Results of the Dutch National Study of the Palliative Effect of Irradiation Using Two Different Treatment Schemes for Non–Small-Cell Lung Cancer

Kramer, G.; Wanders, S; Noordijk, E.M.; Vonk, E.; Houwelingen, Hans C. van; Hout, Wilbert B. van den; Geskus, Ronald B.; Scholten, M.; Leer, Jan-Willem H.

doi:10.1200/jco.2005.01.685

Cited by 103 publications

(98 citation statements)

References 25 publications

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“…In contrast, a study conducted by the National Cancer Institute of Canada [13], found that patients treated with fractionated radiotherapy (20 Gy), had greater improvement in symptoms, ability to carry out normal activities, and better global quality of life than patients treated with single fraction of 10 Gy. Bezjak et al [13] and Erridge et al [15], reported better palliation with higher dose and more fractionated regimen.…”

Section: Discussionmentioning

confidence: 99%

“…In the MRC 1996 [9], shorter regimen of 2 fractions, have more rapid onset of palliating symptoms than higher dose of 13 fractions, although the differences in the proportion of patients who were palliated were not significant. Kramer et al [15] showed that both regimens of 30 Gy/10 fractions and 16 Gy/ 2 fractions were effective in controlling symptoms, but the duration of palliative effect was significantly longer with 30 Gy / 10 fractions compared to 16 Gy/ 2 fractions. MRC 1991 [6], found that the median duration of palliation was similar in the two treatment groups; it ranged from 46 to 73 days in the two-fraction group and from 45 to 101 days in the single fraction group and palliation of symptoms last for at least 50% of survival time.…”

Section: Discussionmentioning

confidence: 99%

“…There have been 14 published randomized clinical trials evaluating the optimal hypofractionation regimen to palliate symptoms of advanced NSCLC, which are considerably less resource and time intensive [1,2,[5][6][7][8][9][10][11][12][13][14][15][16]. However there is still no consensus on which fractionation scheme should be used.…”

Section: Introductionmentioning

confidence: 99%

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Palliative Hypofractionated Radiotherapy in South Egyptian Patients with Stage III and IV Non-Small Cell Lung Cancer

Attia¹

2015

JCPCR

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Background: In patients with advanced non-small cell lung cancer the priority should be given to controlling symptoms of the disease and thoracic radiotherapy remains an important treatment modality for these patients. The use of shorter radiotherapy schedules has an economic and logistic advantage for radiotherapy departments, as well as a high degree of patient convenience. However there is still no consensus on which fractionation scheme should be used.The aim of the study is to evaluate the effect of hypofractionated regimen (36Gy/12 fractions versus 17Gy/2 weekly fractions regimen) on symptoms relief, assessment of treatment related toxicity and its impact on overall survival (OS) in patients with locally advanced stage III and stage IV non-small cell lung cancer (NSCLC). Patients and methods:Patients were randomly assigned into two treatment groups: 1, receive 36 Gy per 12 fractions and group 2, receive 17 Gy per two fractions. Assessments by clinician for improvement of symptoms and toxicity were done weekly during radiotherapy, one month, 3 months and every 3 months thereafter. Symptomatic response was assessed by comparing the initial score for each symptom with the best score during follow-up period. A total symptom score (TSS) was produced for each patient, by adding the scores of each individual symptom. Results:The total symptom scores before radiotherapy was significantly higher to that after radiotherapy (Wilcoxon signed-rank test Z=-6.434, P=.0001). The degree and duration of symptom relief were equivalent in the treatment groups. There were no reported cases of grade 3 or 4 esophagitis or pulmonary toxicity. Grade 2 acute esophagitis was greater among patients received 36 Gy/ 12 fractions compared to those received 17 Gy/ 2 fractions (26.3% vs 14%, P = .177) but did not reach statistical significance. Two patients (3.5%) experienced grade 2 acute pneumonitis. No significant difference in survival among treatment groups was found (one year OS for group 1, was 22.3% and for group 2, was 20.4%, P = .434).Conclusion: 17Gy/2 weekly fractions regimen, provide good symptomatic relief with comparable survival to 36Gy/12 fractions regimen and should be used for patients requesting a shorter treatment course especially in which palliative chemotherapy is planned.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Palliative Hypofractionated Radiotherapy in South Egyptian Patients with Stage III and IV Non-Small Cell Lung Cancer

Attia¹

2015

JCPCR

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“…[4] was drafted, and then updated [5] to determine the most effective and least toxic palliative radiotherapy regime to improve or prevent thoracic symptoms and/or overall survival. In this review, of 14 randomized control trials [6][7][8][9][10][11][12][13][14][15][16][17][18][19], the authors concluded that there was no strong evidence that any of the reviewed dose fractionation schedules provided greater palliation than the other. Patients with good performance status and treated with higher doses of radiotherapy had a modest increase in survival of 5 % at 1 year and 3 % at 2 years, but at the cost of increased acute toxicity, in particular esophagitis.…”

