Presenter: A. Bezjak Affiliation: Dept of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
In comparison to definitive radiation therapy, the optimal doses and fraction schedules for palliative treatments are less well defined.
Theoretically, administration of larger daily fractions over fewer days offers more convenience and economy for the patients, while providing better utilization of limited healthcare resources.
This study was designed to compare the effectiveness of 10 Gy single fraction versus 20 Gy in 5 fractions of thoracic radiotherapy (RT) in the palliation of thoracic symptoms in patients with non-small cell lung cancer (NSCLC).
Materials and Methods
This was a multi-institutional phase III study of 230 patients with thoracic symptoms due to NSCLC, deemed unsuitable for radical treatment.
Primary endpoint was palliation of thoracic symptoms at 1 month following RT, evaluated by a patient-completed daily diary card.
The average mean score at week 5 and change score from baseline to week 5 for each symptom were compared between two treatment arms.
Secondary endpoints were thoracic symptoms evaluated longitudinally using the Lung Cancer Symptom Scale (LCSS); quality of life (evaluated by the EORTC QLQ-C30); treatment toxicity and overall survival.
At 1 month following RT, there was no difference in symptom control between the two arms, as judged by the daily diary scores.
Preliminary analysis of the EORTC QLQ-C30 scores showed that patients receiving 5 fractions had greater improvement in scores with respect to dyspnea (p=0.027).
Change scores on LCSS indicated that fractionated RT group had greater improvement in symptoms related to lung cancer (p=0.037), pain (p=0.017) and the ability to carry out normal activities (p = 0.047).
Patients receiving 5 fractions survived significantly longer (median survival 6.0 mo, 95% CI 5.2 - 7.9 mo) than those given a single fraction (median 4.2 mo, 95% CI 3.7- 5.2 mo); p 0.014.
There was no significant difference in the treatment-related toxicity.
Although the two treatment strategies provided similar degree of palliation of thoracic symptoms, the unexpected difference in survival between the two study arms is of a clinically relevant magnitude.
Possible explanations for this survival difference are being explored.
The results of this study suggest that the pursuit of increased survival in the palliative setting is a reasonable goal and one that should be addressed in future clinical investigations.
Further studies are need to identify the optimal regimens for palliation of thoracic tumors
Jan 21, 2013 - Half of patients with metastatic non-small-cell lung cancer receive at least one course of palliative radiation therapy, with younger patients and those who received chemotherapy or surgery more likely to receive palliative RT, according to a study published online Jan. 7 in the Journal of Clinical Oncology.