Is hypofractionated better than conventionally fractionated RT for stage I NSCLC?

Hypofractionated radiotherapy (HFRT) is not superior to conventionally fractionated radiotherapy (CFRT) in providing survival benefits to patients with stage I nonsmall cell lung cancer (NSCLC), but HFRT is preferable due to its convenience and lower costs, according to a study.

To address the scarcity in comparative data on nonstereotactic body radiation therapy, a research team compared overall survival (OS) between HFRT and CFRT and assessed the OS impact of various HFRT doses in a retrospective study. A total of 2,159 patients from the National Cancer database with stage I NSCLC between 2008 and 2016 were included.

Patients were treated with CFRT (70≤BED₁₀ [biologically effective dose] <100 Gy₁₀ in ≥30 fractions), low-dose HFRT (LD-HFRT; 70≤BED₁₀ [assuming α/β=10] <100 Gy₁₀ in 11 to 24 fractions), or high-dose HFRT (HD-HFRT; 100≤BED₁₀ ≤120 Gy₁₀ in 6 to 10 fractions). Those who underwent surgery, chemotherapy, or immunotherapy were excluded.

The researchers then compared CFRT with all HFRT, and separately CFRT versus LD-HFRT and CFRT versus HD-HFRT. They also assessed OS using the Kaplan-Meier estimator, log-rank test, and Cox regression.

Of the patients, 63.2 percent underwent CFRT, 23.5 percent LD-HFRT, and 13.3 percent HD-HFRT. HFRT was associated with significantly longer OS compared with CFRT on univariable analysis (28.2 vs 26.4 months; log-rank=0.0025) but not on multivariable analysis (hazard ratio [HR], 0.90; p=0.062).

On multivariable analysis, OS was not significantly different between CFRT and LD-HFRT (HR, 0.96; p=0.53) but was significantly longer with HD-HFRT versus CFRT (HR, 0.75; p=0.003). However, such advantage did not reach statistical significance (HR, 0.83; p=0.12) on sensitivity analysis using different multivariable modeling techniques.