Section: External-beam Radiotherapymentioning

confidence: 99%

“…Fairchild et al [20] performed a meta-analysis of 3,473 patients from 13 randomized trials [6][7][8][9][10][11][12][13][15][16][17][18][19] since 1985 that evaluated different dose fractionation schemes for palliative lung radiotherapy. The authors found that there was a greater likelihood of symptom improvement and a modest benefit in overall survival with radiotherapy schedules of 35 Gy 10 BED (i.e., 30 Gy in ten fractions) or greater.…”

Section: External-beam Radiotherapymentioning

confidence: 99%

A review of palliative radiotherapy for lung cancer and lung metastases

et al. 2012

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Introduction Treatment of thoracic symptoms related to lung cancer with palliative radiotherapy is routinely performed in conjunction with radiation oncology practice. Various clinical trials, meta-analyses, practice guidelines, consensus statements, and Cochrane reviews have been conducted on different questions related to palliative thoracic radiotherapy considerations including: patient selection, external-beam radiotherapy dose fractionation, endobronchial brachytherapy, and chemotherapy. Discussion Novel radiotherapy technologies such as stereotactic ablative radiotherapy may allow new populations to benefit from radiotherapy. These new populations include: early stage lung cancer patients not fit for surgery that previously would be treated with best supportive care or palliative approaches and the treatment of oligometastatic lung metastases. ConclusionThe goal of this narrative review is: (1) to review the foundations of what has already been established in palliative thoracic radiotherapy, with a focus on published clinical trials, (2) to review and discuss emerging data and trends in radiotherapeutic options for patients with advanced thoracic malignancies, with a focus on both clinical trials and other forms comparative-effectiveness research, and (3) to discuss active areas of research and future directions for research in this challenging patient population.

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Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy

et al. 2022

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ImportanceApproximately 50% of all patients with cancer have an indication for radiotherapy, and approximately 50% of radiotherapy is delivered with palliative intent, with the aim of alleviating symptoms. Symptoms are best assessed by patient-reported outcomes (PROs), yet their reliable interpretation requires adequate reporting in publications.ObjectiveTo investigate the use and reporting of PROs in clinical trials of palliative radiotherapy.Evidence ReviewThis preregistered systematic review searched PubMed/Medline, EMBASE, and the Cochrane Center Register of Controlled Trials for clinical trials of palliative radiotherapy published from 1990 to 2020. Key eligibility criteria were palliative setting, palliative radiotherapy as treatment modality, and clinical trial design (per National Institutes of Health definition). Two authors independently assessed eligibility. Trial characteristics were extracted and standard of PRO reporting was assessed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) PRO extension. The association of the year of publication with the use of PROs was assessed by logistic regression. Factors associated with higher CONSORT-PRO adherence were analyzed by multiple regression. This study is reported following the PRISMA guidelines.FindingsAmong 7377 records screened, 225 published clinical trials representing 24 281 patients were eligible. Of these, 45 trials (20%) used a PRO as a primary end point and 71 trials (31%) used a PRO as a secondary end point. The most prevalent PRO measures were the Numeric Rating Scale/Visual Analogue Scale (38 trials), European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire C30 (32 trials), and trial-specific unvalidated measures (25 trials). A more recent year of publication was significantly associated with a higher chance of PROs as a secondary end point (odds ratio [OR], 1.04 [95% CI, 1.00-1.07]; P = .03) but not as primary end point. Adherence to CONSORT-PRO was poor or moderate for most items. Mean (SD) adherence to the extension adherence score was 46.2% (19.6%) for trials with PROs as primary end point and 31.8% (19.8%) for trials with PROs as a secondary end point. PROs as a primary end point (regression coefficient, 9.755 [95% CI, 2.270-17.240]; P = .01), brachytherapy as radiotherapy modality (regression coefficient, 16.795 [95% CI, 5.840-27.751]; P = .003), and larger sample size (regression coefficient, 0.028 [95% CI, 0.006-0.049]; P = .01) were significantly associated with better PRO reporting per extension adherence score.Conclusions and RelevanceIn this systematic review of palliative radiotherapy trials, the use and reporting of PROs had room for improvement for future trials, preferably with PROs as a primary end point.

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Results of the Dutch National Study of the Palliative Effect of Irradiation Using Two Different Treatment Schemes for Non–Small-Cell Lung Cancer

Abstract: The 10 x 3-Gy radiotherapy schedule is preferred over the 2 x 8-Gy schedule for palliative treatment, as it improves survival and results in a longer duration of the palliative response.

Cited by 103 publications

References 25 publications

Palliative Hypofractionated Radiotherapy in South Egyptian Patients with Stage III and IV Non-Small Cell Lung Cancer

Palliative Hypofractionated Radiotherapy in South Egyptian Patients with Stage III and IV Non-Small Cell Lung Cancer

A review of palliative radiotherapy for lung cancer and lung metastases

Use and Reporting of Patient-Reported Outcomes in Trials of Palliative Radiotherapy

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