Application of hypofractionated image-guided radiotherapy combined with anlotinib for the treatment of bulky non-small cell lung cancer in elderly patients: effectiveness and safety

Objective To investigate the clinical effectiveness and safety of hypofractionated image-guided radiotherapy (HypoIGRT) combined with anlotinib for the treatment of bulky(> 7 cm) non-small cell lung cancer (NSCLC) in elderly patients. Methods A total of 28 elderly patients with bulky NSCLC (with > 7 cm in tumor diameter) who cannot tolerate surgery and chemotherapy in Xuzhou Cancer Hospital from June 2018 to June 2019 were enrolled. They were treated with HypoIGRT combined with anlotinib. The clinical effectiveness and adverse effects were analyzed. Results Among the 28 patients, there were 1 case of complete remission, 24 cases of partial remission, 2 cases of stable disease, and 1 case of progressive disease. The objective response rate (ORR) was 89.3%. The 1-, 2-, and 3-year overall survival rates were 73.6%, 52.0%, and 26%, respectively. The median overall survival (mOS) was 22.17 months. The 1-, 2-, and 3-year profession-free survival (PFS) rates were 59.5%, 26.8%, and 16.1%, respectively. The median profession-free survival (mPFS) was 17.70 months. In terms of toxicity, there were 24 cases (85.71%) of radiation esophagitis with G 0-1 and 4 cases (14.29%) with G≥2; 23 cases (82.14%) of radiation pneumonitis with G 0-1 and 5 cases (17.86%) with G≥2. Furthermore, hemoptysis occurred in 9 cases (32.40%), hypertension in 17 cases (60.71%), proteinuria in 8 cases (28.57%), gastrointestinal disorders in 7 cases (25.00%), and hand-foot-skin reaction in 5 cases (17.80%), most of which were mild and tolerated after symptomatic treatment. Conclusions HypoIGRT combined with anlotinib is effective and well tolerated in the treatment of bulky NSCLC in elderly patients.