A Four-Tiered Prognostic Score for Patients Receiving Palliative Thoracic Radiotherapy for Lung Cancer

Nieder, Carsten; Tollåli, Terje; Haukland, Ellinor; Reigstad, Anne; Flatøy, Liv Randi; Dalhaug, Astrid

doi:10.1080/07357907.2017.1416394

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…However, the underlying clinical information was probably too complex to be reflected in the limited data extracted for this study. A previous study performed in the first-line palliative irradiation setting revealed that PS, serum lactate dehydrogenase, C-reactive protein, liver/adrenal gland metastases, and extrathoracic disease status significantly predicted survival [7]. The poor prognosis patients survived for a median of 0.8 months.…”

Section: Discussionmentioning

confidence: 89%

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Provider decision regret—a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

et al. 2020

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Background: The overall usefulness of palliative thoracic re-irradiation depends on the balance between efficacy, survival and toxicity, and is difficult to judge from previous studies. In the absence of patient-reported data, we developed a method for provider decision regret that addresses the question "would we re-irradiate this patient again in light of the known outcome?" Furthermore, we analyzed different reasons for decision regret and defined a subgroup at increased risk.Patients and Methods: A retrospective analysis of 33 patients with lung cancer reirradiated with 17-45 Gy was performed. Reasons for decision regret included reirradiation within the last 30 days of life, immediate radiological progression after re-irradiation (as opposed to stable disease or objective response), radiation myelopathy, any grade 4-5 toxicity, grade 3 pneumonitis, other grade 3 toxicity in the absence of a symptomatic benefit or a time period of at least 3 months without worsening of the treated tumor.Results: Median survival time was 5.2 months (95% confidence interval 3.4-7.0 months). Symptomatic and radiological responses were observed. Provider decision regret was declared in 12 patients (36%, two patients with grade 3 pneumonitis, three patients with a short survival (radiotherapy during the last 30 days of life), seven patients with progression). Decision regret was declared only in patients with ECOG performance status (PS) 2 or 3 and was associated with time interval to re-irradiation <6 months. Conclusion:Our data support the usefulness and acceptable side effect profile of palliative re-irradiation for lung cancer. Patients with reduced PS are at increased risk of futile treatment. Future research should aim at prediction of immediate disease progression (the prevailing cause of decision regret). Evaluation of provider decision regret has the potential to improve the way we learn from retrospective databases and should also be considered for other scenarios where high-quality prospective outcome data are lacking.

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Section: Discussionmentioning

confidence: 89%

“…This is a retrospective single-institution study based on a previously described database that is maintained in order to analyze the quality of care for patients with lung cancer at our institution [7]. Staging information in the database relates to the TNM 7 th edition and response data to RECIST 1.1.…”

Section: Methodsmentioning

confidence: 99%

Provider decision regret—a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

et al. 2020

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“…Recognized disease and treatment factors (14) included the following: type of cancer, # of diagnoses, systemic therapy, disease-free interval, radiation dose, disease progression, primary tumor characteristics grade, histology, T stage, N stage, site and size of metastases (bone, lung, hepatic, adrenal gland, brain), site of surgery, tumor thrombus (portal vein) [6][7][8][9]37]. Additionally, common lab factors (4) were identified as prognostically significant in one or more studies, including lactate dehydrogenase, WBC (leukocytosis), hemoglobin (anemia), and C-reactive protein levels [18,20,21,23,26].…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Prognostic Factors in Patients with Cancer Receiving Palliative Radiotherapy: Evidence-Based Recommendations

Tam,

Scarpi,

Maltoni

et al. 2024

Cancers

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(1) Background: Prognostication in patients with cancer receiving palliative radiotherapy remains a challenge. To improve the process, we aim to identify prognostic factors in this population from the literature and offer evidence-based recommendations on prognostication in patients undergoing palliative radiotherapy for non-curable or advanced cancers. (2) Methods: A systematic review was performed on the medical literature from 2005 to 2023 to extract papers on the prognosis of palliative radiotherapy patients with advanced cancer. The initial selection was performed by at least two authors to determine study relevance to the target area. Studies were then classified based on type and evidence quality to determine final recommendations. (3) Results: The literature search returned 57 papers to be evaluated. Clinical and biological prognostic factors were identified from these papers to improve clinical decision making or construct prognostic models. Twenty prognostic models were identified for clinical use. There is moderate evidence supporting (i) evidence-based factors (patient, clinical, disease, and lab) in guiding decision making around palliative radiation; (ii) that certain biological factors are of importance; (iii) prognostication models in patients with advanced cancer; and that (iv) SBRT or re-irradiation use can be guided by predictions of survival by prognostic scores or clinicians. Patients with more favorable prognoses are generally better suited to SBRT or re-irradiation, and the use of prognostic models can aid in this decision making. (4) Conclusions: This evaluation has identified several factors or tools to aid in prognosis and clinical decision making. Future studies should aim to further validate these tools and factors in a clinical setting, including the leveraging of electronic medical records for data availability. To increase our understanding of how causal factors interact with palliative radiotherapy, future studies should also examine and include prediction of response to radiation as an outcome.

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“…The "two fractions of 8.5 Gy"-regime or other short-course radiotherapy regimes might have been a good choice for symptom palliation in these patients with short survival [12][13][14]. We have previously proposed a prognostic model that might help assess these patients before prescribing a 10fractions or more regime [15]. Performance status, serum lactate dehydrogenase, C-reactive protein, presence of liver/adrenal gland metastases, and extrathoracic disease status significantly predicted survival and formed the basis of the score.…”

Section: Discussionmentioning

confidence: 99%

Early High-Grade Thoracic Toxicity After Palliative Radiotherapy for Non-Small Cell Lung Cancer

Nieder¹,

Imingen²

2021

Cureus

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Introduction: Palliative radiotherapy or chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) may cause thoracic toxicities due to the radiation dose delivered to the lungs, heart, and esophagus. We studied severe thoracic toxicities resulting in hospitalization or death during the acute and sub-acute phase, i.e., three months from commencing radiotherapy. In addition, risk factors were identified. Methods: A retrospective review of 165 patients treated with three-dimensional conformal palliative radiotherapy or CRT was performed. The prescribed total dose was equivalent to at least 30 Gy in 10 fractions. Uni- and multivariate analyses were employed. Results: Twelve patients (7%) were hospitalized within three months from the start of radiotherapy or CRT. Six patients were hospitalized for esophagitis, three for dyspnea most likely caused by pneumonitis, and three for cardiac arrhythmia. Fatal toxicity was not observed. However, 19% of the 165 patients died from tumor-related causes during the time period of interest. In multivariate analysis, the only esophageal dose was significantly associated with the risk of hospitalization. Conclusion: The safety profile of palliative radiotherapy or CRT in the acute and subacute phases was satisfactory. The hospitalization rate can be reduced by lowering the esophageal dose, as long as safe lung and heart doses can be maintained.

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A Four-Tiered Prognostic Score for Patients Receiving Palliative Thoracic Radiotherapy for Lung Cancer

Cited by 5 publications

References 24 publications

Provider decision regret—a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

Provider decision regret—a useful method for analysis of palliative thoracic re-irradiation for lung cancer?

A Systematic Review of Prognostic Factors in Patients with Cancer Receiving Palliative Radiotherapy: Evidence-Based Recommendations

Early High-Grade Thoracic Toxicity After Palliative Radiotherapy for Non-Small Cell Lung Cancer

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