Efficacy and Tolerability of Palliative Split-Course Thoracic Chemoradiotherapy for Symptomatic Non-Small Cell Lung Cancer.
BACKGROUND
To assess the efficacy and tolerability of palliative split-course concurrent thoracic chemoradiotherapy (CRT) in patients with incurable locally advanced and metastatic non-small cell lung cancer.


METHODS
All patients with incurable non-small cell lung cancer and symptomatic thoracic disease treated with palliative split-course CRT between March 2006 and February 2013 at a single institution were included in this retrospective study. The primary endpoint was improvement in presenting thoracic symptoms. Secondary endpoints included toxicity, overall survival, and the cumulative incidence of locoregional failure.


RESULTS
Fifty-five patients were identified, of whom 89% had distant metastatic disease at the initiation of treatment. The median radiotherapy dose delivered was 40 Gy over 20 fractions. Over 90% of patients were able to complete at least 2 cycles of chemotherapy, and 89% of patients completed the prescribed course of radiotherapy. Forty percent of patients had improvement in all presenting symptoms and 78% experienced improvement in at least 1 symptom. Nine and 2 patients, respectively, experienced grade 1 and 2 esophagitis and 1 patient experienced grade 2 pneumonitis. There were no cases of grade 3 toxicity. With a median follow-up for surviving patients of 4.5 months, the estimated actuarial 6-, 12-, and 24-month overall survival was 56%, 25%, and 13%, respectively. The actuarial 6-, 12-, and 24-month cumulative incidence of locoregional failure was 6%, 14%, and 22%, respectively.


CONCLUSIONS
Split-course CRT allows for early introduction of systemic therapy while providing durable locoregional control with tolerable morbidity and significant improvement in chest symptomatology. This paradigm is a viable model for chest palliation in selected patients with intact performance status.
*Department of Radiation Oncology ‡Section of Medical Oncology, Rush University Medical Center, Chicago, IL †Trinity School of Medicine, St Vincent, West Indies.
Virag K
VK
Dandekar
Jennifer
J
Young
Krystyna
K
Kiel
Philip
P
Bonomi
Mary J
MJ
Fidler
Marta
M
Batus
David J
DJ
Sher
D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods*; D002637:Chest Pain / Q000209:etiology / Q000628:therapy; D015331:Cohort Studies; D003371:Cough / Q000209:etiology / Q000628:therapy; D004417:Dyspnea / Q000209:etiology / Q000628:therapy; D004941:Esophagitis / Q000209:etiology; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006469:Hemoptysis / Q000209:etiology / Q000628:therapy; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage; D010166:Palliative Care; D000068437:Pemetrexed / Q000008:administration & dosage; D011832:Radiation Injuries / Q000209:etiology; D017564:Radiation Pneumonitis / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome
D000068437:Pemetrexed; D005047:Etoposide; D016190:Carboplatin; D017239:Paclitaxel