To investigate the effects of hyperfractionated radiotherapy versus hypofractionated radiotherapy combined with concurrent chemotherapy on the prognosis of limited-stage small-cell lung cancer (SCLC).

A total of 188 patients with limited-stage SCLC were enrolled in this study and divided into hyperfractionated group (n=92) and hypofractionated group (n=96). The hyperfractionated group received thoracic radiotherapy at 45 Gy in 30 fractions twice a day, while the hypofractionated group received 55 Gy in 22 fractions once a day. The Kaplan-Meier method was used to calculate survival rates, and the Cox model was used for multivariate prognostic analysis.

There were not significant differences in 1-, 2-, and 5-year progression-free survival (PFS) rates and 1-, 2-, and 5-year overall survival (OS) rates between the hyperfractionated group and the hypofractionated group (82% vs. 85%, 61% vs. 69%, 59% vs. 69%, P=0.27; 85% vs. 77%, 41% vs. 34%, 27% vs. 27%, P=0.37). The multivariate analysis showed that the time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days was favorable prognostic factor for PFS (P=0.005). The time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days and prophylactic cranial irradiation were favorable prognostic factors for OS (P=0.044; P=0.000). There were significant differences in incidence rates of grade 2 and 3 acute radiation esophagitis between the two groups (28% vs. 16%, 9% vs. 2%, P=0.009).

Both hyperfractionated radiotherapy and hypofractionated radiotherapy combined with chemotherapy can improve the PFS and OS of patients with limited-stage SCLC. The time from the initiation of chemotherapy to the initiation of thoracic radiotherapy ≤43 days and the time from the initiation of chemotherapy to the end of thoracic radiotherapy ≤63 days are favorable prognostic factors for PFS and OS, respectively. However, the hyperfractionated group has significantly higher incidence rates of grade 2 and 3 acute radiation esophagitis than the hypofractionated group.

Lung neoplasms/radiotherapy; Radiotherapy, intensity-modulated; Radiotherapy, hyperfractionation; Radiotherapy, large fractionation; Lung neoplasms/chemotherapy; Prognosis