Palliative radiotherapy in patients with a poor performance status: the palliative effect is correlated with prolongation of the survival time

Abstract

BackgroundThe purpose of this study was to analyze the efficacy and tolerability of palliative radiotherapy (RT) in patients with a poor performance status (PS) and to evaluate the relationship between the palliative effect and survival time.MethodsOne hundred and thirty-three patients with a poor PS (Eastern Cooperative Oncology Group 3 or 4) were treated with palliative RT using the three-dimensional conformal technique and retrospectively analyzed. Each patient's primary symptom treated with palliative RT as the major cause of the poor PS was evaluated using the second item of the Support Team Assessment Schedule (STAS) at the start and one week after the completion of palliative RT.ResultsOne hundred and fourteen (86%) of the 133 patients completed the planned palliative radiation dose. Grade 3 acute toxicity was observed in two patients (2%) and Grade 2 acute toxicity was observed in 10 patients (9%). No Grade 2 or higher late toxicities were observed, except for Grade 3 radiation pneumonitis in one patient. Improvement in the STAS scores between pre- and post-palliative RT was recorded in 76 (61%) of the 125 patients with available scores of STAS. A significant improvement in the mean STAS score between pre- and post-palliative RT was recognized (p < 0.0001). Improvement in the STAS score was found to be the most statistically significant prognostic factor for overall survival after palliative RT in both the multivariate and univariate analyses. The median overall survival time in the patients with an improvement in the STAS score was 6.4 months, while that in the patients without improvement was 2.4 months (p < 0.0005).ConclusionsPalliative RT in patients with a poor PS provides symptomatic benefits in more than half of patients without inducing severe toxicities. The palliative effect is strongly correlated with prolongation of the survival time and may contribute to improving the remaining survival time in patients with metastatic/advanced cancer with a poor PS.

Short survival time following palliative‐intent hypofractionated radiotherapy for non‐resectable canine thyroid carcinoma: A retrospective analysis of 20 dogs

“…Although measures of a palliative effect are more meaningful when evaluating a palliative treatment, they are more prone to bias and difficult to assess retrospectively. However, in humans treated with palliative radiotherapy, palliation is directly correlated with survival time . This is also likely true in veterinary patients, where euthanasia decisions are based heavily on quality of life.…”

Radiotherapy improves the survival of patients with stage IV NSCLC: A propensity score matched analysis of the SEER database

“…However, one study found that the use of palliative TRT in stage IV NSCLC was associated with younger patients, the receipt of chemotherapy, and having undergone surgery of metastatic sites, which indicates that the survival benefits of palliative TRT may be due to confounding factors . Controlling the primary tumor was found to prolong patient survival and may lead to long‐term survival of patients with stage IV NSCLC . Refusing palliative RT led to poor survival .…”

“…33 Controlling the primary tumor was found to prolong patient survival and may lead to long-term survival of patients with stage IV NSCLC. 34,35 Refusing palliative RT led to poor survival. 36 Both the 2011 American Society for Radiation Oncology (ASTRO) Guideline and the 2014 European Society for Medical Oncology (ESMO) Guideline concluded that RT plays a major role in controlling the symptoms of metastases, such as painful chest wall disease, superior vena cava syndrome, soft tissue, or neural invasion.…”

Modern head and neck brachytherapy: from radium towards intensity modulated interventional brachytherapy

“…Phase III study results indicate that postoperative full-dose EBRT reirradiation combined with chemotherapy after salvage surgery significantly improved disease free survival, but had no significant impact on overall survival. Regarding toxicity, an increase in both acute and late toxicity was observed [ 147 ]. The palliative effect of a given treatment is strongly correlated with the prolongation of the survival time, and may contribute to improving the remaining survival time in patients with metastatic/advanced cancer with a poor performance status [ 148 ].…”