Fractionated palliative thoracic radiotherapy in non-small cell lung cancer - futile or worth-while?
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Fractionated palliative thoracic radiotherapy in non-small cell lung cancer - futile or worth-while? / Støchkel Frank, Malene; Schou Nørøxe, Dorte; Nygård, Lotte; Fredberg Persson, Gitte.
I: BMC Palliative Care, Bind 17, Nr. 1, 2018, s. 15.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Fractionated palliative thoracic radiotherapy in non-small cell lung cancer - futile or worth-while?
AU - Støchkel Frank, Malene
AU - Schou Nørøxe, Dorte
AU - Nygård, Lotte
AU - Fredberg Persson, Gitte
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions.METHODS: Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included. We noted pathology, tumor, node and metastasis (TNM) classification of malignant tumors, stage, indication, start date, schedule for PTR, completed y/n, performance status (PS) and time of death. Analyses were performed as an intention-to-treat using Cox regression, Fishers exact test and Kaplan Meier.RESULTS: A total of 159 patients were included. Median overall survival (OS) was 4.2 months. Sixteen patients (10%) did either not begin or finish PTR. Of these, eight (5%) died prior to or during PTR. Of the 151 patients receiving PTR, sixteen patients (11%) died within 14 days, thirty-three (22%) within 30 days and fifty (33%) within 2 months. PS 0-1 and squamous cell carcinoma were correlated with a better survival.CONCLUSIONS: Our study show that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 0-1 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 0-1 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for high dose single fraction only or supportive palliative care.
AB - BACKGROUND: Palliative thoracic radiotherapy (PTR) can relieve symptoms originating from intra-thoracic disease. The optimal timing and fractionation of PTR is unknown. Time to effect is 2 months. The primary aim of this retrospective study was to investigate survival after PTR, hypothesizing that a significant number of patients received futile fractionated PTR. The secondary aim was to find prognostic factors to guide treatment decisions.METHODS: Patients with non-small-cell lung cancer (NSCLC) planned for PTR in the period of 2010-2011 at the University Hospital of Copenhagen were included. We noted pathology, tumor, node and metastasis (TNM) classification of malignant tumors, stage, indication, start date, schedule for PTR, completed y/n, performance status (PS) and time of death. Analyses were performed as an intention-to-treat using Cox regression, Fishers exact test and Kaplan Meier.RESULTS: A total of 159 patients were included. Median overall survival (OS) was 4.2 months. Sixteen patients (10%) did either not begin or finish PTR. Of these, eight (5%) died prior to or during PTR. Of the 151 patients receiving PTR, sixteen patients (11%) died within 14 days, thirty-three (22%) within 30 days and fifty (33%) within 2 months. PS 0-1 and squamous cell carcinoma were correlated with a better survival.CONCLUSIONS: Our study show that a significant number of patients who received PTR died before they could achieve optimal effect of the treatment. PS and histology were significant prognostic factors favoring PS 0-1 and squamous cell carcinoma. Based on our study, we suggest that patients with PS 0-1 should be considered for fractionated PTR whereas patients with PS ≥ 2 should be considered for high dose single fraction only or supportive palliative care.
KW - Non-small-cell lung cancer
KW - NSCLC
KW - Overall survival
KW - Palliative
KW - Performance status
KW - Ps
KW - Radiotherapy
KW - Thoracic
U2 - 10.1186/s12904-017-0270-4
DO - 10.1186/s12904-017-0270-4
M3 - Journal article
C2 - 29304789
AN - SCOPUS:85053511669
VL - 17
SP - 15
JO - BMC Palliative Care
JF - BMC Palliative Care
SN - 1472-684X
IS - 1
ER -
ID: 357367137