Palliative thoracic radiotherapy for lung cancer

Kępka, Lucyna; Olszyna-Serementa, Marta

doi:10.1586/era.10.22

Cited by 15 publications

(20 citation statements)

References 64 publications

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“…Overall the Cochrane conclusions were as follows: (1) there was no strong evidence favoring 1 EBRT schedule over another with respect to efficacy of palliation; (2) acute toxicity was greater with higher-dose regimens; (3) patients with better performance status might have a survival benefit with the higher dose regimens (5% at 1 year and 3% at 2 years); and (4) radiation myelopathy may be associated with some regimens (eg, 17 Gy/2 fractions), requiring appropriate RT planning. A 2008 review 30 and a recent 2010 review 31 have arrived at similar conclusions.…”

Section: Resultsmentioning

confidence: 71%

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline

Rodrigues

Videtic

Sur

et al. 2011

Practical Radiation Oncology

171

123

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PurposeTo provide guidance to physicians and patients with regard to the use of external beam radiotherapy, endobronchial brachytherapy, and concurrent chemotherapy in the setting of palliative thoracic treatment for lung cancer, based on available evidence complemented by expert opinion.Methods and MaterialsA Task Force authorized by the American Society for Radiation Oncology (ASTRO) Board of Directors synthesized and assessed evidence from 3 systematic reviews on the following topics: (1) dose fractionation in thoracic external beam radiotherapy (EBRT); (2) clinical utility of initial and salvage endobronchial brachytherapy (EBB); and (3) use of concurrent chemotherapy (CC) with palliative thoracic radiotherapy. Practice guideline recommendations were produced and are contained herein.ResultsStudies suggest that higher dose/fractionation palliative EBRT regimens (eg, 30 Gy/10 fraction equivalent or greater) are associated with modest improvements in survival and total symptom score, particularly in patients with good performance status. As these improvements are associated with an increase in esophageal toxicity, various shorter EBRT dose/fractionation schedules (eg, 20 Gy in 5 fractions, 17 Gy in 2 weekly fractions, 10 Gy in 1 fraction), which provide good symptomatic relief with fewer side effects, can be used for patients requesting a shorter treatment course and/or in those with a poor performance status. No defined role for EBB in the routine initial palliative treatment of chest disease has been demonstrated; however, EBB can be a reasonable option for the palliation of endobronchial lesions causing obstructive symptomatology including lung collapse, or for hemoptysis after EBRT failure. The integration of concurrent chemotherapy with palliative intent/fractionated radiotherapy is not currently supported by the medical literature.ConclusionThis Guideline is intended to serve as a guide for the use of EBRT, EBB, and CC in thoracic palliation of lung cancer outside the clinical trial setting. Further prospective clinical investigations with relevant palliative endpoints into the respective roles of EBB and CC/targeted therapy in the thoracic palliation of lung cancer are warranted, given the current state of the medical literature in these areas.

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Section: Resultsmentioning

confidence: 71%

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline

Rodrigues

Videtic

Sur

et al. 2011

Practical Radiation Oncology

171

123

View full text Add to dashboard Cite

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“…A number of clinical trials of lone RT therapy have randomized patients to different dosing schedules and intensity; a survival benefit has been observed in some of these trials associated with higher RT doses or more frequent administrations, but improvements in mortality have not been consistent between trials. [20–22] Moreover, clinical trials evaluating the effectiveness of different RT regimens have included younger NSCLC patients, limiting generalizability of these data to the elderly. One retrospective single-center study has reported their experience with elderly patients with unresectable stage III NSCLC and found a significantly increased survival with higher doses of RT.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer

et al. 2013

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Purpose Chemoradiotherapy is the standard of care for unresectable stage III non-small cell lung cancer (NSCLC). Elderly patients, who are often considered unfit for combined chemoradiotherapy, frequently receive radiation therapy (RT) alone. Using population-based data, we evaluated the effectiveness and tolerability of lone RT in unresected elderly stage III NSCLC patients. Methods and Materials Using the Surveillance, Epidemiology and End Results (SEER) registry linked to Medicare records we identified 10,376 cases of unresected stage III NSCLC that were not treated with chemotherapy, diagnosed between 1992 and 2007. We used logistic regression to determine propensity scores for RT treatment using patients’ pre-treatment characteristics. We then compared survival of patients who underwent lone RT vs. no treatment using a Cox regression model adjusting for propensity scores. The adjusted odds for toxicity among patients treated with and without RT were also estimated. Results Overall, 6,468 (62%) patients received lone RT. Adjusted analyses showed that RT was associated with improved overall survival in unresected stage III NCSLC (hazard ratio [HR]: 0.76; 95% confidence interval [CI]: 0.74–0.79) after controlling for propensity scores. RT treated patients had an increased adjusted risk of hospitalization for pneumonitis (odds ratio [OR]: 89, 95% CI: 12–636), and esophagitis (OR: 8, 95% CI: 3–21). Conclusions These data suggest that use of RT alone may improve the outcomes of elderly patients with unresected stage III NSCLC. Severe toxicity, however, was considerably higher in the RT treated group. The potential risks and benefits of RT should be carefully discussed with eligible elderly NSCLC patients.

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“…Moreover, survival seems better when definitive rather than palliative doses of radiation are used 58. Typically, chemotherapy is used before radiation in the sequential approach, but radiation can be used initially for patients with tracheabronchial or superior vena cava obstruction, hemoptysis, chest pain, or other local symptoms, with later consideration for systemic therapy 59,60…”

Section: Radiationmentioning

confidence: 99%

“…Systemic therapy is the primary treatment, but radiation therapy can be effective in palliating local symptoms due to tumors causing bronchial obstruction, superior vena cava compression, hemoptysis, chest pain, bony pain or threatening fracture, spinal epidural disease or cord compression, brain metastases, etc 59,60. SBRT can also be used in the treatment of oligometastatic disease 61…”

Section: Radiationmentioning

confidence: 99%

Non-small cell lung cancer therapy: safety and efficacy in the elderly

Glotzer¹,

Fabian²,

Chandra³

et al. 2013

DHPS

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BackgroundOur objective was to evaluate and review the current literature on the treatment of non-small cell lung cancer (NSCLC) in the elderly.MethodsWe selected recent peer-reviewed articles addressing ageing, cancer treatment in the elderly, and lung cancer treatment in the elderly. We defined elderly as over the age of 70.ResultsThe population is ageing dramatically throughout most of the world. Given that situation, clinicians are seeing and being asked to treat more elderly patients that have NSCLC. Elderly patients are less likely to participate or be allowed to participate in prospective or retrospective studies of treatments for NSCLC. Elderly patients are also less likely to be staged appropriately for their advanced tumors, and are less likely to be referred for surgery or adjuvant therapy after surgery. When treatment is tailored to patient comorbidities but not to age, the data support survival and outcomes comparable to those of younger patients.ConclusionsData are limited on the treatment of elderly patients with NSCLC. No data exist to support limiting recommendations for treatment based on age alone. Treatments should be determined on an individual basis.

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Palliative thoracic radiotherapy for lung cancer

Cited by 15 publications

References 64 publications

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline

Palliative thoracic radiotherapy in lung cancer: An American Society for Radiation Oncology evidence-based clinical practice guideline

Effectiveness of radiation therapy alone for elderly patients with unresected stage III non-small cell lung cancer

Non-small cell lung cancer therapy: safety and efficacy in the elderly

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