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Does high-dose radiotherapy benefit palliative lung cancer patients?

An intradepartmental comparison of two dose regimens

Profitieren Palliativpatienten mit Bronchialkarzinomen von Therapiekonzepten mit hoher Dosis?

Ein Vergleich von zwei palliativen Dosiskonzepten

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Abstract

Background and purpose

The present analysis compares two palliative treatment concepts for lung cancer in terms of overall survival.

Patients and methods

Survival data from 207 patients were used in a retrospective analysis. All patients received palliative treatment comprising either 25 Gy applied in 5 fractions or 50 Gy in 20 fractions. A subgroup analysis was performed to compare patients with a good–fair vs. poor overall condition.

Results

Median survival times were 21 weeks (range 6–26 weeks) for patients treated with 25 Gy in 5 fractions and 23 weeks (range 14.5–31.5 weeks) for patients treated with 50 Gy in 20 fractions (95 % confidence interval, CI; p = 0.334). For patients with a good–fair overall condition, median survival times were 30 weeks (21.8–39.2 weeks) for 25 Gy in 5 fractions and 28 weeks (14.2–41.8 weeks) for 50 Gy in 20 fractions (CI 95 %, p = 0.694). In patients with a poor overall condition, these values were 18 weeks (14.5–21.5 weeks) and 21 weeks (13.0–29.0 weeks), respectively (CI 95 %, p = 0.248).

Conclusion

The palliative treatment concept of 25 Gy applied in 5 fractions is sufficient for radiation of lung cancer, given that there was no obvious survival improvement in patients treated with the higher total dose regimen.

Zusammenfassung

Ziel

Die vorliegende Arbeit vergleicht zwei palliative Behandlungskonzepte für Patienten mit Bronchialkarzinomen bezüglich der Gesamtüberlebenszeit.

Patienten und Methode

Die Überlebensdaten von 207 Patienten wurden für eine retrospektive Überlebenszeitanalyse herangezogen. Alle Patienten erhielten eine palliative Bestrahlung, entweder mit einer Gesamtdosis von 25 Gy in 5 Fraktionen oder 50 Gy in 20 Fraktionen. Zusätzlich wurde eine Subgruppenanalyse der Patienten mit gutem bis mittlerem vs. schlechtem Allgemeinzustand durchgeführt.

Ergebnisse

Die mediane Überlebenszeit für alle Patienten betrug 21 Wochen (95 % CI 16–26 Wochen) bei Patienten, die mit 25 Gy/5 Fraktionen behandelt wurden und 23 Wochen (95 % CI 14,5–31,5 Wochen) bei Patienten, die mit 50 Gy/20 Fraktionen behandelt wurden (p = 0,334). Bei Patienten mit gutem-mittleren Allgemeinzustand betrug die mittlere Überlebenszeit 30 Wochen (95 % CI 21,8–39,2 Wochen) für 25 Gy/5 Fraktionen und 28 Wochen (95 % CI 14,2–41,8 Wochen) für 50 Gy/20 Fraktionen (p = 0,694). Bei Patienten mit schlechtem Allgemeinzustand verändern sich diese Werte auf 18 Wochen (95 % CI 14,5–21,5 Wochen) und 21 Wochen (95 % CI 13,0–29,0 Wochen; p = 0,248).

Schlussfolgerungen

Das Behandlungskonzept mit einer Gesamtdosis von 25 Gy und einer Fraktionsdosis von 5 Gy ist ausreichend für die palliative Bestrahlung von Patienten mit Bronchialkarzinomen. Bei Verwendung des Bestrahlungskonzeptes mit einer höheren Gesamtdosis von 50 Gy war keine Verlängerung der mittleren Überlebenszeit nachzuweisen.

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References

  1. Abratt RP, Shepherd LJ, Salton DG (1995) Palliative radiation for stage 3 non-small cell lung cancer—a prospective study of two moderately high dose regimens. Lung Cancer 13:137–143

    Article  PubMed  CAS  Google Scholar 

  2. Appold S, Baumann M, Neidt F et al (1999) Ergebnisse der Bestrahlung inoperabler nichtkleinzelliger Bronchialkarzinome im Stadium III mit 25 Gy in fünf Fraktionen. Strahlenther Onkol 175:267–270

    Article  PubMed  CAS  Google Scholar 

  3. Bezjak A, Dixon P, Brundage M et al (2002) Randomized phase iii trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15). Int J Radiat Oncol Biol Phys 54:719–728

    Article  PubMed  Google Scholar 

  4. Budach W, Belka C (2004) Palliative percutaneous radiotherapy in non-small cell lung cancer. Lung Cancer 45:239–245

    Article  Google Scholar 

  5. Cross CK, Berman S, Buswell L et al (2004) Prospective study of palliative hypofractionated radiotherapy (8.5 Gy × 2) for patients with symptomatic non-small cell lung cancer. Int J Radiat Oncol Biol Phys 58:1098–1105

    Article  PubMed  Google Scholar 

  6. De Ruysscher D, Van Meerbeeck J, Vandecasteele K et al (2012) Radiation-induced oesophagitis in lung cancer patients. Strahlenther Onkol 188:564–567

    Article  Google Scholar 

  7. Erridge SC, Gaze MN, Prize A et al (2005) Symptom control and quality of life in people with lung cancer: a randomized trial of two palliative radiotherapy fractionation schedules. Clin Oncol (R Coll Radiol) 17:61–67

