title: Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15).
abstract: OBJECTIVE
  This multi-institutional Phase III randomized study compared 10 Gy single-fraction radiotherapy (RT) with 20 Gy in five fractions in the palliation of thoracic symptoms from lung cancer.
  
  
  METHODS
  The primary end point was palliation of thoracic symptoms at 1 month after RT, evaluated by a patient-completed daily diary card. Secondary end points included quality of life, toxicity, and survival.
  
  
  RESULTS
  Most (69%) of 230 patients randomized had locally advanced disease unsuitable for curative treatment. The treatment arms were well balanced with respect to the known prognostic factors. At 1 month after RT, no difference was found in symptom control between the two arms, as judged by the daily diary scores. The changes in the scores on the Lung Cancer Symptom Scale indicated that the fractionated RT (five fractions) group had greater improvement in symptoms related to lung cancer (p = 0.009), pain (p = 0.0008), ability to carry out normal activities (p = 0.037), and better global quality of life (p = 0.039). The European Organization for Research and Treatment of Cancer QLQ-C30 scores showed that patients receiving five fractions had a greater improvement in scores with respect to pain (p = 0.04). No significant difference was found in treatment-related toxicity. Patients who received five fractions survived on average 2 months longer (p = 0.0305) than patients who received one fraction.
  
  
  CONCLUSIONS
  Although the two treatment strategies provided a similar degree of palliation of thoracic symptoms, the difference in survival between the two study arms was of a clinically relevant magnitude.
authors.affiliation: Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, ON, Canada. andrea.bezjak@rmp.uhn.on.ca
authors.forename: Andrea
authors.initials: A
authors.lastname: Bezjak
authors.forename: Peter
authors.initials: P
authors.lastname: Dixon
authors.forename: Michael
authors.initials: M
authors.lastname: Brundage
authors.forename: Dong
authors.initials: D
authors.lastname: Tu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Palmer
authors.forename: Paul
authors.initials: P
authors.lastname: Blood
authors.forename: Clive
authors.initials: C
authors.lastname: Grafton
authors.forename: Catherine
authors.initials: C
authors.lastname: Lochrin
authors.forename: Carson
authors.initials: C
authors.lastname: Leong
authors.forename: Liam
authors.initials: L
authors.lastname: Mulroy
authors.forename: Colum
authors.initials: C
authors.lastname: Smith
authors.forename: James
authors.initials: J
authors.lastname: Wright
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Pater
mesh_terms: D002170:Canada; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D010166:Palliative Care; D011788:Quality of Life; D016019:Survival Analysis