Hotwani C, Agarwal J P, Prabhash K, Munshi A, Joshi A, Misra S, Kumar D, Das S, Laskar S G
Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India.
Indian J Cancer. 2017 Jan-Mar;54(1):262-266. doi: 10.4103/0019-509X.219587.
Majority of patients of lung cancer present with locally advanced or metastatic disease, where systemic therapy is the treatment of choice. Many of these patients have local symptoms due to thoracic disease, wherein radiotherapy is proven to be an effective modality for alleviation of symptoms. However, the optimal dose of radiotherapy for adequate palliation remains debatable. The purpose of this retrospective study was to assess the efficacy of two different schedules of thoracic radiotherapy (TRT) with respect to symptom palliation.
A total of 100 consecutively treated patients with stages III-IV lung cancer treated with two different fractionation regimens of palliative TRT, either protracted course 20 Gy/5# over 1 week or short course of 17 Gy/2# over 8 days were assessed for symptom relief and survival. Impact of patient, tumor and treatment-related factors on response and overall survival (OS) was done by univariate analysis using log-rank test.
Median age of the entire cohort was 60 years, majority being males, smokers with low Eastern Cooperative Oncology Group performance status (performance score ≥2). Predominant symptoms were chest pain (68) followed by cough (21) and dyspnea (15). Palliative TRT was offered as either protracted course 20 Gy/5# over 1 week or short course of 17 Gy/2# over 8 days in 21 and 79 patients respectively. Median duration of symptom relief was 2 months, no differences in OS at 1 year with either regimen.
TRT is an effective means of palliation having similar symptom relief and outcomes with weekly (17 Gy/2# over 8 days) or protracted radiotherapy regimens (20 Gy/5#over 1 week). Short TRT schedules are convenient and economical for patients as well as resource sparing for high volume centers.
大多数肺癌患者就诊时已处于局部晚期或转移性疾病阶段，此时全身治疗是首选治疗方法。这些患者中有许多人因胸部疾病出现局部症状，放疗已被证明是缓解症状的有效方式。然而，用于充分缓解症状的最佳放疗剂量仍存在争议。这项回顾性研究的目的是评估两种不同的胸部放疗（TRT）方案在症状缓解方面的疗效。
共有100例连续接受治疗的III-IV期肺癌患者，接受了两种不同分割方案的姑息性TRT，即1周内20 Gy/5次的延长疗程或8天内17 Gy/2次的短疗程，评估其症状缓解情况和生存率。使用对数秩检验通过单因素分析评估患者、肿瘤和治疗相关因素对反应和总生存期（OS）的影响。
整个队列的中位年龄为60岁，大多数为男性，是吸烟者，东部肿瘤协作组体能状态较低（体能评分≥2）。主要症状为胸痛（68例），其次是咳嗽（21例）和呼吸困难（15例）。分别有21例和79例患者接受了1周内20 Gy/5次的延长疗程或8天内17 Gy/2次的短疗程姑息性TRT。症状缓解的中位持续时间为2个月，两种方案在1年时的总生存期无差异。
TRT是一种有效的缓解症状方法，每周（8天内17 Gy/2次）或延长放疗方案（1周内20 Gy/5次）在症状缓解和结果方面相似。短疗程TRT方案对患者来说方便且经济，对大容量中心而言也节省资源。
