Split-Course Palliative Radiotherapy Effective for Advanced Non-Small-Cell Lung Cancer

Researchers recently assessed the overall efficacy of split-course palliative chest radiotherapy (RT) for symptom relief in patients with advanced non-small-cell lung cancer (NSCLC) and found that the technology represents a beneficial alternative for patients who cannot tolerate continuous radiation treatment courses.

Moreover, the scientists investigated the impact the regimen's two-week break has on survival outcomes. The majority of lung cancer patients present with locally advanced or stage IV disease. The primary challenge in treating these patients is that most present with poor performance status and the benefit of treatment may be doubtful because of poor tolerance to any form of therapy. Palliative chest RT for lung malignancies has shown to be effective in relieving serious chest symptoms from tumor bleeding or mass effect on major airways, vessels, and nerves. However, there is a lack of consensus for an optimal palliative RT regimen.

Researchers reviewed the medical records of 140 patients in a retrospective analysis. The team evaluated symptom relief and toxicity during and after completion of RT treatment from clinician notes and patient-reported symptom inventory forms. Then, the researchers examined the impact of the treatment regimen on survival rates. Symptomatic relief was observed in all types of chest symptoms with an extent ranging from 52-84%. Long-lasting symptom relief was experienced in 58% of patients. Therapy was well tolerated, and toxicity was mild and transient, with grade 1 or 2 treatment-related esophagitis completely resolved during the two-week break. Furthermore, cancer survival was not adversely affected by a break in treatment.

"Balancing symptomatic relief with the side effects of radiotherapy remains a critical element of patient treatment,” explained lead investigator, Su K. Metcalfe, M.D., MPH of the James P. Wilmot Cancer Center at the University of Rochester (NY, USA). "Our selection design represents a viable option for patients who cannot tolerate continuous radiation treatment courses. Furthermore, the study's finding provides the basis for future large prospective studies that evaluate split-course palliative chest radiotherapy against other regimens.”

The study was published in the February 2010 issue of the Journal of Thoracic Oncology.

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