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Five-Fraction Palliative Radiotherapy May Improve NSCLC Survival

Five-Fraction Palliative Radiotherapy May Improve NSCLC Survival

SAN FRANCISCO—Patients with inoperable non-small-cell lung cancer
(NSCLC) who receive 20 Gy of radiation therapy in five fractions achieved
slightly superior palliation of thoracic symptoms than those receiving a
single 10-Gy dose, according to a study presented at the 43rd Annual Meeting
of the American Society for Therapeutic Radiology and Oncology (abstract
30). An unexpected finding was that patients receiving the five-fraction
therapy survived significantly longer, the study authors said.

"There was a significant difference in survival between those
receiving single fraction and five-fraction therapy," said Clive
Grafton, FRCPC, PhD, of the British Columbia Cancer Agency, Vancouver.
"But this survival benefit was limited to patients who had an ECOG
performance status between 0 and 1."

Although symptoms in both groups improved, the improvement was small,
according to Dr. Grafton. "The benefits in quality of life for these
patients were quite modest," he added.

Similar Palliation

Previous studies since 1991 have shown that higher-dose radiation
therapies offer a small survival benefit to cancer patients when compared
with lower-dose therapies. High- and low-dose therapies, however, achieve
similar palliation, according to recent studies.

In the Canadian study, patients were randomized between August 1997 and
January 2001 to receive 10-Gy single-fraction therapy or 20 Gy in five
fractions. Patients came from 13 cancer centers across Canada.

The majority of patients (69%) had locally advanced disease while a
minority (24%) had stage IV disease. "Many of these patients were not
suitable for radical treatment, yet still required palliation of
symptoms," Dr. Grafton said. The reasons patients were deemed
unsuitable for radical treatment included bulky disease that could not be
irradiated safely to high doses, ECOG performance status of 2 or 3, weight
loss greater than 10%, inability to tolerate chemotherapy, and cytologically
positive pleural effusion.


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