Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer

Abstract

Survival and prognostic variables in patients with advanced or metastatic non-small cell lung cancer (NSCLC) requiring thoracic palliative radiotherapy using a moderately hypofractionated regime (13-15 × 3Gy) were evaluated. From March 2006 to April 2012, 120 patients with a physician estimated prognosis of 6-12months were treated with this regime using CT-based 3D conformal radiotherapy. We collected data on patient characteristics, comorbidities, toxicity, and treatment parameters. Radiotherapy was completed as prescribed in 114patients (95.0 %, premature termination 5.0 %). Acute grade3 toxicity was seen in 6.4 % of patients. The median survival of all patients was 5.8months. Nonmetastatic patients survived significantly longer than patients with metastatic disease (median 11.7months vs 4.7months, p = 0.0001) and 18.6 % of nonmetastatic patients survived longer than 2years. In 12.7 % radiotherapy started less than 30days before death and 14.2 % of patients received radiotherapy within 14days before death. In the multivariate analysis, good general condition, nonmetastatic disease, and a stable or improved general condition at the end of radiotherapy were significant. The treatment parameters, age, and comorbidities were not statistically significant. Our data confirm considerable effectiveness of 13 × 3Gy with conformal radiotherapy for patients with locally confined NSCLC not fit for radical treatment and raise doubt for this regimen in metastatic patients and ECOG ≥ 2 when burden, acute toxicity, and resources are considered.