Journal Article

DKFZ-2025-01548

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Real-world insights into moderately hypofractionated thoracic radiotherapy in elderly and multimorbid patients with stage II/III NSCLC: a retrospective study.

Kravutske, H. ; Mansoorian, S. ; Käsmann, L.DKFZ* ; Lehmann, J. ; Richlitzki, C. ; Kauffmann-Guerrero, D. ; Schmidt-Hegemann, N.-S. ; Reinmuth, N. ; Tufman, A. ; Dinkel, J. ; Gaus, R. ; Manapov, F. ; Belka, C.DKFZ* ; Eze, C.

2025
Taylor & Francis Group Abingdon

Abstract: Investigating real-world outcomes of moderately hypofractionated radiotherapy (hypoRT) in elderly and multimorbid stage IIB-IIIC non-small-cell lung cancer (NSCLC) patients ineligible for concurrent chemoradiation.We retrospectively analysed 70 patients with primary or recurrent stage IIB-IIIC NSCLC (TNM, 8th edition). HypoRT was administered to a total dose of 38-56 Gy in 10-17 fractions (2.5-3.8 Gy/fraction). Patterns of recurrence, survival outcome, and toxicity were assessed.Seventy patients, with a median age of 76.4 years (range: 51.6-88.2 years), who received hypoRT between August 2015 and September 2022, were reviewed. At baseline, the median Charlson Comorbidity Index (CCI) with oncological diagnosis was 8 (range: 3-13). With a median follow-up post-radiotherapy of 63.9 months (95% Confidence Interval [CI]: 34.8-93.1 months), median progression-free survival (PFS) was 7.6 months (95% CI 6.0-11.0 months), and the median overall survival (OS) was 20.7 months (95% CI 16.7-30.7 months). Competing risk analysis revealed 12-month cumulative incidences of locoregional and distant failure in 41% (95% CI 30-53%) and 14% (95% CI 6-23%) of patients, respectively. Following disease progression, 45 patients received subsequent therapy: 25 underwent additional radiotherapy, 22 received systemic treatment (including immunotherapy), and 19 were referred for best supportive care. Treatment was well tolerated; only 3 patients (4%) developed grade 3 pneumonitis. No adverse events of grade > 3 were reported.Moderately hypoRT is a safe, feasible, and effective treatment option for elderly and multimorbid patients with stage IIB-IIIC NSCLC, offering encouraging survival outcomes and low toxicity rates. Future prospective studies are needed to validate these findings and optimise treatment strategies for this high-risk population.

Keyword(s): Humans (MeSH) ; Aged (MeSH) ; Carcinoma, Non-Small-Cell Lung: radiotherapy (MeSH) ; Carcinoma, Non-Small-Cell Lung: pathology (MeSH) ; Carcinoma, Non-Small-Cell Lung: mortality (MeSH) ; Retrospective Studies (MeSH) ; Female (MeSH) ; Male (MeSH) ; Lung Neoplasms: radiotherapy (MeSH) ; Lung Neoplasms: pathology (MeSH) ; Lung Neoplasms: mortality (MeSH) ; Aged, 80 and over (MeSH) ; Middle Aged (MeSH) ; Radiation Dose Hypofractionation (MeSH) ; Neoplasm Staging (MeSH) ; Multimorbidity (MeSH) ; Follow-Up Studies (MeSH) ; Neoplasm Recurrence, Local: pathology (MeSH) ; Progression-Free Survival (MeSH)

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Contributing Institute(s):

1. DKTK Koordinierungsstelle München (MU01)

Research Program(s):

1. 899 - ohne Topic (POF4-899) (POF4-899)

Appears in the scientific report 2025

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