Clinical Research Of Non-small-cell Lung Cancer And Metastatic Tumor In Lung Treated With Hypofractioned Radiotherapy

Objective: To observe the effectiveness and toxicity of thehypofractionated radiotherapy of non-small cell lung cancer and metastatictumor in lung, evaluate the safety, effectiveness and feasibility of thehypofractionated radiotherapy.Methods: From March2009to November2013,22patients withnon-small-cell lung cancer(NSCLC) or metastatic tumor in lung were eligiblefor the research. There were8males and14females, the median age was61years (range35-81years); the median Karnofsky performance score was90points (range80-95points). All of them were peripheral lung cancer.Pathological types: In the primary lung cancer, one was squamous cellcarcinoma,7were adenocarcinomas,6were find carcinoma cells but did notdetermine pathological type.8were metastatic tumors from other site,6ofthem were cervical carcinomas, one was breast cancer and one wasesophageal cancer. Clinical stages: in primary lung cancer,6were stageⅠ,one was stageⅡ,4were stageⅢ,3were stageⅣ. The median prescriptiondose was48Gy, median biological equivalent dose was86.4Gy, median singledose was6.0Gy, once a day,3-5times a week. Observed with effective rate,1,2,3,4-years local control rate,1,2,3,4-years overall survival rate, mediansurvival time, acute and late toxicity.Results: From the radiotherapy started date to February28,2014,nobody lost follow-up. The following rate was100%. The median follow-uptime was27.5months (range3.6-52.9months). All patients completedtreatment without interruption by toxicity. The median treatment time was13.5days (range7-26days). The acute radiation esophagitis, acute radiationpneumonitis, myelosuppression, late pulmonary injuries and late esophageal injuries occurred in45.45%,4.55%,40.91%,54.55%and9.09%, respectively.3patients occurred grade3late pulmonary injuries and2patients occurredgrade2late esophageal injuries. after treatment, the effective rate was90.91%.1,2,3,4-years local control rate were63.2%,51.0%,38.3%,30.6%,respectively. Median progression-free survival time was15.1months.1,2,3,4-years overall survival rate were78.60%,72.0%,52.4%,37.4%, respectively.Median survival time was27.1months. Combined stage Ⅰ and Ⅱ patientsand analyzed local control and survival by stage, the median progression-freesurvival time showed that stage Ⅰ-Ⅱ:22.5months (5.6-46.5months), stageⅢ:9.8months (9.8-16.2months), stage Ⅳ:29months (6.4-48.9months)，metastatic tumors:35.4months (8.2-51.6months).77.27%of the patients notobserved local progression till the death or the end of follow-up.Conclusions: Hypofractionated radiotherapy may suit early stage lungcancer and small metastases in lung better. There was not serious toxicity withthe method that limit the whole lung V5≤45%, V20≤20%, spinal cordmaximum dose＜25Gy, but the safe mode still needs further research. Acuteand advanced lung injury, acute and advanced esophageal injury andhematologic toxicity were the common toxicity in the hypofractionatedradiotherapy. The side effects were acceptable after treatment. The patients’survival rate, survival time and local control effect can be improved byhypofractionated radiotherapy, which showed its effectiveness. Thehypofractionated radiotherapy has a shorter treatment time, which prove thathypofractionated radiotherapy has nice social and economic effect.