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

Abstract

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.

Shortened Palliative Radiotherapy Results in a Lower Rate of Treatment During the Last Month of Life

“…If the primary aim of treatment is symptom palliation, priority is given to convenient, short-course regimens, which avoid toxicity [ 5 ]. In selected patients, 13 fractions of 3 Gy and comparable regimens have been preferred if increased tumor cell killing is desirable, which potentially increases time to in-field failure [ 6 ]. With prolonged overall treatment time, the risks of disease progression outside the irradiated area or clinical deterioration increases due to various causes, resulting in a higher likelihood of premature termination of the planned treatment course.…”