Immediate or delayed radiotherapy in advanced non-small cell lung cancer (NSCLC)? Data from a prospective randomised study.
OBJECTIVE
To compare the course of symptoms and health-related quality-of-life (HRQOL) after immediate thoracic radiotherapy (TRT) between symptomatic (S) and non-symptomatic (NS) patients with advanced NSCLC.


METHODS
407 stage III/IV patients were initially treated with immediate TRT within a randomised phase III trial comparing different fractionation schedules. At inclusion, patients were prospectively stratified according to presence (S) or absence (NS) of tumour-related chest/airway symptoms to facilitate comparison between these groups. The EORTC QLQ-C30 and LC-13 were used for symptom and HRQOL assessments at baseline and at regular intervals up to 1 year (N=395).


RESULTS
NS patients had significantly more favourable baseline characteristics when compared to S patients with a median survival of 11.8 versus 6.0 months (P<0.0001), respectively. At baseline, S patients demonstrated HRQOL scores inferior to those of NS patients (P<0.01) for most scales. Until week 14, NS patients developed more symptoms while S patients experienced symptom relief in most scales. After week 14, no significant differences could be observed between the groups.


CONCLUSIONS
This study indicates that immediate TRT, given to patients with minimal/none chest symptoms, does not prevent development of disease-related symptoms and diminished HRQOL. A wait-and-see policy appears to be acceptable.
Sundstrøm
Stein
S
Department of Oncology, St. Olavs Hospital of Trondheim, Norway. stein.sundstrom@stolav.no
Bremnes
Roy
R
Brunsvig
Paal
P
Aasebø
Ulf
U
Olbjørn
Klepp
K
Fayers
Peter M
PM
Kaasa
Stein
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D011788:Quality of Life; D013997:Time Factors