A Comparative Study of Palliative Hypo-fractionated vs Conventional Fractionated Radiotherapy in Locally Advanced Non Small Cell Lung Cancer

Purpose: To compare the compliance, tumor response, quality of life and survival between a hypo-fractionated and a conventional fractionated RT schedule in locally advanced NSCLC patients. Materials and Methods: Total 50 patients with unresectable stage III NSCLC were given 3 cycle of neoadjuvant chemotherapy. After 3-4 weeks of completion of 3rd cycle, 25 patients received a total 17Gy in 2 fr (8.5Gy/fr) on day 1 and day 8 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 and 6 month. Then follow up was done after 1yr, 2yr and 3yr to evaluate the overall survival. Result: none of patients in both arms had complete response at any follow up. Locoregional disease control was observed in 18% & 27% in study and control arm respectively (p value>0.05). Median survival was 10 months and 12.5 months in study and control arm respectively which was not statistically significant. There was no statistically difference in grade of toxicities. OS rates at 1, 2 and 3years were 40%, 10% and 0% in study arm and 50%, 20% and 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 and short life span, the palliative hypo-fractionated 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.