2 Gy to the primary target volume in the morning, followed by a 1.5 Gy boost to a reduced field in the evening, with a minimum 6-hour interval resulting in a total dose of 59 Gy over 25 fractions in five weeks.
Results: Patient demographics were well-matched. The response rate for Arm-A was 54.2%, and in Arm-B, it was 72.9% (P=0.035). Arm-B demonstrated a longer median progression-free survival of 11 months compared to Arm-A's 9 months. The cumulative radiation-induced toxicities between the two groups did not show any statistically significant differences.
Conclusions: Accelerated fractionated radiotherapy has significant potential as a treatment option for patients with inoperable NSCLC.
Keywords
Non-Small-Cell Lung
Progression-Free Survival
Toxicity

Subjects

[1] Girard N, Perol M, Simon G, Valette CA, Gervais R, Debieuvre D, et al. Treatment strategies for unresectable locally advanced non-small cell lung cancer in the real-life ESME cohort. Lung Cancer. 2021;162:119-27. https://doi.org/10.1016/j.lungcan.2021.10.017.
[2] Oh S, Botros GN, Patel M, Haigentz M, Patel E, Kontopidis I, et al. Locally Advanced Lung Cancer. Hematology/Oncology Clinics. 2023;37(3):533-55.
[3] Edwards DM, Schonewolf CA, Rice JD, Schipper M, Ten Haken RK, Matuszak M, et al. Phase II Trial Assessing Toxicity of Personalized Response-Based Radiation Treatment in Patients with Locally Advanced Non-Small Cell Lung Cancer. International Journal of Radiation Oncology* Biology* Physics. 2024. https://doi.org/10.1016/j.ijrobp.2024.06.018.
[4] Ramaekers BL, Joore MA, Lueza B, Bonastre J, Mauguen A, Pignon JP, et al. Cost Effectiveness of Modified Fractionation Radiotherapy versus Conventional Radiotherapy for Unresected Non–Small-Cell Lung Cancer Patients. Journal of Thoracic Oncology. 2013;8(10):1295-307. https://doi.org/10.1097/JTO.0b013e31829f6c55.
[5] Sanuki N, Takeda A, Eriguchi T, Tsurugai Y, Tateishi Y, Kibe Y, et al. Local control correlates with overall survival in radiotherapy for early-stage non-small cell lung cancer: A systematic review. Radiotherapy and Oncology. 2023;183:109664. https://doi.org/10.1016/j.radonc.2023.109664.
[6] Huang HT, Nix MG, Brand DH, Cobben D, Hiley CT, Fenwick JD, et al. Dose-response analysis describes particularly rapid repopulation of non-small cell lung cancer during concurrent chemoradiotherapy. Cancers. 2022;14(19):4869. https://doi.org/10.3390/cancers14194869.
[7] Zhang W, Liu Q, Dong X, Lei P. A meta-analysis comparing hyperfractionated vs. conventional fractionated radiotherapy in non-small cell lung cancer. Journal of Thoracic Disease. 2015;7(3):478-85. https://doi.org/10.3978/j.issn.2072-1439.2015.02.20.
[8] Nath A, Sathishkumar K, Das P, Sudarshan KL, Mathur P. A clinicoepidemiological profile of lung cancers in India–Results from the National Cancer Registry Programme. Indian Journal of Medical Research. 2022;155(2):264-72. https://doi.org/10.4103/ijmr.ijmr_1364_21.
[9] Kim YH, Ahn SJ, Moon SH, Kim JH, Kim YC, Oh IJ, et al. Randomized, multicenter, phase 3 study of accelerated fraction radiation therapy with concomitant boost to the gross tumor volume compared with conventional fractionation in concurrent chemoradiation in patients with unresectable stage III non-small cell lung cancer: the Korean Radiation Oncology Group 09-03 trial. International Journal of Radiation Oncology* Biology* Physics. 2023;115(4):873-85. https://doi.org/10.1016/j.ijrobp.2022.10.014.
[10] Prasad KT, Kaur H, Muthu V, Aggarwal AN, Behera D, Singh N. Interconversion of two commonly used performance tools: An analysis of 5844 paired assessments in 1501 lung cancer patients. World Journal of Clinical Oncology. 2018;9(7):140-7. https://doi.org/10.5306/wjco.v9.i7.140.
[11] Buccheri G, Ferrigno D. Lung cancer: clinical presentation and specialist referral time. European Respiratory Journal. 2004;24(6):898-904. https://doi.org/10.1183/09031936.04.00113603.
[12] Elmesidy SE, Moussa MM, Darwish DO, Khafagy HA, Amin E, Kamal M. Accelerated concomitant boost conformal radiotherapy versus conventional sequential boost in patients with locally advanced inoperable non-small cell lung cancer. 2015;33(15):e18530. https://doi.org/10.1200/jco.2015.33.15_suppl.e18530.
[13] Izmirli M, Yaman F, Buyukpolat MY, Yoney A, Unsal M. An accelerated radiotherapy scheme using a concomitant boost technique for the treatment of unresectable stage III non-small cell lung cancer. Japanese journal of clinical oncology. 2005;35(5):239-44. https://doi.org/10.1093/jjco/hyi075.
[14] Koutaı̈ssoff S, Wellmann D, Coucke P, Ozsahin M, Pampallona S, Mirimanoff RO. Hyperfractionated accelerated radiotherapy (HART) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (NSCLC): results of a phase II study for patients ineligible for combination radiochemotherapy. International Journal of Radiation Oncology* Biology* Physics. 1999;45(5):1151-6. https://doi.org/10.1016/S0360-3016(99)00307-7.
[15] Abrão FC, Moreira FR, de Abreu IR, Marciano MG, Younes RN. Real-Life Long-Term Cohort of Patients With Stage IIIA Non–Small-Cell Lung Cancer: Overall Survival Related to Patients' Characteristics and Multiple Treatment Models. JCO Global Oncology. 2021;7:1572-85. https://doi.org/10.1200/GO.21.00219.
International Journal of Scientific Research in Dental and Medical Sciences
Volume 6, Issue 3
Summer 2024
Pages 99-105

  • Receive Date 01 July 2024
  • Revise Date 15 August 2024
  • Accept Date 22 August 2024
  • Publish Date 01 November 2024