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Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer

Überleben und prognostische Faktoren nach moderat hypofraktionierter palliativer thorakaler Strahlentherapie beim nicht-kleinzelligen Bronchialkarzinom

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Abstract

Background

Survival and prognostic variables in patients with advanced or metastatic non-small cell lung cancer (NSCLC) requiring thoracic palliative radiotherapy using a moderately hypofractionated regime (13–15 × 3 Gy) were evaluated.

Methods

From March 2006 to April 2012, 120 patients with a physician estimated prognosis of 6–12 months were treated with this regime using CT-based 3D conformal radiotherapy. We collected data on patient characteristics, comorbidities, toxicity, and treatment parameters.

Results

Radiotherapy was completed as prescribed in 114 patients (95.0 %, premature termination 5.0 %). Acute grade 3 toxicity was seen in 6.4 % of patients. The median survival of all patients was 5.8 months. Nonmetastatic patients survived significantly longer than patients with metastatic disease (median 11.7 months vs 4.7 months, p = 0.0001) and 18.6 % of nonmetastatic patients survived longer than 2 years. In 12.7 % radiotherapy started less than 30 days before death and 14.2 % of patients received radiotherapy within 14 days before death. In the multivariate analysis, good general condition, nonmetastatic disease, and a stable or improved general condition at the end of radiotherapy were significant. The treatment parameters, age, and comorbidities were not statistically significant.

Conclusion

Our data confirm considerable effectiveness of 13 × 3 Gy with conformal radiotherapy for patients with locally confined NSCLC not fit for radical treatment and raise doubt for this regimen in metastatic patients and ECOG ≥ 2 when burden, acute toxicity, and resources are considered.

Zusammenfassung

Hintergrund

Analyse der Überlebenszeiten und prognoserelevanter Variablen von Patienten mit lokal fortgeschrittenem und metastasiertem nicht-kleinzelligen Lungenkrebs nach moderat hypofraktionierter Strahlentherapie (13- bis 15-mal  3 Gy).

Methoden

Zwischen März 2006 und April 2012 wurden 120 Patienten mit ärztlich eingeschätzter Lebenserwartung von 6–12 Monaten mit diesem Regime mittels CT-basierter 3-D-konformaler Strahlentherapie behandelt. Wir analysierten soziodemographische Daten, Komorbiditäten, Akuttoxizität und Bestrahlungsparameter.

Ergebnisse

Bei 114 Patienten konnte die Strahlentherapie planmäßig durchgeführt werden (95,0 %, Abbruchrate 5,0 %). Akutnebenwirkungen vom Grad 3 entwickelten 6,4 % der Patienten. Die mittlere Überlebenszeit lag bei 5,8 Monaten. Patienten in nichtmetastasierten Stadien lebten signifikant länger als metastasierte Patienten (median 11,7 Monate vs. 4,7 Monate; p = 0,0001) und 18,6 % der nichtmetastasierten Patienten lebten länger als 2 Jahre. Bei 12,7 % der Patienten begann die Strahlentherapie in den letzten 30 Lebenstagen und 14,2 % der Patienten wurden innerhalb der letzten 14 Lebenstagen bestrahlt. In der multivariaten Analyse waren guter Allgemeinzustand, nichtmetastasiertes Tumorstadium und ein stabiler oder verbesserter Allgemeinzustand bei Abschluss der Radiatio signifikante Prediktoren für ein längeres Überleben. Bestrahlungsparameter, Alter und Komorbiditäten waren nicht signifikant.

Schlussfolgerung

Nach den vorgelegten Daten profitierten Patienten mit lokal begrenztem NSCLS und Kontraindikation für eine radikale Therapie deutlich von der konformalen Strahlentherapie mit 13 Fraktionen zu  3 Gy. Es muss bezweifelt werden, inwieweit dieses Konzept für Patienten in metastasierten Stadien mit eingeschränktem Allgemeinzustand (ECOG ≥ 2) sinnvoll ist, wenn Behandlungsbelastung, Akuttoxizität und Ressourcen berücksichtigt werden.

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Compliance with ethical guidelines

Conflict of interest. B. van Oorschot, B. Assenbrunner, M. Schuler, G. Beckmann, and M Flentje have made no statement.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Interdisziplinäres Zentrum Palliativmedizin, Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland

    B. van Oorschot, B. Assenbrunner, G. Beckmann & M. Flentje

  2. Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, Würzburg, Deutschland

    M. Schuler

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  1. B. van Oorschot
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  2. B. Assenbrunner
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  5. M. Flentje
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Correspondence to B. van Oorschot.

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Consent of the head of the institute (Prof. Dr. med. Michael Flentje) was given 15 August 2013.

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van Oorschot, B., Assenbrunner, B., Schuler, M. et al. Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer. Strahlenther Onkol 190, 270–275 (2014). https://doi.org/10.1007/s00066-013-0507-y

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