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Fractionated palliative thoracic radiotherapy in non-small cell lung cancer – futile or worth-while?

Fractionated palliative thoracic radiotherapy in non-small cell lung cancer – futile or worth-while?
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Støchkel Frank M, Schou Nørøxe D, Nygård L, Fredberg Persson G,


Støchkel Frank M, Schou Nørøxe D, Nygård L, Fredberg Persson G, (click to view)

Støchkel Frank M, Schou Nørøxe D, Nygård L, Fredberg Persson G,

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BMC palliative care 2018 01 0517(1) 15 doi 10.1186/s12904-017-0270-4
Abstract
BACKGROUND
Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions.

METHODS
Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included. We noted pathology, tumor, node and metastasis (TNM) classification of malignant tumors, stage, indication, start date, schedule for PTR, completed y/n, performance status (PS) and time of death. Analyses were performed as an intention-to-treat using Cox regression, Fishers exact test and Kaplan Meier.

RESULTS
A total of 159 patients were included. Median overall survival (OS) was 4.2 months. Sixteen patients (10%) did either not begin or finish PTR. Of these, eight (5%) died prior to or during PTR. Of the 151 patients receiving PTR, sixteen patients (11%) died within 14 days, thirty-three (22%) within 30 days and fifty (33%) within 2 months. PS 0-1 and squamous cell carcinoma were correlated with a better survival.

CONCLUSIONS
Our study show that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 0-1 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 0-1 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for high dose single fraction only or supportive palliative care.

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