Randomized Study of Single Versus Fractionated Radiotherapy (RT) in the Palliation of Non-Small Cell Lung Cancer; NCIC CTG SC.15
William Levin, MD
University of Pennsylvania Cancer Center
Last Modified: November 4, 2001
Presenter: A. Bezjak
Affiliation: Dept of Radiation Oncology, Princess Margaret Hospital, Toronto, ON, Canada
- In comparison to definitive radiation therapy, the optimal doses and fraction schedules for palliative treatments are less well defined.
- Theoretically, administration of larger daily fractions over fewer days offers more convenience and economy for the patients, while providing better utilization of limited healthcare resources.
- This study was designed to compare the effectiveness of 10 Gy single fraction versus 20 Gy in 5 fractions of thoracic radiotherapy (RT) in the palliation of thoracic symptoms in patients with non-small cell lung cancer (NSCLC).
Materials and Methods
- This was a multi-institutional phase III study of 230 patients with thoracic symptoms due to NSCLC, deemed unsuitable for radical treatment.
- Primary endpoint was palliation of thoracic symptoms at 1 month following RT, evaluated by a patient-completed daily diary card.
- The average mean score at week 5 and change score from baseline to week 5 for each symptom were compared between two treatment arms.
- Secondary endpoints were thoracic symptoms evaluated longitudinally using the Lung Cancer Symptom Scale (LCSS); quality of life (evaluated by the EORTC QLQ-C30); treatment toxicity and overall survival.
- At 1 month following RT, there was no difference in symptom control between the two arms, as judged by the daily diary scores.
- Preliminary analysis of the EORTC QLQ-C30 scores showed that patients receiving 5 fractions had greater improvement in scores with respect to dyspnea (p=0.027).
- Change scores on LCSS indicated that fractionated RT group had greater improvement in symptoms related to lung cancer (p=0.037), pain (p=0.017) and the ability to carry out normal activities (p = 0.047).
- Patients receiving 5 fractions survived significantly longer (median survival 6.0 mo, 95% CI 5.2 - 7.9 mo) than those given a single fraction (median 4.2 mo, 95% CI 3.7- 5.2 mo); p 0.014.
- There was no significant difference in the treatment-related toxicity.
- Although the two treatment strategies provided similar degree of palliation of thoracic symptoms, the unexpected difference in survival between the two study arms is of a clinically relevant magnitude.
- Possible explanations for this survival difference are being explored.
- The results of this study suggest that the pursuit of increased survival in the palliative setting is a reasonable goal and one that should be addressed in future clinical investigations.
- Further studies are need to identify the optimal regimens for palliation of thoracic tumors