The response, outcome and toxicity of aggressive palliative thoracic radiotherapy for metastatic non-small cell lung cancer patients with controlled extrathoracic diseases
Journal
PLoS ONE
Journal Volume
10
Journal Issue
12
Date Issued
2015
Abstract
Background and Purpose: For metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. In the present study, we sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients. Materials and Methods: Between March 2006 and December 2014, 56 patients with metastatic NSCLC who had responsive or stable extrathoracic diseases after chemotherapy and/or molecular targets, and received thoracic RT for stable and progressive primary lung lesions were included. RT with a median dose of 55 Gy (range, 40-62 Gy) was administered in 1.8-2.5 Gy fractions to primary lung tumor and regional mediastinal lymph nodes using modern RT technique. Overall survival (OS) from diagnosis, and locoregional progression-free survival (LRPFS), and survival calculated from radiotherapy (OS-RT) were estimated using the Kaplan-Meier method. Results: There were 37 men and 19 women with a median age of 60 years at diagnosis. The median interval from the diagnosis of metastatic disease to thoracic RT was 8 months. Following thoracic RT, 26 patients (46%) achieved complete or partial response (overall response rate, ORR). Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034). EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284). At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months. Conclusion: Radical palliative throractic RT is safe and might be beneficial for primary lung lesions of metastatic NSCLC patients with controlled extrathoracic diseases. ? 2015 Chiang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
SDGs
Other Subjects
cisplatin; docetaxel; epidermal growth factor; etoposide; gefitinib; navelbine; paclitaxel; pemetrexed; adult; aged; Article; blood toxicity; cancer chemotherapy; cancer patient; cancer radiotherapy; cancer survival; coughing; dermatitis; dysphagia; dyspnea; EGFR gene; esophagitis; extrapulmonary disease; fatigue; febrile neutropenia; female; follow up; gene mutation; genetic association; human; major clinical study; male; non small cell lung cancer; overall survival; palliative therapy; progression free survival; radiation dose; radiation pneumonia; retrospective study; survival rate; thorax disease; treatment response; cancer grading; cancer staging; Carcinoma, Non-Small-Cell Lung; Kaplan Meier method; Lung Neoplasms; metastasis; middle aged; mortality; multimodality cancer therapy; palliative therapy; pathology; procedures; treatment outcome; very elderly; Adult; Aged; Aged, 80 and over; Carcinoma, Non-Small-Cell Lung; Combined Modality Therapy; Female; Humans; Kaplan-Meier Estimate; Lung Neoplasms; Male; Middle Aged; Neoplasm Grading; Neoplasm Metastasis; Neoplasm Staging; Palliative Care; Retrospective Studies; Treatment Outcome
Publisher
Public Library of Science
Type
journal article