Higher doses of palliative lung radiotherapy are associated with better survival in patients with non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), regardless of performance status, according to a research by the Christie NHS Foundation Trust and the University of Manchester.
A retrospective univariable (n=925) and multivariable (n=422) survival analysis of the prognostic significance of baseline patient characteristics and treatment prescription was carried out on patients with NSCLC and SCLC treated with palliative lung radiotherapy.
The covariates investigated included gender, age, performance status, histology, co-morbidities, stage, tumour location, tumour side, smoking status, pack year history, primary radiotherapy technique and fractionation scheme. The overall mortality rate at 30 and 90 days of treatment was calculated.
Univariable analysis revealed that performance status (P<.001 fractionation scheme co-morbidities small cell histology never smoking status and gender were associated with survival.>
On multivariable analysis, only better performance status (P=.01) and increased dose/fractionation regimens of up to 30 Gy/10 fractions (P<.001 were associated with increased survival.>
Eighty-five (9.2%) and 316 patients (34%) died within 30 and 90 days of treatment, respectively.
The difference in median overall survival between receiving 10 Gy/one fraction and 30 Gy/10 fractions in patients with a good, mid and poor performance status was 126, 80.5 and 77 days, respectively. Similar results were found when NSCLC patients were assessed in isolation.
The authors concluded that increased fractionation regimens (up to and including 30 Gy/10 fractions) were associated with better survival, regardless of performance status. However, this retrospective, single-centre analysis is limited by a lack of data on systemic anticancer treatments, toxicity and quality of life.