Efficacy and safety of high-dose hypofractionated palliative radiotherapy (40 Gy in 10 daily fractions) for non-small cell lung cancer

Sep 29, 2026

Palliative thoracic radiotherapy is central for managing non-small cell lung cancer, yet conventional fractionation often produces limited and brief responses. This study assessed the efficacy and safety of a high-dose hypofractionated regimen delivering 40 Gy in 10 daily fractions for NSCLC patients treated between 2017 and 2022 at two tertiary oncology centers. Responses were evaluated with RECIST criteria, local control estimated with cumulative incidence accounting for death, and radiation pneumonitis and esophagitis monitored. Sixty-two patients showed a 69.3% overall response rate and favorable control with manageable toxicity.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

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Purpose

Materials and Methods

Results

Conclusion

Original Article pISSN 2234-1900 · eISSN 2234-3156 Radiat Oncol J 2025;43(4):188-194 [https://doi.org/10.3857/roj.2025.00346](https://doi.org/10.3857/roj.2025.00346) | Efficacy and safety of high-dose hypofractionated palliative radiotherapy (40 Gy in 10 daily fractions) for non–small cell lung cancer
James C. H. Chow1, Jeffrey C. F. Lui1, Chris K. C. Tong1, Anthony H. P. Tam1, Jeffrey C. H. Chan1, Jeannie Y. K. Chik1, Gavin T. C. Cheung2, Ka Man Cheung1, Luke T. Y. Lee1, Kam Hung Wong1, Kwok Hung Au1
1 Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, China 2Department of Oncology, United Christian Hospital, Hong Kong SAR, China | | | | --- | --- | --- | | Received: June 11, 2025
Revised: July 31, 2025
Accepted: August 4, 2025
Correspondence:
James C. H. Chow
Department of Clinical Oncology, Queen Elizabeth Hospital, Room 1116, 11/F, Block R, Queen Elizabeth Hospital, 30 Gascoigne Road, Kowloon, Hong Kong SAR, China Tel: +852-35067394
[E-mail: cch932@ha.org.hk](E-mail: cch932@ha.org.hk)[ ](E-mail: cch932@ha.org.hk)ORCID:
[https://orcid.org/0000-0001-5305-4342](https://orcid.org/0000-0001-5305-4342) | Purpose: Palliative thoracic radiotherapy plays a crucial role in the management of patients with non–small cell lung cancer (NSCLC). Conventional dose-fractionation schemes often yield modest and short-lived tumor responses. This study aims to evaluate the efficacy and safety of a high-dose hypofractionated radiotherapy regimen of 40 Gy in 10 daily fractions in NSCLC.
Materials and Methods: Consecutive NSCLC patients who underwent palliative thoracic radiotherapy using the 40 Gy in 10 daily fractions regimen between January 2017 and December 2022 were identified from institutional databases of two tertiary oncology centers. Treatment responses were assessed using the Response Evaluation Criteria in Solid Tumor criteria. Local tumor control rate was estimated using cumulative incidence function, considering death as a competing event. The rates of radiation pneumonitis and esophagitis were assessed.
Results: Sixty-two eligible patients were included. Median age was 72.6 years, with 52 patients (83.4%) having Eastern Cooperative Oncology Group performance status of ≥2. Radiotherapy was given to 33 patients (53.2%) with locally advanced primary NSCLC and 29 patients (47.8%) with oligopersistent or oligoprogressive NSCLC. Fifty-three tumors (85.4%) were considered unsuitable for stereotactic radiotherapy by location or size. With a median follow-up of 4.1 years, the overall response rate was 69.3%. Local control rates at 1 and 3 years were 96.7% and 76.9%, respectively. Grade 1–2 radiation pneumonitis and esophagitis occurred in 46.7% and 8.1% of patients. One case of grade 3 esophagitis was observed.
Conclusion: The 40 Gy in 10 daily fractions regimen demonstrates high local tumor control rate anda favorable safety profile, representing an effective and safe palliative option for NSCLC patients.
Keywords: Non-small cell lung carcinoma, Radiotherapy, Radiotherapy dosage, Palliative care | | | Introduction | | in 10 fractions [2,3]. While these regimens are effective in alleviating symptoms, the resulting tumor response is often modest and | | Over half of patients with non–small cell lung cancer (NSCLC) | | short-lived. Higher-dose regimens, such as 39 Gy in 13 fractions, | | present with locally advanced or metastatic disease [1]. Current | | has been shown to improve overall survival compared with conven- | | practices in conventional palliative radiotherapy for NSCLC vary | | tional schedules, at the expense of a slightly higher incidence of | | significantly across clinicians and institutions, with common regi- | | radiation-induced esophagitis [4]. Aggregate data from a system- | | mens ranging from 8–10 Gy in a single fraction to 30 Gy delivered | | atic review also suggest a modest survival advantage survival with | Copyright © 2025 The Korean Soc

FAQs

What treatment regimen was evaluated for non-small cell lung cancer patients?

The study evaluated high-dose hypofractionated palliative thoracic radiotherapy: 40 Gy delivered in 10 daily fractions.

How were treatment responses and local control assessed?

Responses were assessed using RECIST criteria, and local tumor control rates were estimated with a cumulative incidence approach treating death as a competing event.

What were the main safety findings regarding radiation-related toxicities?

Grade 1–2 radiation pneumonitis and esophagitis occurred in 46.7% and 8.1% of patients, respectively, with one case of grade 3 esophagitis observed.

Sep 29, 2026

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