A Comparative Analysis of Two Hypofractionated Palliative Radiotherapy Regimens for Inoperable Metastatic Non-Small Cell Lung Cancer

Abstract

Introduction: Non-small cell lung cancer (NSCLC) is a leading cause of cancer-related mortality globally, including in India. Most patients present with advanced-stage disease, often experiencing severe, quality-of-life-limiting symptoms. Palliative radiotherapy plays a vital role in symptom management for these patients. This study aims to evaluate the effectiveness of a high-dose, weekly palliative radiotherapy regimen compared to the standard palliative schedule. Methodology: This prospective randomized control trial was conducted from July 2023 to July 2024, involving 50 patients with biopsy-confirmed NSCLC. Patients were randomized into two treatment arms: Arm A received 21 Gy in 3 fractions (one fraction per week, 25 patients), while Arm B received the standard 30 Gy in 10 fractions over two weeks (25 patients). Symptom assessment was performed using the EORTC QLQ-LC13 questionnaire before treatment, immediately after completion, and at 1 and 3 months post-treatment. Results: Overall, there was no significant difference in symptomatic relief between the two arms. Patient-reported outcomes at the end of treatment were comparable, with no significant differences in palliation of cough, dyspnea, or other symptoms, except for pain, which was statistically improved in Arm A (p = 0.021). At the 1-month follow-up, no significant differences were observed across parameters, while at 3 months, cough relief remained better in Arm B (p = 0.021), with other symptoms showing no significant difference. Conclusion: The hypofractionated regimen of 21 Gy in 3 weekly fractions offers comparable symptomatic relief to the standard 30 Gy in 10 fractions regimen, making it a viable, shorter treatment option for patients with advanced NSCLC and thoracic symptoms.