    Google Scholar 

  8. Fairchild A, Harris K, Barnes E et al (2008) Palliative thoracic radiotherapy for lung cancer: a systematic review. J Clin Oncol 26:4001–4011

    Article  PubMed  Google Scholar 

  9. Fowler JF (1992) Brief summary of radiobiological principles in fractionated radiotherapy. Semin Radiat Oncol 2:16–21

    Article  Google Scholar 

  10. Kramer GW, Wanders SL, Noordijk EM et al (2005) Results of the dutch national study of the palliative effect of irradiation using two different treatment schemes for non-small cell lung cancer. J Clin Oncol 23:2962–2970

    Article  PubMed  Google Scholar 

  11. Lupattelli M, Maranzano E, Bellavita R et al (2000) Short-course palliative radiotherapy in non-small cell lung cancer: results of a prospective study. Am J Clin Oncol 23:89–93

    Article  PubMed  CAS  Google Scholar 

  12. Mac Manus MP, Matthews JP, Wada M et al (2006) Unexpected long-term survival after low-dose palliative radiotherapy for non-small cell lung cancer. Cancer 106:1110–1116

    Article  Google Scholar 

  13. Maurer J, Hipp M, Schäfer C et al (2011) Dysphagia. Strahlenther Onkol 187:744–749

    Article  PubMed  Google Scholar 

  14. Medical Research Council Lung Cancer Working Party (1991) Inoperable non-small cell lung cancer: a medical research council randomized trial of palliative radiotherapy with two fractions or ten fractions. Br J Cancer 63:265–270

    Article  Google Scholar 

  15. Medical Research Council Lung Cancer Working Party (1992) A Medical Research Council (MRC) randomized 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. Br J Cancer 65:935–941

    Google Scholar 

  16. Medical Research Council Lung Cancer Working Party (1996) 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. Clin Oncol (R Coll Radiol) 8:167–175

    Google Scholar 

  17. Nestle U, Nieder C, Walter K et al (2000) A palliative accelerated irradiation regimen for advanced non-small cell lung cancer vs. conventionally fractionated 60 Gy: results of a randomized equivalence study. Int J Radiat Oncol Biol Phys 48:95–103

    Article  PubMed  CAS  Google Scholar 

  18. Oken MM, Creech, RH, Tormey DC et al (1982) Toxicity and response criteria of the eastern cooperative oncology group. Am J Clin Oncol 5:649–655

    Article  PubMed  CAS  Google Scholar 

  19. Plataniotis GA, Kouvaris JR, Dardoufas C et al (2002) A short radiotherapy course for locally advanced non-small cell lung cancer (NSCLC). Effective palliation and patients’ convenience. Lung Cancer 35:203–207

    Article  PubMed  CAS  Google Scholar 

  20. Rees GJG, Devrell CE, Barley VL et al (1997) Palliative radiotherapy for lung cancer: two versus five fractions. Clin Oncol (R Coll Radiol) 9:90–95

    Google Scholar 

  21. Reinfuss M, Glinski B, Kowalska T et al (1999) Radiothérapie du Cancer Bronchique non à Petites Cellules de Stade III, Inoperable, Asymptomatique. Résultats Définitifs d’un Essai Prospectif Randomisé (240 Patients). Cancer/Radiothérapie 3:475–479

  22. Rodrigues G, Videtic G, Sur R et al (2011) Palliative thoracic radiotherapy in lung cancer: an american society for radiation oncology evidence-based clinical practice guideline. Pract Radiat Oncol 1:60–71

    Article  Google Scholar 

  23. Senkus-Konefka E, Dziadziuszko R, Bednaruk-Młyński E et al (2005) A prospective, randomized study to compare two palliative radiotherapy schedules for non-small cell lung cancer (NSCLC). Br J Cancer 92:1038–1045

    Article  PubMed  CAS  Google Scholar 

  24. Simpson JR, Francis ME, Perez-Tamayo R et al (1985) Palliative radiotherapy for inoperable carcinoma of the lung: final report of a RTOG multi-institutional Trial Int J Radiat Oncol Biol Phys 11:751–758

  25. Sundstrøm S, Bremnes R, Aasebø U et al (2004) Hypofractionated palliative radiotherapy (17 Gy per two fractions) in advanced non-small cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 22:801–810

    Article  PubMed  Google Scholar 

  26. Toy E, Macbeth F, Coles B et al (2003) Palliative thoracic radiotherapy for non-small cell lung cancer. Am J Clin Oncol 26:112–120

    Article  PubMed  Google Scholar 

  27. Oorschot B van, Schuler M, Simon A et al (2011) Patterns of care and course of symptoms in palliative radiotherapy. A multicenter pilot study analysis. Strahlenther Onkol 187:461–466

    Article  PubMed  Google Scholar 

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Klinik für Strahlentherapie und Radioonkologie, Ruppiner Kliniken GmbH, Neuruppin, Germany

    C. Schröder & A. Buchali

  2. Institut für Anatomie und Zellbiologie, Justus Liebig Universität Gießen, Gießen, Germany

    M. Ivo

  3. Justus Liebig Universität Gießen, Giessen, Germany

    C. Schröder

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  1. C. Schröder
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  2. M. Ivo
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Correspondence to C. Schröder.

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Schröder, C., Ivo, M. & Buchali, A. Does high-dose radiotherapy benefit palliative lung cancer patients?. Strahlenther Onkol 189, 771–776 (2013). https://doi.org/10.1007/s00066-013-0360-z

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