Long-term survival in patients with NSCLC treated with single-fraction vs. multi-fraction palliative radiotherapy in the case of lung tumor, brain metastases and bone metastases
, 3, 1
Abstract
Background: Patients with advanced non-small cell lung cancer (NSCLC) are candidates for different types of treatment, including chemotherapy and radiotherapy or supportive care. Despite the fatal prognosis in advanced disease, many experienced radiation oncologists will apply radiation at low doses with the intention of palliative care. Methods: We used an extensive database of medical patients diagnosed with NSCLC, treated with palliative radiotherapy at the Oncology Centre in Bydgoszcz, from June 1998 to December 2013. A group of 3202 patients was divided into subgroups: Group A)1762 patients irradiated on the lung tumor (without distant metastases): Total dose: A1) 6Gy/1 fr.(n=19); A2) 8Gy/1fr.(n=276); A3) 20Gy/5fr.(n=1349); A4) 30Gy/10fr.(n=118). Group B) 548 patients irradiated on the central nervous system (CNS) metastases: B1) 20Gy/5fr.(n=476); B2) 30Gy/10fr.(n=72). Group C) 892 patients irradiated on the bone metastases: C1) 8Gy/1fr.(n=452); C2) 10Gy/1fr.(n=30); C3) 20Gy/5fr.(n=341); C4) 30Gy/10fr.(n=69). Results: Patients with irradiation of a lung tumor: The longest OS was observed in the group of patients irradiated with doses of 20 Gy (76%) and 30 Gy (7%). Patients with irradiation of bone metastases: No significant differences in OS were observed between the employed fractionation regimens. Patients with irradiation of CNS metastases: The choice of a higher dose of radiation therapy did not demonstrate differences in median OS values compared to a lower dose. Conclusions: The patients who were prescribed single fraction palliative radiotherapy did not have poorer prognoses or experience shorter survival than patients who were prescribed multi-fraction pRT in the case of lung tumor, brain metastases and bone metastases.
Keywords: palliative radiotherapysurvivalNSCLCsingle-fractionmulti-fraction
References
- Wang J, Ji Z, Wang X, et al. Radical thoracic radiotherapy may provide favorable outcomes for stage IV non-small cell lung cancer. Thorac Cancer. 2016; 7(2): 182–189.
- Cullen MH, Billingham LJ, Woodroffe CM, et al. Mitomycin, ifosfamide, and cisplatin in unresectable non-small-cell lung cancer: effects on survival and quality of life. J Clin Oncol. 1999; 17(10): 3188–3194.
- Shepherd FA. Chemotherapy for non-small cell lung cancer: have we reached a new plateau? Semin Oncol. 1999; 26(1 Suppl 4): 3–11.
- 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(3): 167–175.
- Tang JI, Shakespeare TP, Lu JJ, et al. Patients' preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancer. J Med Imaging Radiat Oncol. 2008; 52(5): 497–502.
- Bayly JL, Lloyd-Williams M. Identifying functional impairment and rehabilitation needs in patients newly diagnosed with inoperable lung cancer: a structured literature review. Support Care Cancer. 2016; 24(5): 2359–2379.
- Culleton S, Kwok S, Chow E. Radiotherapy for pain. Clin Oncol (R Coll Radiol). 2011; 23(6): 399–406.
- Wu JSY, Wong R, Johnston M, et al. Cancer Care Ontario Practice Guidelines Initiative Supportive Care Group. Meta-analysis of dose-fractionation radiotherapy trials for the palliation of painful bone metastases. Int J Radiat Oncol Biol Phys. 2003; 55(3): 594–605.
- Adamietz I. Radiotherapy. Frontiers of Radiation Therapy and Oncology. 2009: 164–172.
- Ma JT, Zheng JH, Han CB, et al. Meta-analysis comparing higher and lower dose radiotherapy for palliation in locally advanced lung cancer. Cancer Sci. 2014; 105(8): 1015–1022.
- Nieder C, Tollali T, Yobuta R, et al. Palliative Thoracic Radiotherapy for Lung Cancer: What Is the Impact of Total Radiation Dose on Survival? J Clin Med Res. 2017; 9(6): 482–487.
- Chow R, Hoskin P, Hollenberg D, et al. Efficacy of single fraction conventional radiation therapy for painful uncomplicated bone metastases: a systematic review and meta-analysis. Ann Palliat Med. 2017; 6(2): 125–142.
- Bedard G, Hoskin P, Chow E. Overall response rates to radiation therapy for patients with painful uncomplicated bone metastases undergoing initial treatment and retreatment. Radiother Oncol. 2014; 112(1): 125–127.
- Schofield P, Ball D, Smith JG, et al. Optimism and survival in lung carcinoma patients. Cancer. 2004; 100(6): 1276–1282.
- Mott TF. Lung Cancer: Management. FP Essent. 2018; 464: 27–30.
- Frank MS, Nørøxe DS, Nygård L, et al. Fractionated palliative thoracic radiotherapy in non-small cell lung cancer – futile or worth-while? BMC Palliative Care. 2018; 17(1).
- Wang TJC, Brown PD. Brain metastases: fractionated whole-brain radiotherapy. Handb Clin Neurol. 2018; 149: 123–127.
- Miyazawa K, Shikama N, Okazaki S, et al. Predicting prognosis of short survival time after palliative whole-brain radiotherapy. J Radiat Res. 2018; 59(1): 43–49.
- Tsakonas G, Hellman F, Gubanski M, et al. Prognostic factors affecting survival after whole brain radiotherapy in patients with brain metastasized lung cancer. Acta Oncol. 2018; 57(2): 231–238.
- Nieder C, Norum J, Hintz M, et al. Short Survival Time after Palliative whole Brain Radiotherapy: Can We Predict Potential Overtreatment by Use of a Nomogram? J Cancer. 2017; 8(9): 1525–1529.