title: Hypofractionated external beam radiotherapy as retreatment for symptomatic non-small-cell lung carcinoma: an effective treatment?
abstract: OBJECTIVE
  To evaluate prospectively the efficacy, toxicity, and duration of the palliative effect of retreatment with external beam radiotherapy in symptomatic patients with recurrent non-small-cell lung cancer.
  
  
  METHODS
  Twenty-eight symptomatic patients with local recurrence of non-small-cell lung cancer underwent repeated treatment after previous radiotherapy (equivalent dose, 46-60 Gy). Reirradiation consisted of two fractions of 8 Gy on Days 1 and 8 with two opposed beams using 6-18-MV photon beams at the site of pulmonary recurrence. The physician scored symptom resolution.
  
  
  RESULTS
  Relief of hemoptysis and superior vena cava syndrome could be obtained in all assessable cases (100%). Treatment was less effective for coughing (67%) and dyspnea (35%). The overall median duration of this palliative effect was 4 months. Palliation in almost all patients lasted more than one-half of their remaining life span. The Karnofsky performance score improved in 45% of assessable cases. One patient had Grade 2 esophagitis. Complications consisted of tumor-related fatal hemoptysis in 5 patients (17%) and 1 death from bronchoesophageal fistula (4%).
  
  
  CONCLUSIONS
  External beam hypofractionated reirradiation can be effective as a palliative treatment for local complaints in non-small-cell lung cancer. The complication rate of reirradiation was acceptably low.
authors.affiliation: Radiotherapy Institute ARTI, Joint Centre of Oncology RADIAN, Arnhem, The Netherlands. g.kramer@radian.nl
authors.forename: Gijsbert W P M
authors.initials: GW
authors.lastname: Kramer
authors.forename: Steven
authors.initials: S
authors.lastname: Gans
authors.forename: Eric
authors.initials: E
authors.lastname: Ullmann
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Meerbeeck
authors.forename: Catherine C
authors.initials: CC
authors.lastname: Legrand
authors.forename: Jan-Willem H
authors.initials: JW
authors.lastname: Leer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000532:radiotherapy*; D016001:Confidence Intervals; D003371:Cough / Q000532:radiotherapy; D004417:Dyspnea / Q000532:radiotherapy; D005260:Female; D006469:Hemoptysis / Q000532:radiotherapy; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000150:complications / Q000532:radiotherapy*; D010166:Palliative Care; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D019233:Retreatment; D013479:Superior Vena Cava Syndrome / Q000532:radiotherapy; D016019:Survival Analysis