Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15).
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.
Bezjak
Andrea
A
Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, Toronto, ON, Canada. andrea.bezjak@rmp.uhn.on.ca
Dixon
Peter
P
Brundage
Michael
M
Tu
Dong
D
Palmer
Michael J
MJ
Blood
Paul
P
Grafton
Clive
C
Lochrin
Catherine
C
Leong
Carson
C
Mulroy
Liam
L
Smith
Colum
C
Wright
James
J
Pater
Joseph L
JL
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