Abstract
Introduction: Palliative radiotherapy or chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) may cause thoracic toxicities due to the radiation dose delivered to the lungs, heart, and esophagus. We studied severe thoracic toxicities resulting in hospitalization or death during the acute and sub-acute phase, i.e., three months from commencing radiotherapy. In addition, risk factors were identified. Methods: A retrospective review of 165 patients treated with three-dimensional conformal palliative radiotherapy or CRT was performed. The prescribed total dose was equivalent to at least 30 Gy in 10 fractions. Uni- and multivariate analyses were employed.Results: Twelve patients (7%) were hospitalized within three months from the start of radiotherapy or CRT. Six patients were hospitalized for esophagitis, three for dyspnea most likely caused by pneumonitis, and three for cardiac arrhythmia. Fatal toxicity was not observed. However, 19% of the 165 patients died from tumor-related causes during the time period of interest. In multivariate analysis, the only esophageal dose was significantly associated with the risk of hospitalization. Conclusion: The safety profile of palliative radiotherapy or CRT in the acute and subacute phases was satisfactory. The hospitalization rate can be reduced by lowering the esophageal dose, as long as safe lung and heart doses can be maintained.
Highlights
Palliative radiotherapy or chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) may cause thoracic toxicities due to the radiation dose delivered to the lungs, heart, and esophagus
Thirty-six percent had a diagnosis of chronic obstructive pulmonary disease (COPD)
Twelve patients (7%) were hospitalized for thoracic toxicity during the same time period (six for esophagitis common terminology criteria for adverse events (CTCAE) grade 3, three for dyspnea most likely caused by pneumonitis (CTCAE grade 3), and three for cardiac arrhythmia)
Summary
Palliative radiotherapy or chemoradiotherapy (CRT) for non-small cell lung cancer (NSCLC) may cause thoracic toxicities due to the radiation dose delivered to the lungs, heart, and esophagus. Intermediate radiation doses between 30 and 60 Gy, such as the Norwegian CONRAD regime (42 Gy in 15 fractions), are endorsed in current guidelines, preferably in combination with platinum-based chemotherapy [8,9]. Both chemotherapy and radiation are highly likely to induce at least mild or moderate side effects [10,11]. In order to study treatment safety, we performed a retrospective analysis of hospitalization and death within three months from the start of palliative radio- or chemoradiotherapy
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