TITLE:
A Prospective Study of the Effect of Different Palliative Radiotherapy Fractionation Schedules on Tumor Response and Toxicity in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients
AUTHORS:
Mohamed Lotayef, Yaser Abd Elkader, Amr Amin, Azza Taher, Ehab El-Kest, Momen Abdelall
KEYWORDS:
Non-Small Cell Lung Cancer, Palliative Thoracic Radiation, Fractionation Schedules, Symptoms, Randomized Trial
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.7 No.12,
November
16,
2016
ABSTRACT: Background: The optimal dose of palliative radiotherapy (RT) in
symptomatic advanced lung cancer is unclear. Patients and methods: Patients
with advanced NSCLC who were indicated for thoracic palliative RT with age up to 65 y and Performance Status (PS) 0 - 2 and no
significant cardiac or lung co-morbidities were randomized into two fractionation arms: arm A: 30 Gy/10 over
2 weeks and arm B: 27 Gy/6 over 3 weeks (2 fractions per week) using 2
anterior posterior (AP-PA)
fields in both arms. Primary
end points were symptomatic and radiological tumor response, respiratory functions assessment.
Secondary end point was toxicity. Results: From December 2014 to October 2015, 40 patients were
randomized, 20
patients in each arm. There was statistically insignificant higher symptomatic
improvement in arm B. Four weeks after treatment, 12 out of 40 patients (30%),
6 patients in each arm, had radiological Partial Response (PR) of the primary
thoracic lesion without significant difference between the two arms. There was
a tendency for improvement in the post treatment mean Forced Vital Capacity (FVC) and Forced Expiratory
Volume in one second (FEV1) in each arm without statistical significance. There
were no reported skin reactions or
esophagitis in both
arms up to 4 weeks after treatment. Eleven out of the 40 patients (27.5%), 6 in
arm B and 5 in arm A, had radiological signs of radiation pneumonitis without
significant difference between both arms. Conclusion: The two RT fractionation
schedules showed equal efficacy in terms of symptoms relief, radiological response
of the primary thoracic tumor, respiratory functions and toxicity. Thus the 27 Gy/6 fractionation arm appears preferable compared
to 30 Gy/10 arm
to minimize the patients’ visits
and load on the machines.