ELCC: Hyperfractionated radiotherapy could improve survival for some

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When treated with hyperfractionated or accelerated radiotherapy as opposed to a traditional combined radio-chemotherapy schedule, patients with both non-small-cell lung cancer and small-cell lung cancer benefit in terms of overall survival, according to the results of a meta-analysis presented at the second annual European Lung Cancer Conference (ELCC) last week.

Cecile Le Pechoux, MD, and colleagues from Institut Gustave Roussy in Villejuif, France, explained that patients treated with hyperfractionated or accelerated radiotherapy regimens are given their treatments more frequently and over a shorter period of time. However, she noted that the benefits of these treatment methods for this patient population have put forth contradictory results in different randomized trials.

For their analysis, the researchers considered ten trials that included 2,279 patients with non-metastatic lung cancer. In eight of the trials that pertained to non-small-cell lung cancer, which represent approximately 80 percent of lung cancer cases, Le Pechoux and colleagues determined that modified fractionation of the radiotherapy improved overall survival compared to conventional radiotherapy.  Absolute benefit was 3 percent higher after five years in the modified fractionation groups, noted the researchers.

"The clinical benefit we found was small, but comparable to the benefit found in other meta-analyses concerning non-small-cell lung cancer," Le Pechoux said.

In cases of small-cell lung cancer--a less common form of the disease representing approximately 20 percent of cases--similar results were found, although the difference in survival between the standard and modified radiotherapy regimens was not statistically significant because of lack of power, the researchers explained.

“Interest in modified fractionation was uncertain before the meta-analysis, but the current results will lead to renewed interested in this research field," said Le Pechoux, who noted that the results could help physicians determine how best to deliver radiotherapy for this patient population.

"In the most recent meta-analysis evaluating the best way to combine radiotherapy and chemotherapy in NSCLC, the results showed that concomitant chemo-radiation is superior to sequential chemo-radiation and the best results shown in randomized trials in small-cell lung cancer limited disease show five-year survival rates of 20-25 percent,” concluded  Le Pechoux. “Thus, there is need for improvements of both radiotherapy and chemotherapy."