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Palliative radiotherapy regimens for non-small cell lung cancer

  • Review
  • Intervention

Authors

  • F Macbeth,

  • E Toy,

  • B Coles,

  • A Melville,

  • A Eastwood


Dr Fergus MacBeth, Director, National Collaborating Centre for Cancer, Park House, Greyfriars Road, Cardiff, CF10 3AF, UK. fergus.macbeth@velindre-tr.wales.nhs.uk.

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 strategy

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conference proceedings, and discussion with experts were used to identify potentially eligible trials, published and unpublished.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

Ten 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. There is evidence for a modest increase in survival (6% at 1 year and 3% at 2 years) in patients with better performance status given higher dose radiotherapy.

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 and more homogeneous studies are needed.

Plain language summary

Plain language summary

A short course of radiotherapy for 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, treating the tumour in the lung with radiotherapy to relieve symptoms such as cough, breathlessness and pain, is useful and often recommended. This review shows that 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 one or two years, but with more immediate side effects, especially soreness swallowing.

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