Table 7. Summary of the randomised trials of high-dose palliative radiotherapy in patients with NSCLC.
| Reference | Patient cohort | Treatment arms | ORR | Local symptom palliation | Median OS (mos) |
|---|---|---|---|---|---|
| Michael et al | 24 Stage 1 – limited IV, local symptoms | Cis+Vin/40 Gy/20#s/5 pw → Cis+Vin × 2 | 65% | 21–50% | 13.5 |
| Nestle et al (2000) | 121 Stage IIIa, and 31 limited stage IVa | 60 Gy/30#s/5 pw 32/16#s/10 pw | 66% NS | Upto 33% NS | 8.4 |
| Reinfuss et al (1999) | 240 Stage IIIa | 50 Gy/25#/5 pw 40 Gy/10#/5b pw (60)c Delayed:20 Gy/5#/5 pw (30) | 12 9 6 | ||
| Macbeth et al (1996) | 509a No distant disease | 17 Gy/2#s/1 pw (44.6) 39 Gy/13#s/5 pw (48.7) | ND | 45–89% at 3 months | 7 9 |
| Sundstrom et al (2004) | 421, Stage III, IV,a local Sx | 17 Gy/2#s/1 pw (44.6) 42 Gy/15#s/5 pw (50.4) 50 Gy/25#s/5 pw | ND | 20–90% NS | 8.2 7 6.8 |
| Teo et al (1988) | 273d, Stage III or IV | 45 Gy/18#s/5 pw (50.6) 31.2 Gy/4#s/1 pw (76.4) | 53%e 50% | 71%f 54% (P<0.02) | 4.6 NS |
| Simpson et al (1985) | 409, T4NxM0, TxN3M0 | 40 Gy/10#s/5 pw, split course (60) 30 Gy/10#s/5 pw (37.5) 40 Gy/20#s/5 pw Post RT → Chemo vs Observation | 40%g 44% 42% NS | Overall, 24.5% Sx free & 46.9% ↓ Sx intensity | 6.2 6.4 6.9 |
| Gaze (2001) | 148, Stage ND | 30 Gy/10#s/5pw (37.5) 10 Gy/1# (30) | ND | 70.1% 46.7% | 6.4 5.3 NS |
| Abratt et al (1995) | 84, Stage 3 (primary disease >6 cm or >1 mediastinal node | 35 Gy/10#s/5 pw (48.1) 45 Gy/15#s/5 pw (56.2) | 56%e 51% | 68%h 76% | 8.5 8.5 |
Chemo=chemotherapy; Cis=cisplatin; NE=not evaluated; NS=no significant difference between arms; ND=not documented; Obs=observation; pw=per week; RT=radiotherapy; Sx=symptoms; Vin=vinorelbine.
Patients unsuitable for radical approaches.
Two courses of 20 Gy/5#s per week separated by 4 weeks.
Biological effective dose, based on an α : β of 2 Gy.
Patients with bilateral pulmonary disease, N3 disease, malignant effusion, bulky tumour or nodes >8 cm rendering radical therapy undeliverable, chest wall infiltration with rib erosion, extrathoracic metastases.
Chest X-ray assessment of response.
Symptom response if disappearance of all Sx, or reduced severity or frequency of one or more Sx without the emergence of new intrathoracic symptoms.
Radiotherapy alone arms only.
Complete and partial symptom response rate.