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Clinical survey for registering treatment decision criteria in advanced non-small-cell lung cancer radiotherapy and determination of the dose–response relationship for 1-year survival

Published online by Cambridge University Press:  22 April 2013

Ioanna Chalimou ,
Helena Lind ,
Georgios C. Sakellaropoulos ,
Bengt K. Lind ,
Nikos Papanikolaou ,
Georgios C. Nikiforidis  and
Panayiotis Mavroidis
Ioanna Chalimou
Affiliation:
Laboratory of Medical Physics, Medical School, University of Patras, Patras, Greece
Helena Lind
Affiliation:
Department of Oncology – Pathology, Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
Georgios C. Sakellaropoulos
Affiliation:
Laboratory of Medical Physics, Medical School, University of Patras, Patras, Greece
Bengt K. Lind
Affiliation:
Division of Medical Radiation Physics, Karolinska Institutet and University of Stockholm, Stockholm, Sweden
Nikos Papanikolaou
Affiliation:
Division of Medical Physics, Department of Radiation Oncology, University of Texas Health Sciences Center, San Antonio, TX, USA
Georgios C. Nikiforidis
Affiliation:
Laboratory of Medical Physics, Medical School, University of Patras, Patras, Greece
Panayiotis Mavroidis*
Affiliation:
Division of Medical Radiation Physics, Karolinska Institutet and University of Stockholm, Stockholm, Sweden Division of Medical Physics, Department of Radiation Oncology, University of Texas Health Sciences Center, San Antonio, TX, USA
*
Correspondence to: Panayiotis Mavroidis, Division of Medical Physics, Department of Radiation Oncology, University of Texas Health Sciences Center at San Antonio, 7979 Wurzbach Rd, MC 7889, San Antonio TX 78229-4427, USA. Tel: +1 210-450-1027. Fax: +1 210-450-1076. E-mail: mavroidis@uthscsa.edu
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Abstract

Purpose

Recent studies have suggested significant variations in radiotherapy schedules used to treat advanced non-small-cell lung cancer (NSCLC), both between different centers in one country as well as between countries. In this study, different treatment methodologies have been explored using management plans proposed by radiation oncologists regarding general questions and theoretical case histories for patients with advanced NSCLC.

Materials and methods

The survey was conducted by sending a questionnaire to 24 radiotherapy centers in Europe. The questionnaire was composed of two sections. The first section concerned reasons for giving radiotherapy, parameters that influence the choice of total dose and fractionation for radiotherapy and kind of equipment used. The second section concerned the management of five theoretical patients (A–E) regarding the selection of the radiotherapy technique and the aim of treatment (radical or palliative). Furthermore, 19 trials comparing different regimens of palliative radiotherapy in patients with NSCLC were reviewed. There were marked differences in the doses of the investigated radiotherapy schemes, the patient characteristics and the assessed outcome measures.

Results

70% of the responders answered that the most important factors for deciding what dose and fractionation scheme to use were: metastases, performance status (PS) of the patient, lung function and size of the primary tumour. The most common reasons for giving the treatment were symptom relief, prolongation of life and, in some cases, possibly cure. More than 95% of the responders stated that they would give radiotherapy in each of these cases. The total doses proposed where 20 Gy in five fractions or 30 Gy in ten fractions in 2 weeks for the cases A and D. If the previous two schemes were converted to a fractionation scheme delivering 2 Gy per fraction, the equivalent doses would be 23 and 33 Gy, respectively. For the cases B, C and E, the proposed fractionation schemes were 2 Gy daily to 60–68 Gy in 6 weeks or 2 Gy daily to 68 Gy in 7 weeks. For the case E, 20% of the responders suggested Stereotactic Body Radiotherapy (SBRT) giving 21 Gy three times a week with a day apart to 63 Gy. The total dose and number of fractions of radiotherapy are related to the perceived aims and expectations of treatment. Those aiming at extending life would give significantly higher total doses in a larger number of fractions, whereas those aiming at relieving symptoms would give significantly lower total doses. There is evidence for an increase in survival, in patients who are given higher radiotherapy doses, especially in those patients with better PS.

