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 3^rd 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.

1. GLOBOCAN 2012(IARC) section of cancer information database, International Agency for Research on Cancer, World Health Organization. Available at http://www-dep.iarc.fr/, last accessed January 12, 2014 Globocan.iarc.fr/pages/fact_sheet_population. aspx?country=356
2. Kaneko S, Ishikawa KB, Yoshimi I, et al. Projection of Lung cancer mortality in Japan. Cancer Sci 2003;94(10):919.
3. Park. Park’s Textbook of Preventive and Social Medicine, 21st edition.chapter no.6- Epidemiology of chronic non communicable disease and conditions. Page no. 353-54.
4. Perez C, Pajak T, Rubin P, et al. Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the Lung treated with definitive radiotherapy. Report by the Radiation Therapy Oncology Group. Cancer 1987;59:1874-1881.
5. https://www.cancer.org/cancer/non-small-cell-lung-cancer/treating/by-stage.html
6. https://www.sciencedirect.com/topics/medicine-and-dentistry/induction-chemotherapy
7. http://ozradonc.wikidot.com/altered-fractionation
8. Ml Saunders', A Rojas2, BE Lyn', K Pigott', M Powell', K Goodchild', PJ Hoskin', H Phillips' and N Verma. Experience with dose escalation using CHARTWEL (continuous hyperfracti-onated accelerated radiotherapy weekend less) in non-small-cell lung cancer. British Journal of Cancer 1 998; 7841 0: 1 323-1328.
9. Jindal SK, Malik SK, Datta BN; Lung cancer in Northern India     in relation to age, sex and smoking habits. Eur J Respir Dis, 1987. Jan;70(1):23-28.
10. Curran W, Scott C, Langer C, et al. Long-term benefit is observed in a phase III comparison of sequential vs. concurrent chemo-radiation for patients with unresected stage III nonsmall-cell lung cancer: Pro Am Soc Clin Oncol 2003;22:621.
11. Rolland E, LE Chevalier T, Auperin A et al. sequential radio-chemotherapy vs concurrent radio-chemotherapy vs radiotherapy alone in Locally Advanced NSCLC; Two meta-analysis using Individual Patients Data(IPD) from randomized clinical trials(RCTs). J Thorac Oncol (2007);2(8):s309-s310.
12. Auperin A, Le Pechoux C, Rolland E, et al. Meta-analysis of CCRT verses sequential radiochemotherap in locally advanced non-small-cell lung cancer. J Clin Oncol 2010;28:2181-90.
13. Curran WJ Jr1, Paulus R, Langer CJ, Komaki R, Lee JS, Hauser S, Movsas B, Wasserman T, Rosenthal SA, Gore E, Machtay M, Sause W, Cox JD. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011 Oct 5;103(19):1452-60. doi: 10.1093/jnci/djr325. Epub 2011 Sep 8.
14. Fournel P1, Robinet G, Thomas P, Souquet PJ, Léna H, Vergnenégre A, Delhoume JY, Le Treut J, Silvani JA, Dansin E, Bozonnat MC, Daurés JP, Mornex F, Pérol M; Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non-small-cell lung cancer: Groupe Lyon-Saint-Etienne d'Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie NPC 95-01 Study. J Clin Oncol. 2005 Sep 1;23(25):5910-7. Epub 2005 Aug 8.
15. Aupérin A1, Le Péchoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, Yamanaka T, Bozonnat MC, Uitterhoeve A, Wang X, Stewart L, Arriagada R, Burdett S, Pignon JP. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010 May 1;28(13):2181-90. doi: 10.1200/JCO.2009.26.2543. Epub 2010 Mar 29.
16. Dillman R, Seagren S, Propert K, et al. A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med 1990; 323:940-945.
17. Vokes EE, Herndon JE 2nd, Kelley MJ, Cicchetti MG, Ramnath N, et al. induction chemotherapy followed by chemoradiot-herapy compared with chemoradiotherapy alone for regionally advanced unresectable stage III Non-small-cell lung cancer: Cancer and Leukemia Group B. J Clin Oncol2007;25:1698-704.
18. Belani CP, Choy H, Bonomi P, et al. Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol. J Clin Oncol 2005;23:5883-5891.
19. Hotta, K., et al., Addition of platinum compounds to a new agent in patients with advanced non-small-cell lung cancer: a literature based meta-analysis of randomised trials. Ann Oncol, 2004. 15(12): p. 1782-9.
20. Saunders M, Dische S, Barrett A, et al. Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell Lung cancer: mature data from the randomised multicentre trial. Radiother Oncol 1999;52:137-148.
21. M.I. Saunders, A. Rojasf1,B.E. Lyn,E. Wilson, H. Phillips. Dose-escalation with CHARTWEL (Continuous Hyperfract-ionated Accelerated Radiotherapy Week-End Less) Combined with Neo-adjuvant Chemotherapy in the Treatment of Locally Advanced Non-small Cell Lung Cancer. Clinical oncology, october 2002;14( 5): 352–360.

Dr Saroj Dhaka

Resident Doctor, Radiation Oncology Department, ATRCTRI, S.P. Medical College, Bikaner, India