60 for 60.

Top Line: Is 60 Gy in 15 fractions superior to 60 Gy in 30 fractions for patients with NSCLC who can’t receive concurrent chemoradiation? 

The Study: It’s not uncommon to encounter patients with potentially curable, stage II or III NSCLC, who aren’t good candidates for concurrent chemoradiation--usually due to medical comorbidities. The problem is that 60 Gy in 30 fractions without concurrent chemo isn’t exactly potent. So, could hypofractionation improve outcomes for this population. This randomized, phase 3 trial set out to determine if 60 Gy in 15 fractions could improve overall survival over 60 Gy in 30 fractions in patients with stage II/III NSCLC who weren’t candidates for standard chemoradiation. The idea was that the higher BED might improve locoregional disease control and translate into better survival outcomes. Over 100 patients were enrolled and randomized over a 6 year period. This was slower than expected as many patients who may not be candidates for “standard” chemoradiation are often still candidates for less intensive concurrent chemo regimens. At 1 year, there was no difference between arms for any treatment outcome including overall survival, progression-free survival, and time to local failure. Overall survival at 1 year was < 50% in both arms and most patients died of something other than lung cancer. So, hypofractionation wasn’t superior but it wasn’t exactly inferior and cut treatment duration in half without significantly increasing toxicity.

TBL: Among patients with stage II/III NSCLC and poor performance status who can’t receive standard treatment with concurrent chemo, 60 Gy in 15 fractions doesn’t improve outcomes over 60 Gy in 30 fractions. | Iyengar, JAMA Oncol 2021