Conclusions

This survey demonstrates a range of treatment strategies for advanced and inoperable NSCLC within Europe. There are a number of factors that influence the perceived aims of treatment and treatment planning. These factors should be taken into account when evaluating the effectiveness of different irradiation techniques, especially in the determination of radiobiological parameters and dose–response relations. The majority of patients should be treated with short courses of palliative radiotherapy, of one or two fractions. The use of high-dose palliative regimens using many fractions or SBRT should be considered for selected patients with good PS.

Keywords

clinical surveynon-small-cell lung cancer1-year survivalpalliative treatmentradiotherapy protocol
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 13 , Issue 1 , March 2014 , pp. 18 - 28
Copyright
Copyright © Cambridge University Press 2013 

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References

1.Hansen, H H, Bunn, P A Jr. Lung Cancer Therapy Annual. London: Martin Dunitz Ltd, 2000.Google Scholar
2.Mitera, G, Zeiadin, N, Kirou-Mauro, Aet al. Retrospective assessment of cancer pain management in an outpatient palliative radiotherapy clinic using the Pain Management Index. J Pain Symptom Manage 2010; 39: 259–267.Google Scholar
3.Wong, K H. Palliative radiotherapy and palliative chemotherapy. In: Proceedings of the 4th Hong Kong Palliative Care Symposium, Hong Kong Society of Palliative Medicine Newsletter, 2004; 1: 22–25.Google Scholar
4.Sandler, A, Gray, R, Perry, M Cet al. Paclitaxel–carboplatin alone or with bevacizumab for non-small cell lung cancer. N Engl J Med 2006; 355: 2542–2550.CrossRefGoogle ScholarPubMed
5.Robnett, T J, Machtay, M, Vines, E Fet al. Factors predicting severe radiation pneumonitis in patients receiving definitive chemoradiation for lung cancer. Int J Radiat Oncol Biol Phys 2000; 48: 89–94.Google Scholar
6.Ohe, Y, Yamamoto, S, Suzuki, Ket al. Risk factors of treatment-related death in chemotherapy and thoracic radiotherapy for lung cancer. Eur J Cancer 2001; 37: 54–63.Google Scholar
7.Lester, J F, Macbeth, F R, Toy, Eet al. Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev 2006; 4: CD002143.Google Scholar
8.Saunders, M, Dische, S, Barrett, Aet al. Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: a randomised multicentre trial. Lancet 1997; 350: 161–165.Google Scholar
9.Begg, A C, Hofland, I, Glebekke, Met al. Predictive value of potential doubling time for radiotherapy of head and neck tumor patients: results from the EORTC cooperative trial 22851. Semin Radiat Oncol 1992; 2: 22–25.CrossRefGoogle Scholar
10.Price, A. Lung cancer: state of the art radiotherapy for lung cancer. Thorax 2003; 58: 447–452.CrossRefGoogle ScholarPubMed
11.Abratt, R P, Shepherd, L J, Mameena Salton, D G. Palliative radiation for stage 3 non-small cell lung cancer – a prospective study of two moderately high dose regimens. Lung Cancer 1995; 13: 137–143.Google Scholar
12.Bezjak, A, Dixon, P, Brundage, Met al. Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC 15). Int J Radiat Oncol Biol Phys 2002; 54: 719–728.Google Scholar
13.Erridge, S C, Gaze, M N, Price, Aet al. Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol 2005; 17: 61–67.Google Scholar
14.Kramer, G W, Wanders, S L, Noordijk, E Met al. Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small cell lung cancer. J Clin Oncol 2005; 23: 2962–2970.Google Scholar
15.Macbeth, F R, Bolger, J J, Hopwood, Pet al. Medical Research Council Lung Cancer Working Party. Randomized trial of palliative two-fraction versus more intensive thirteen fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Clin Oncol 1996; 8: 167–175.Google Scholar
16.Medical Research Council Lung Cancer Working Party. Inoperable non-small-lung cancer: a Medical Research Council randomised trial of palliative radiotherapy with two fractions or ten fractions. Br J Cancer 1991; 63: 265–270.Google Scholar
17.Medical Research Council Lung Cancer Working Party. A Medical Research Council (MRC) randomised trial of palliative radiotherapy with two fractions or a single fraction in patients with inoperable non-small-cell lung cancer (NSCLC) and poor performance status. Br J Cancer 1992; 65: 934–954.Google Scholar
18.Nestle, U, Nieder, N, