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18F-FDG/PET-CT (positron emission tomography with 2-deoxy-2-fluoro-D-glucose integrated with computed tomography) in treatment position showed the primary tumor with pleural contact in the right upper lobe and positive lymph nodes in the ipsilateral hilum and mediastinum. The histology was an adenocarcinoma of the lung, epidermal growth factor receptor (EGFR) wild-type without anaplastic lymphoma kinase (ALK)-translocation. Tumor-related symptoms included worsening of dyspnea. She had chronic obstructive pulmonary disease (COPD) Global Initiative for Chronic Obstructive Lung Disease (GOLD) III at baseline. Keywords: Hypofractionated radiotherapy, Image-guided radiotherapy, NSCLC, Thoracic radiotherapyĪ 72-year-old woman (current non-smoker) with the Eastern Cooperative Oncology Group (ECOG) performance status 2 presented with stage IIIA NSCLC.

Hypo-IGRT is feasible treatment option in locally advanced node-positive NSCLC patients with very limited lung function (FEV1 ≤ 1 L). Both patients showed good clinical and radiological response. ITV to planning target volume margin was 5 mm in all directions. Internal target volume (ITV) was defined as the overlap of gross tumor volume delineated on 10 phases of 4D-CT. Planning was based on positron emission tomography-computed tomography (PET/ CT) and four-dimensional computed tomography (4D-CT). Hypo-IGRT was delivered to a total dose of 45 Gy to the primary tumor and involved lymph nodes. We describe two cases of locally advanced node-positive non-small cell lung cancer (NSCLC) patients with very limited lung function treated with induction chemotherapy and moderate hypofractionated image-guided radiotherapy (Hypo-IGRT).

Patients with locally advanced lung cancer and very limited pulmonary function (forced expiratory volume in 1 second ≤ 1 L) have dismal prognosis and undergo palliative treatment or best supportive care.