Has the pattern of practice in the prescription of radiotherapy for the palliation of thoracic symptoms changed between 1999 and 2006 at the rapid response radiotherapy program?
OBJECTIVE
Eleven randomized controlled trials (RCT) comparing various radiotherapy (RT) schedules for locally advanced lung cancer published since 1991 found no difference in palliation of intrathoracic symptoms. The most commonly prescribed schedule by Canadian Radiation Oncologists (RO) (20 Gy in five fractions [20 Gy/5]), when first evaluated versus 10 Gy/1 in a 2002 RCT, showed a significant survival benefit. A subsequent RCT assessing 20 Gy/5 found worse survival versus 16 Gy/2. This study examines whether the RT prescription for lung cancer palliation in the Rapid Response Radiotherapy Program (RRRP) has changed over time.


METHODS
Chart review was conducted for patients treated with palliative thoracic RT across three periods (1999-2006). Patient demographics, tumor, treatment, and organizational factors were analyzed descriptively. Chi-square test was used to detect differences in proportions between unordered categorical variables. Continuous variables were tested using analysis of variance. Multivariate logistic regression was used to identify independent predictors of RT schedule prescribed.


RESULTS
A total of 117 patients received 121 courses of palliative thoracic RT. The most common dose (20 Gy/5) comprised 65% of courses in 1999, 68% in 2003, and 60% in 2005-2006 (p = 0.76). The next most common dose was 30 Gy/10 (13%). Overall, the median survival was 14.9 months, independent of RT schedule (p = 0.68). Multivariate analysis indicated palliative chemotherapy and certification year of RO were significant predictors of prescription of 20 Gy/5.


CONCLUSIONS
RT schedule for palliation of intrathoracic symptoms did not mirror the results of sequential, conflicting RCTs, suggesting that factors other than the literature influenced practice patterns in palliative thoracic RT.
Fairchild
Alysa
A
Rapid Access Palliative Radiotherapy Program, Cross Cancer Institute, Edmonton, Alberta, Canada.
Goh
Philiz
P
Sinclair
Emily
E
Barnes
Elizabeth A
EA
Ghosh
Sunita
S
Danjoux
Cyril
C
Barbera
Lisa
L
Tsao
May
M
Chow
Edward
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D015397:Program Evaluation; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D015996:Survival Rate; D013899:Thoracic Neoplasms / Q000532:radiotherapy