Abstract: ob＜x＞jective To investigate the clinical efficacy and safety of hypofractionated image-guided radiotherapy(HypoIGRT) combined with Anlotinib in the treatment of elderly bulky（> 7cm） non‐small cell lung cancer(NSCLC). Methods Data from 28 elderly NSCLC patients with mass > 7cm who can’t tolerate surgery and chemotherapy in Xuzhou Cancer Hospital between June 2018 and June 2019 were analyzed. Patients received HypoIGRT combined with Anlotinib treatment. The clinical effect and adverse effects were analyzed. Results Of the 28 patients, 1 had complete remission, 24 had partial remission, 2 had stable, and 1 had progressive disease. The total response rate was 89.3%. The 1-, 2-, and 3-year overall survival rates were 73.6%, 52.0%, and 26%, the median OS was 22.17 months. The 1-, 2-, and 3-year PFS rates were 59.5%, 26.8%, and 16.1%, the median PFS was 17.70 months. In terms of toxicity, radiation esophagitis occurred in 24 cases(85.71%) with G0-1 and 4 cases(14.29%) with G≥2, radiation pneumonitis occurred in 23 cases(82.14%) with G0-1 and 5 cases(17.86%) with G≥2, and hemoptysis occurred in 9 cases (32.4%), hypertension in 17 cases (60.71%), proteinuria in 8 cases (28.57%), hand-foot-skin reaction occurred in 5 cases (17.8%), most of which were mild and tolerated after symptomatic treatment. Conclusions: HypoIGRT combined with Arotinib is effective and well tolerated in the treatment of elderly patients with bulky NSCLC.