The online version of this article (https://doi.org/10.1186/s12904-017-0270-4) contains supplementary material, which is available to authorized users.
Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions.
Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included. We noted pathology, tumor, node and metastasis (TNM) classification of malignant tumors, stage, indication, start date, schedule for PTR, completed y/n, performance status (PS) and time of death. Analyses were performed as an intention-to-treat using Cox regression, Fishers exact test and Kaplan Meier.
A total of 159 patients were included. Median overall survival (OS) was 4.2 months. Sixteen patients (10%) did either not begin or finish PTR. Of these, eight (5%) died prior to or during PTR. Of the 151 patients receiving PTR, sixteen patients (11%) died within 14 days, thirty-three (22%) within 30 days and fifty (33%) within 2 months. PS 0-1 and squamous cell carcinoma were correlated with a better survival.
Our study show that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 0-1 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 0-1 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for high dose single fraction only or supportive palliative care.
Additional file 1: Figure S1: Cox regression analysis showing correlation between OS and histology from prescription of PTR to death. Mixed AC/SCC is included. There was a significant difference in OS and histology, favoring both SCC and mixed AC/SCC over AC. Mixed AC/SCC had a HR = 0.25 (95% CI: 0.12-0.51), p = 0.000. The rest of the results are listed in Fig. 1. (DOCX 26 kb)
Additional file 2: Figure S2. Cox regression analysis showing correlation between OS and age > or <70 years from prescription of PTR to death. There was a trend towards better OS and high age, but this was not statistical significant. Age > 70 years had a HR = 0.79 (95% CI: 0.58-1.09), p = 0.15. (DOCX 25 kb)12904_2017_270_MOESM2_ESM.docx
Additional file 3: Figure S3. Cox regression analysis showing correlation between OS and radiotherapy schedules 25Gy/5F or 30Gy/10F from prescription of PTR to death. There was a trend towards better OS with 30Gy/10F but this was not statistical significant. 30Gy/10F had a HR = 0.74 (95% CI: 0.52-1.04), p = 0.08 (DOCX 25 kb)12904_2017_270_MOESM3_ESM.docx
Collins LG, Haines C, Perkel R, et al. Lung cancer: diagnosis and management. Am Fam Physician. 2007;75:56–63. PubMed
Stevens R, Macbeth F, Toy E, et al. Palliative radiotherapy regimens for patients with thoracic symptoms from non-small cell lung cancer. Cochrane Database Syst Rev. 2015;1:CD002143. PubMed
A Medical Research Council (MRC) randomised trial of palliative radiotherapy with two fractions or a single fraction in patients with inoperable non-small-cell lung cancer (NSCLC) and poor performance status. Medical Research Council Lung Cancer Working Party. Br J Cancer 1992; 65: 934-41.
Erridge SC, Gaze MN, Price A, et al. Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol (R Coll Radiol ). 2005;17:61–7. CrossRef
Rees GJ, Devrell CE, Barley VL, et al. Palliative radiotherapy for lung cancer: two versus five fractions. Clin Oncol (R Coll Radiol ). 1997;9:90–5. CrossRef
Stanley KE. Prognostic factors for survival in patients with inoperable lung cancer. J Natl Cancer Inst. 1980;65:25–32. PubMed
Macbeth FR, Bolger JJ, Hopwood P, et al. Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council lung cancer working party. Clin Oncol (R Coll Radiol ). 1996;8:167–75. CrossRef
- Fractionated palliative thoracic radiotherapy in non-small cell lung cancer – futile or worth-while?
Malene Støchkel Frank
Dorte Schou Nørøxe
Gitte Fredberg Persson
- BioMed Central
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