A prospective study of the effect of different palliative radiotherapy fractionation schedules on tumour response and toxicity in advanced Non Small Cell Lung Cancer (NSCLC) patients

Abstract

This study included forty Patients with advanced NSCLC who presented to radiation oncology department, National Cancer Institute, Cairo University - from December 2014 to October 2015 - for palliative irradiation to the lung. The patients were randomized into two fractionation arms: 30Gy in 10 fractions over two weeks (arm A) and 27Gy in 6 fractions over three weeks, two fractions per week (arm B). Twenty patients were included in each arm. Primary outcome was the effect of the two treatment arms on symptomatic improvement, radiological response of thoracic tumour and respiratory functions. Secondary outcome was toxicity.

The patients and disease criteria were well matched between the two treatment arms. Age ranged from 40-65 years with a mean age of 58.40 years. Males constituted 38 out of the 40 patients (95%). Thirty eight out of the 40 patients (95%) were heavy smokers and the remaining 2 patients (5%) were non smokers. Median years of smoking were 30 years in the two treatment arms. Weight loss more than 5% before radiation was reported in 22 patients (55%). According to ECOG /WHO PS, 21 patients (52.5 %) were PS 1 compared to 19 patients (47.5%) with PS 2. HB ranged from 9.8 mg/ dl to 14.6 mg/ dl with a mean value of 12.5mg/ dl. Adenocarcinoma was the most common pathology type, presenting 55 % (22 patients). SCC was the second common type, presenting 35 % (14 patients) followed by large cell carcinoma which was present in 4 patients (10%). According to TNM 2010 (AJCC, 7th edition), major