Short-course palliative radiotherapy in non-small-cell lung cancer - Results of a prospective study

From February 1993 to October 1997, 91 consecutive patients with inoperable (stage IIIB-IV) histologically confirmed nonsmall-cell lung cancer underwe nt palliative hypofractionated radiotherapy. Recently, the Medical Research Council studies on hypofractionated short-course radiotherapy (8.5 Gy x 2) have reported high control of symptoms caused by thoracic disease without toxicity. Based on these experiences and our previous positive trial on sho rt-course radiotherapy (8 Gy x 2) in metastatic spinal cord compression, a prospective study of short-course palliative radiotherapy in non-small-cell lung cancer was carried out. The regimen was 16 Gy given in two 8-Gy fract ions, 1 week apart. Eighty-one patients were evaluable for response to trea tment. Forty-eight (59%) patients were 65 years or older. Forty (49%) patie nts were naive to radiotherapy, whereas 41 (51%) had previous cisplatin-bas ed chemotherapy. All but four stage IV patients (95%) had poor Eastern Coop erative oncology Group performance status (i.e., 2-3). Clinical palliation was achieved in 62 (77%) patients. Performance status improved in 59 (73%) patients. The median palliation time ranged from 28% to 57% of patient surv ival. The median survival from the beginning of treatment was 148 days (ran ge, 5-681 days). No difference in overall survival according to stage and p revious chemotherapy was observed. Only performance status conditioned surv ival (performance status 1-2 vs. performance status 3; p = 0.0289). Short-c ourse radiotherapy gave good results in terms of clinical palliation for th oracic symptoms, even in patients with poor performance status and pretreat ed with chemotherapy. The median palliation time was similar to 50% of pati ent survival time. Treatment was generally well tolerated-only 4 (5%) patie nts experienced World Health Organization grade III dysphagia. No late toxi city was recorded. The two-fraction regimen had social and economic advanta ges compared with the conventional ones.