SAN FRANCISCOPatients 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.
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.