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Background <p>This study assesses recent treatments for locally advanced non-small cell lung cancer (LA-NSCLC) ineligible for surgery, comparing high-dose-rate (HDR) brachytherapy with conventional low linear energy transfer (LET) hypofractionated radiotherapy methods.</p> Methods <p>From 9435 papers, 8 meeting criteria were selected, covering 484 LA-NSCLC patients (2005–2019). Analysis focused on comparing outcomes, exploring biologically effective doses (BED), and examining toxicities.</p> Results <p>HDR brachytherapy had better effectiveness. Specific data revealed that the median overall survival (OS) with HDR brachytherapy was 38 months, with a significant 2-year OS rate of 68.0% (95% CI, 58.2-79.4%). In comparison, stereotactic body radiation (SBRT) and proton treatment had 2-year OS rates of 54% (95% CI, 36-71%), and 56% (95% CI, 42-70%), respectively. In terms of local control (LC), the 2-year LC rate for HDR brachytherapy stood at 87.1% (95% CI, 79-95%), whereas the 2-year LC rates for SBRT and proton therapy were 75% (95% CI, 63-86%) and 84% (95% CI, 68 -100%), respectively. The 2-year OS for BED<sub>10</sub> equal to or greater than 78&#xa0;Gy was 62% (95% CI, 51-72%), compared to 38% (95% CI, 17-58%) for BED<sub>10</sub> less than 78&#xa0;Gy. Acute toxicity was lower with HDR brachytherapy (95% CI, 0-10%) versus SBRT (95% CI, 8-16%), with no grade 3 + events reported for proton therapy. Furthermore, the rate of late toxicity events above grade 3 was 3% (95% CI, 0-6%) for SBRT and 14% (95% CI, 4-24%) for proton therapy, while no late toxicities above grade 3 were observed with brachytherapy.</p> Conclusions <p>Hypofractionated low LET irradiation is efficacious and safe for LA-NSCLC, while HDR brachytherapy provides significant OS and LC advantages with few toxicities. Achieving BED<sub>10</sub> ≥ 78&#xa0;Gy significantly impacts OS. These findings guide clinical practice and stimulate further LA-NSCLC treatment advancements.</p>

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Innovations in modern low-LET radiotherapy regimens for locally advanced non-small cell lung cancer: a meta-analysis and systematic review of high-dose-rate brachytherapy, stereotactic body radiotherapy, and hypofractionated proton therapy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年5月26日

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  • Mingyu Tan,
  • Lu Li,
  • Bangxian Tan,
  • Jinxin Yang

摘要

Background

This study assesses recent treatments for locally advanced non-small cell lung cancer (LA-NSCLC) ineligible for surgery, comparing high-dose-rate (HDR) brachytherapy with conventional low linear energy transfer (LET) hypofractionated radiotherapy methods.

Methods

From 9435 papers, 8 meeting criteria were selected, covering 484 LA-NSCLC patients (2005–2019). Analysis focused on comparing outcomes, exploring biologically effective doses (BED), and examining toxicities.

Results

HDR brachytherapy had better effectiveness. Specific data revealed that the median overall survival (OS) with HDR brachytherapy was 38 months, with a significant 2-year OS rate of 68.0% (95% CI, 58.2-79.4%). In comparison, stereotactic body radiation (SBRT) and proton treatment had 2-year OS rates of 54% (95% CI, 36-71%), and 56% (95% CI, 42-70%), respectively. In terms of local control (LC), the 2-year LC rate for HDR brachytherapy stood at 87.1% (95% CI, 79-95%), whereas the 2-year LC rates for SBRT and proton therapy were 75% (95% CI, 63-86%) and 84% (95% CI, 68 -100%), respectively. The 2-year OS for BED10 equal to or greater than 78 Gy was 62% (95% CI, 51-72%), compared to 38% (95% CI, 17-58%) for BED10 less than 78 Gy. Acute toxicity was lower with HDR brachytherapy (95% CI, 0-10%) versus SBRT (95% CI, 8-16%), with no grade 3 + events reported for proton therapy. Furthermore, the rate of late toxicity events above grade 3 was 3% (95% CI, 0-6%) for SBRT and 14% (95% CI, 4-24%) for proton therapy, while no late toxicities above grade 3 were observed with brachytherapy.

Conclusions

Hypofractionated low LET irradiation is efficacious and safe for LA-NSCLC, while HDR brachytherapy provides significant OS and LC advantages with few toxicities. Achieving BED10 ≥ 78 Gy significantly impacts OS. These findings guide clinical practice and stimulate further LA-NSCLC treatment advancements.