Palliative Hypofractionated Radiotherapy For Non-Small Cell Lung Cancer (NSCLC) Patients Previously Treated By Induction Chemotherapy: Is It For Many, Some, All, Or None?

Abstract

pproximatelyis 30% of patients with non-smallpatients with adequate performance status, many disease that surgically unresectable (1). In current practice guidelines recommend that these patients be treated with a combination of chemotherapy and external beam irradiation (2). Over the last several years, the use of chemotherapy with radiation has been supported by several phase III multi-institutional randomized studies, with patients diagnosed with locally advanced NSCLC, having a better progression-free (PFS) and overall survival (OS) when treated with combination therapy than with radiation alone (3, 4). Despite improvements in outcome, results remain modest with aggressive combined modality therapy, with 2 and 5 year survivals in the range of 30% and 20%, respectively (4, 5). In addition, these combined modality approaches are associated with significant toxicity in a patient population that in many cases is already limited in terms of functional reserve before they even initiate definitive therapy. Despite curative efforts, many patients have disease progression or are overly symptomatic either from treatment or from their disease. It could be argued that for certain locally advanced patients, aggressive systemic and local treatment causes more harm than good.