Palliative radiotherapy regimens for non-small cell lung cancer

  • Review
  • Intervention

Authors


Abstract

Background

Palliative radiotherapy to the chest is often used in patients with lung cancer, but radiotherapy regimens are more often based on tradition than research results.

Objectives

To discover the most effective and least toxic regimens of palliative radiotherapy for non-small cell lung cancer, and whether higher doses increase survival.

Search methods

The electronic databases MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials, reference lists, handsearching of journals and conference proceedings, and discussion with experts were used to identify potentially eligible trials, published and unpublished.

Selection criteria

Randomised controlled clinical trials comparing different regimens of palliative radiotherapy in patients with non-small cell lung cancer.

Data collection and analysis

Fourteen randomised trials were reviewed. There were important differences in the doses of radiotherapy investigated, the patient characteristics and the outcome measures. Because of this heterogeneity no meta-analysis was attempted.

Main results

There is no strong evidence that any regimen gives greater palliation. Higher dose regimens give more acute toxicity, especially oesophagitis. There is evidence for a modest increase in survival (5% at 1 year and 3% at 2 years) in patients with better performance status (PS) given higher dose radiotherapy. Some regimens are associated with an increased risk of radiation myelitis.

Authors' conclusions

The majority of patients should be treated with short courses of palliative radiotherapy, of 1 or 2 fractions. Care should be taken with the dose to the spinal cord. The use of high dose palliative regimens should be considered for and discussed with selected patients with good performance status. More research is needed into reducing the acute toxicity of large fraction regimens and into the role of radical compared to high dose palliative radiotherapy. In the future, large trials comparing different RT regimens may be difficult to set up because of the increasing use of systemic chemotherapy. Trials looking at how best to integrate these two modalities, particularly in good PS patients, need to be carried out.

摘要

背景

非小細胞肺癌之緩和性放射線治療處方

胸部的緩和性放射線治療常被用來治療肺癌的病人,但是放射線治療處方常常是根據傳統的處方而不是研究的結果

目標

去發現對非小細胞肺癌最有效且最少毒性的緩和性放射線治療處方,並探討是否較高的劑量會增加存活期

搜尋策略

電子資料庫(MEDLINE, EMBASE, Cancerlit and the Cochrane Central Register of Controlled Trials)、文獻的參考文獻、以人工搜尋期刊和研討會手冊以及與專家的討論等以尋找符合資格的臨床試驗,無論其是否已經發表。

選擇標準

比較不同緩和性放射線治療處方在非小細胞肺癌治療的隨機對照試驗

資料收集與分析

一共回顧了14個隨機試驗,發現放射線治療的劑量、病人的特性和治療成果的評估都有重大的不同。因為其間的異質性太大,所以無法做統合分析

主要結論

沒有很強的證據支持哪一種處方可以得到比較好的緩解。較高的劑量較易產生急性的毒性,特別是食道炎。有證據顯示在體能狀況比較好的病人身上給予較高的放射治療劑量,可以輕微的增加存活率(第1年為5%;第2年為3%)。有些處方則會增加放射性脊髓炎的危險性。

作者結論

大多數的病人需接受1或2個短程的緩和性放射線治療。脊髓的照射劑量更要小心的計算。高劑量的緩和性療法可考慮使用與體能較好的病患討論。我們須要更多的研究來探討如何在使用較多療程的治療時減少其急性毒性;並且比較根除性與高劑量緩和性放射線治療的角色。未來因為越來越常使用全身性化療(systemTc chemotherapy),比較不同放射線治療處方的大規模試驗可能更困難實施。所以需要在體能狀況良好的病患進行臨床試驗,以尋找如何整合這2種治療的最好方式。

翻譯人

本摘要由臺北榮民總醫院葉尚倫翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

一個短程的胸部放射線治療可以改善肺癌病人的症狀而且沒有明顯副作用。在大多數的已開發國家,肺癌是最常見的腫瘤,只有10%到20%的病人有機會接受手術治癒。 對其餘大多數的病人,肺部放射線治療可以改善咳嗽、呼吸困難以及疼痛等症狀。這篇回顧顯示在大多數的病人身上,一個短程約1到2次的放射線治療就可以改善這些常見的症狀,其效果跟較長的療程差不多,而且副作用較少。在某些體況較好的病人身上,較長的療程可能有略好1到2年的存活機率,可是會有較多立即的副作用,特別是吞嚥疼痛。

Plain language summary

A short course of radiotherapy to the chest for patients with lung cancer can improve symptoms without major side effects

In most developed countries lung cancer is one of the commonest tumours. Only 10 to 20% of patients can have surgery with a chance of cure. For many of the rest it can be beneficial to treat the tumour in the lung with radiotherapy to relieve symptoms such as cough, breathlessness and pain. This review shows that in the majority of patients, a short course of radiotherapy with only one or two visits, improves these common symptoms as effectively as longer courses, without more side effects. For some fitter patients, a longer course of radiotherapy may give a slightly better chance of living for one or two years, but with more immediate side effects, especially sore swallowing.

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