Split-Course Palliative Radiotherapy for Advanced Non-small Cell Lung Cancer

Metcalfe, S.K.; Milano, Michael T.; Bylund, Kevin; Smudzin, T.; Rubin, Philip; Chen, Yuhchyau

doi:10.1097/jto.0b013e3181c6eb20

Cited by 15 publications

(14 citation statements)

References 26 publications

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“…Only prospective studies can determine whether uncompensated treatment interruption compromises quality of life. It should also be noted that a variety of palliative split-course radiotherapy regimens with quite long OTT have been developed which result in good symptom relief and duration of palliation [23]. Jones et al have stated that it is debatable whether compensation should be applied in all patients [4], and the present data support this view, at least when one focuses on overall survival.…”

Section: Discussionsupporting

confidence: 59%

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

et al. 2011

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PURPOSE To evaluate whether reduced overall treatment time (OTT), i.e., administration of more than 5 fractions per week, or uncompensated treatment interruption resulting in increased OTT influences survival of patients treated with whole-brain radiotherapy (WBRT) for brain metastases. METHODS Retrospective multi-institutional intention-to-treat study including 233 patients treated with primary WBRT (prescribed dose 10 fractions of 3 Gy; no previous SRS or surgery) administered over 10-38 days. Four groups were studied: OTT 10-11 vs. 12 days, 13-15 or >15 days. RESULTS Fourteen patients (6%) failed to complete WBRT and received 3-9 fractions (median 7). Their median survival was 0.5 months as compared to 3 months in patients who completed WBRT. No significant impact of OTT on survival was found. Median survival was 1.5, 2.9, 3.0 and 3.1 months in the four groups mentioned above. CONCLUSIONS Compensation for unintended treatment interruption is generally recommended but might not always be feasible. Depending on histological tumour type or expected repopulation, prognostic factors and neurological status, it might be acceptable to complete an interrupted course of WBRT without compensation in selected patients. While survival might be largely independent from OTT, it should also be evaluated whether this parameter has any impact on quality of life and duration of palliation.

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Section: Discussionsupporting

confidence: 59%

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

et al. 2011

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“…The utility of split-course RT in rectal cancer has not been reported, and thus it is unclear whether such an approach is associated with a negative impact on outcome in terms of local control or survival. There are several examples in other cancer types, associated with reduced toxicity while maintaining efficacy (Pradier et al , 2004; Metcalfe et al , 2010; Fukuda et al , 2012; Gogna et al , 2012). The high metabolic response rates of the primary rectal cancer reported here support that this strategy warrants further study, but it should also be noted that split-course radiation was reported to have a negative impact in head and neck (Daoud et al , 2007; Miszczyk et al , 2014), gynaecological (Pedersen et al , 1994), and anal cancers (John et al , 1996).…”

Section: Discussionmentioning

confidence: 99%

Phase II trial evaluating the feasibility of interdigitating folfox with chemoradiotherapy in locally advanced and metastatic rectal cancer

et al. 2014

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Background:Patients (pts) with metastatic rectal cancer and symptomatic primary, require local and systemic control. Chemotherapy used during chemoradiotherapy (CRT) is adequate for radiosensitisation, but suboptimal for systemic control. The aim of this phase II study was to assess tolerability, local/systemic benefits, of a novel regimen delivering interdigitating intensive chemotherapy with radical CRT.Methods:Eligible pts had untreated synchronous symptomatic primary/metastatic rectal cancer. A total of 12 weeks of treatment with split-course pelvic CRT (total 50.4 Gy with concurrent oxaliplatin and 5-FU infusion) alternating with FOLFOX chemotherapy. All pts staged with CT, MRI and FDG-PET pre and post treatment.Results:Twenty-six pts were treated. Rectal primary MRI stage: T3 81% and T4 15%. Liver metastases in 81%. Twenty-four pts (92%) completed the 12-week regimen. All patients received planned RT dose, and for both agents over 88% of patients achieved a relative dose intensity of >75%. Grade 3 toxicities: neutropenia 23%, diarrhoea 15%, and radiation skin reaction 12%. Grade 4 toxicity: neutropenia 15%. FDG-PET metabolic response rate for rectal primary 96%, and for metastatic disease 60%.Conclusions:Delivery of interdigitating chemotherapy with radical CRT was feasible to treat both primary and metastatic rectal cancer. High completion and response rates were encouraging.

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“…Thirty-four patients (71%) underwent their primary RT at our institution, whereas 14 patients were treated at our institution only upon recurrence. Although split-course radiation for bulky disease 10,11 was occasionally used at our institution during this timeframe, such patients were not included in this analysis; only 1 patient in this series was retreated to the thorax within 4 months of original thoracic radiation.…”

Section: Methodsmentioning

confidence: 99%

Reirradiation for Locoregionally Recurrent Lung Cancer

Kruser

McCabe

Mehta

et al. 2014

American Journal of Clinical Oncology

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Objectives To our knowledge this is the largest report analyzing outcomes for reirradiation (reRT) for locoregionally recurrent lung cancer, and the first to assess thoracic reRT outcomes in patients with small cell lung cancer (SCLC). Methods Forty-eight patients (11 SCLC, 37 non–small cell lung cancer [NSCLC]) receiving reRT to the thorax were identified; 44 (92%) received reRT by intensity-modulated radiotherapy. Palliative responses, survival outcomes, and prognostic factors were analyzed. Results NSCLC patients received a median of 30 Gy in a median of 10 fractions, whereas SCLC patients received a median of 37.5 Gy in a median of 15 fractions. Median survival for the entire cohort from reRT was 4.2 months. Median survival for NSCLC patients was 5.1 months, versus 3.1 months for the SCLC patients (P = 0.15). In NSCLC patients, multivariate analysis demonstrated that Karnofsky performance status≥80 and higher radiation dose were associated with improved survival following reRT, and 75% of patients with symptoms experienced palliative benefit. In SCLC, 4 patients treated with the intent of life prolongation for radiographic recurrence had a median survival of 11.7 months. However, acute toxicities and new disease symptoms limited the duration of palliative benefit in the 7 symptomatic SCLC patients to 0.5 months. Conclusions ReRT to the thorax for locoregionally recurrent NSCLC can provide palliative benefit, and a small subset of patients may experience long-term survival. Select SCLC patients may experience meaningful survival prolongation after reRT, but reRT for patients with symptomatic recurrence and/or extrathoracic disease did not offer meaningful survival or durable symptom benefit.

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Split-Course Palliative Radiotherapy for Advanced Non-small Cell Lung Cancer

Cited by 15 publications

References 26 publications

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

Phase II trial evaluating the feasibility of interdigitating folfox with chemoradiotherapy in locally advanced and metastatic rectal cancer

Reirradiation for Locoregionally Recurrent Lung Cancer

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