A PALLIATIVE ACCELERATED IRRADIATION REGIMEN (PAIR) FOR ADVANCED NON-SMALL-CELL LUNG-CANCER (NSCLC)

In order to avoid overtreatment in advanced NSCLC we developed a palli ative accelerated irradiation regimen (PAIR) applying a total dose of 32 Gy in 10 days with two daily fractions of 2 Gy. This paper reports on a I-year pilot study carried out in preparation of a randomised tri al. Data for the 34 patients receiving PAIR were compared to 179 conve ntionally irradiated historical controls selected from a pre-existing database according to identical inclusion criteria. Statistical analys is showed that PAIR patients had a significantly longer survival than controls (P = 0.0029). Median survival was 11.8 and 5.8 months, respec tively, while 1-year survival was 45.6% vs. 21.2%. Compared to the sub group of controls who had received the full planned dose of 60 Gy (n = 104) PAIR patients showed no significant difference in survival. In o rder to adjust for possible imbalances we used a comprehensive blinded prognostic rating design creating one score value per patient out of several known prognostic factors. After adjustment for the resulting p rognostic score by means of the Cox proportional hazards model PAIR pa tients still showed significantly longer survival. We conclude that in advanced NSCLC survival after a palliative short-term regimen appears to be at least equivalent to that following conventional high-dose ir radiation.