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.

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