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Palliative Thoracic Radiotherapy for Non-Small-Cell Lung Cancer

A Systematic Review

Toy, Elizabeth, M.B.B.S., M.R.C.P.(UK), F.R.C.R.; Macbeth, Fergus, M.A., D.M., F.R.C.P., F.R.C.R.; Coles, Bernadette, B.Sc., M.Sc., MCLIP; Melville, Arabella, B.Sc., Ph.D.; Eastwood, Alison, B.A., M.Sc.

American Journal of Clinical Oncology: April 2003 - Volume 26 - Issue 2 - p 112–120

Non-small-cell lung cancer is one of the most common malignant tumors worldwide. The majority of patients are not treatable with curative intent because of the extent of disease or patient comorbidity. Radiotherapy to the primary intrathoracic tumor is used with the aim of palliating troublesome local symptoms in approximately 25% of patients. The dose/fractionation regimens used evolved empirically, and surveys have shown widespread variation. It has not yet been clearly established which regimens give the most benefit and least toxicity. This systematic review identified 12 randomized controlled trials comparing palliative external beam radiotherapy regimens. Narrative synthesis has been performed. Palliative radiotherapy is effective in controlling symptoms. There is no strong evidence that better palliation is obtained with higher radiation doses but good evidence that toxicity is greater. There is evidence of a modest survival benefit with higher dose schedules in patients with good performance status. The majority of patients should receive short courses (one or two fractions) of hypofractionated radiotherapy, Selected patients with good performance status should be considered for higher dose regimens if the chance of modest improvement in survival and palliation is considered worth the additional inconvenience and toxicity.

From the Velindre Hospital (E.T., F.M., B.C.), Cardiff; Independent Consultant (A.M.), Bryn Derwen, Porthmadag, Gwynedd; and Centre for Reviews and Dissemination, University of York (A.E.), Heslington York, UK.

This study was first published in electronic format in the Cochrane Library (Update Software, 2001, Issue 2). Future revisions and updates will be published at that site.

Fergus Macbeth was a member of the Medical Research Council Lung Cancer Working Party from 1989 to 1993, when three of the studies reviewed were either published, or carried out. He was a major participant in two of these trials (MRC 1992(9) and MRC 1996(10)).

Address correspondence and reprint requests to Dr. Elizabeth Toy, Consultant Clinical Oncologist, Exeter Oncology Centre, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, UK EX2 5DW.

© 2003 Lippincott Williams & Wilkins, Inc.