​Concurrent Hyperfractionated Chemoradiation Versus Conventional Fractionated Chemoradiation With Low-Dose Weekly Paclitaxel In Locally Advanced Non–Small-Cell Lung Cancer In A Tertiary Cancer Center In Kashmir: A Prospective Study

ABSTRACT

Introduction: Lung cancer is the most common cancer worldwide and has a poor prognosis but integration of chemoradiationhas led to an increase in overall survival time and percentage of cured patients with acceptable toxicity.Purpose: The purpose of this study was to compare the efficacy of hyperfractionated (HFX) radiotherapy with conventionalradiotherapy and weekly concurrent paclitaxel in stage IIB/III non-small-cell lung cancer (NSCLC).Materials and Methods: A total of 60 patients were enrolled, of which 30 patients were given twice daily radiotherapy(1.2 Gy each) to a total of 72 Gy over 5–6 weeks and 30 patients were given single daily fraction (2 Gy) to a total of 66 Gy forthe same duration to achieve a comparable biological effective dose. Both groups received weekly 50 mg/m2 paclitaxel.Results: An overall response of 83.3% versus 56.6% with a partial response of 70% versus 53.3% and complete response(CR) of 13.3% versus 3% was seen in HFX radiotherapy versus conventional radiotherapy which was statistically significant(P = 0.04). 10 of 25 patients and 11 of 17 patients who achieved response in study and control groups, respectively, progressed.The median survival of patients in HFX radiotherapy arm was 18 months, compared to 9 months in conventional radiotherapyarm. The median time to local recurrence was 19 versus 11 months with local recurrence-free survival of 72% versus 66% at1 year follow-up. The 1 and 2 year survival rates were 76% and 40% in study arm and 50% and 26% in control arm (P - 0.005).Esophagitis (70% vs. 63.3%), skin reaction (70% vs. 63.3%), and radiation-induced pneumonitis (50% vs. 43.3%) were thecommon toxicities with no statistical significance between the two groups. Overall, there was mild chemotherapy-related toxicity.Conclusions: The combination of HFX radiation with weekly paclitaxel is effective treatment with a moderate degree of toxicityin stage IIB/III NSCLC. An average response to treatment and the use of lesser drugs have made us to consider this therapyin locally advanced NSCLC.