Real-world insights into moderately hypofractionated thoracic radiotherapy in elderly and multimorbid patients with stage II/III NSCLC: a retrospective study

Kravutske, Helene; Mansoorian, Sina; Käsmann, Lukas; Lehmann, Janina; Richlitzki, Cedric; Kauffmann-Guerrero, Diego; Schmidt-Hegemann, Nina-Sophie; Reinmuth, Niels; Tufman, Amanda; Dinkel, Julien; Gaus, Richard; Manapov, Farkhad; Belka, Claus; Eze, Chukwuka (2025): Real-world insights into moderately hypofractionated thoracic radiotherapy in elderly and multimorbid patients with stage II/III NSCLC: a retrospective study. Acta Oncologica (64). pp. 957-965. ISSN 1651-226X

Abstract

Purpose: 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 concur-rent chemoradiation.Methods: 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.Results: 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.Interpretation: Moderately hypoRT is a safe, feasible, and effective treatment option for elderly and mul-timorbid 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.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Klinik und Poliklinik für Strahlentherapie und Radioonkologie
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892