Writing in a July 31st online issue of Lung Cancer, Dr. Marian Reinfuss and colleagues at the Center of Oncology–Maria Sklodowska-Curie Memorial Institute, Krakow note that the great majority of patients with advanced lung cancer who are not candidates for radical treatment experience symptoms due to intra-thoracic tumor growth.
“The treatment of choice for patients ineligible for palliative chemotherapy is palliative thoracic radiotherapy,” the authors say in reporting their experience with short-time, split course palliative thoracic radiation in 1250 patients.
All the patients were considered unfit for palliative chemotherapy because of poor performance status, weight loss, comorbidities, or old age. The radiotherapy protocol consisted of two series of 20 Gy in five fractions each, 4 weeks apart. “The treatment volume included the primary tumor with a 2-cm margin of normal tissue in the mediastinum,” the team notes.
Overall palliation success was 51% with resolution of symptoms in 25.1%. Specifically, “Palliation of symptoms was achieved in 54.1% of patients for cough, 68% for hemoptysis, 51.1% for thoracic pain, 38.3% for dyspnea, 12% for hoarseness and 8% for dysphagia,” Dr. Reinfuss and colleagues report.
Tolerance to radiotherapy was 92%. That is to say, 100 of the 1250 patients did not undergo the second course of radiation for various reasons; however, it was discontinued because of toxicity in only 12 patients, and only 14 patients actively chose to discontinue.
Nonetheless, all the treated patients complained of painful swallowing due to radiation esophagitis, and 22% suffered from nausea. Most recovered from esophagitis within 2-4 weeks after the first course, and by 5-6 weeks after the second course.
The authors conclude that the protocol is safe and effective for patients with advanced NSCLC who are not eligible for palliative chemotherapy.
They add, “Low costs, low frequency of hospitalization, good patient compliance, and a good therapeutic index favor hypofractionated regimens against longer schedules in patients with poor performance status.”