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Abstract
Non small cell lung cancer is a highly lethal disease, presenting in advanced stages in more than two thirds of patients diagnosed with this disease. The majority of these patients have symptoms related to the loco-regional tumor growth, including dyspnea, cough, hemoptysis and chest pain as the most frequent symptoms. Unfortunately, many patients are unfit to combined chemotherapy and radical RT regimens. Palliative radiotherapy alone plays an important role in the palliation of these patients and in the preservation of their quality of life.
There is a significant role of hypofractionation in palliative therapy as proved by many radiobiological and clinical studies. It requires fewer trips to the RT facility for the patient, and smaller direct and indirect costs for society, especially in developing countries with limited resources. So, in patients with advanced disease and poor PS who have short expected survival time, hypofractionation could be a suitable choice.
The aim of the present work was to investigate whether the effect of hypofractionated thoracic radiotherapy is comparable to more standard fractionated radiotherapy.
A total of 30 patients with locally advanced stage III or stage IV NSCLC tumors, seen in the department of clinical oncology and nuclear medicine, Alexandria University hospital from June 2008 till December 2009, were included. These patients were randomly assigned into one of two groups: group A (15 patients) received RT regimen of 30 Gy in 10 fractions, and group B (15 patients) received 17 Gy in 2 fractions separated by one week. The study end points were primarily symptomatic palliation of the intrathoracic symptoms and secondarily treatment tolerance, quality of life, tumor control, and overall survival. The EORTC Quality of Life Questionnaire (QLQ)-C30 and EORTC QLQ-lung cancer–specific module (LC13) were used to investigate symptom relief and changes in HRQOL at base line, 1, 6 and 16 weeks after the end of radiotherapy.
The patient’s major clinical characteristics as well as incidence and degree of initial disease-related symptoms were homogenous between the both study groups. Significant palliation of the airway symptoms was achieved equally in both arms as reported by patients and also as assessed clinically. Hemoptysis had the highest improvement rate of 100% in both groups followed by the other symptoms. Treatment tolerance was good and did not differ between study arms. Quality of life was preserved equally in both arms. There was no significant statistical difference in the overall survival among both arms with a median survival of 5 and 6 months in group A and B, respectively.
We concluded that the hypofractionated regimen is equally effective as the more protracted regimen in terms of palliative effect, treatment tolerance and overall survival. This may hopefully convince at least some radiation oncologists still using more protracted regimens to adopt this simple and efficient treatment .