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. 2025 Jul 25:64:957-965.
doi: 10.2340/1651-226X.2025.43496.

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

Helene Kravutske  1 , Sina Mansoorian  1 , Lukas Käsmann  2 , Janina Lehmann  1 , Cedric Richlitzki  1 , Diego Kauffmann-Guerrero  3 , Nina-Sophie Schmidt-Hegemann  1 , Niels Reinmuth  4 , Amanda Tufman  3 , Julien Dinkel  5 , Richard Gaus  6 , Farkhad Manapov  1 , Claus Belka  7 , Chukwuka Eze  8
Affiliations

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

Helene Kravutske et al. Acta Oncol. .

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 concurrent 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 multimorbid 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.

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Conflict of interest statement

The Department of Radiation Oncology of the LMU University Hospital, LMU Munich, has research agreements with ViewRay Inc., Elekta, Brainlab, and C-RAD outside the submitted work. HK reports no conflict of interest for this work, SM reports no conflict of interest for this work, LK reports an grants or contracts from AstraZeneca (unrestricted research grant),AMGEN and Art Tempi (MasterClass LucaNext 2023/2024), receives honoraria for lecturing from the German Cancer Society, AstraZeneca and Art Tempi, receives support attending meetings or travel from AstraZeneca and ELCC all outside the submitted work, JL reports no conflict of interest for this work, CR reports no conflict of interest for this work, DK reports no conflict of interest for this work, NSSH reports no conflict of interest for this work, NR reports no conflict of interest for this work, AT reports no conflict of interest for this work, JD reports no conflict of interest for this work , RG reports no conflict of interest for this work, CR reports no conflict of interest for this work, FM reports a research grant from AstraZeneca and honoraria from AstraZeneca, Novartis, Roche, Lilly, Elekta and Brainlab outside the submitted work and serves on the advisory board of AstraZeneca, Novartis. CB reports receiving grants or contracts from ViewRay, Brainlab, and Elekta; payment or honoraria from Bristol-Myers Squibb, Roche, Merck, AstraZeneca, Opasca, C-RAD, Elekta, and ViewRay; receiving support for attending meetings or travel from Bristol-Myers Squibb, Roche, Merck, AstraZeneca, Elekta, and ViewRay; and having a leadership or fiduciary role with ESTRO, all outside the submitted work. CE reports consulting fees from Novartis outside the submitted work.

Figures

Figure 1
Figure 1
Kaplan-Meier estimate of overall survival (OS) and progression-free survival (PFS). Median OS was 20.7 months (95% CI 16.7–30.7 months). Median PFS was 7.6 months (95% CI 6.0–11.0 months).
Figure 2
Figure 2
Cumulative Incidence of locoregional failure and distant failure with death as a competing risk event. Twelve-month rate of locoregional failure 41% (95% CI 30–53%) and distant failure 14% (95% CI 6–23%).
See this image and copyright information in PMC

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