Safety and palliative efficacy of single-dose 8-Gy reirradiation for painful local failure in patients with stage IV non-small cell lung cancer previously treated with radical chemoradiation therapy.
OBJECTIVE
To investigate the safety and efficacy of single-dose 8-Gy palliative chest reirradiation (CRI) in metastatic non-small cell lung cancer (M-NSCLC) patients with painful thoracic failures (TF) within the previous radiation portal.


METHODS
We retrospectively analyzed the clinical data of 78 M-NSCLC patients who received single-dose 8-Gy CRI for painful TF after concurrent chemoradiation therapy to a total radiation dose of 52 to 66 Gy between 2007 and 2012. Primary endpoints included significant pain relief (SPR) defined as a ≥2 point decrement in the Visual Analogue Scale for Pain inventory (VAS-P), time to pain relief, and duration of pain control. Secondary objectives were survival and prognostic factors.


RESULTS
Treatment was well tolerated, with only 5.1% grade 3 pneumonitis and 1.3% grade 2 esophagitis. Pre-CRI median and post-CRI minimum VAS-P were 7 and 3 (P<.001), respectively. SPR was noted in 67 (85.9%) patients, and only 3 (3.9%) scored progressive pain. Median time to lowest VAS-P and duration of pain control were 27 days and 6.1 months, respectively. Median overall survival (OS) was 7.7 months, and the 1-year OS rate was 26.5%. On multivariate analyses, lower Eastern Cooperative Oncology group score (1-2; P<.001), absence of anemia (P=.001), and fewer metastatic sites (1-2; P<.001) were found to be associated with longer OS.


CONCLUSIONS
Single-dose 8-Gy CRI provides safe, effective, and durable pain palliation for TF in radically irradiated M-NSCLC patients. Because of its convenience, lower cost, and higher comfort, the present protocol can be considered an appropriate option for patients with limited life spans.
Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey. Electronic address: docdretopkan@gmail.com.
Erkan
E
Topkan
Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey.
Berna Akkus
BA
Yildirim
Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey.
Ozan Cem
OC
Guler
Baskent Department of Radiation Oncology, University Adana Medical Faculty, Adana, Turkey.
Cem
C
Parlak
Koc University, School of Medicine, Department of Radiation Oncology, Istanbul, and American Hospital, University of Texas MD Anderson Radiation Treatment Center, Istanbul, Turkey.
Berrin
B
Pehlivan
Medstar Hospital, Department of Radiation Oncology, Antalya, Turkey.
Ugur
U
Selek
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D059248:Chemoradiotherapy; D002637:Chest Pain / Q000209:etiology / Q000532:radiotherapy*; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010166:Palliative Care / Q000379:methods; D011014:Pneumonia / Q000209:etiology; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D019233:Retreatment / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome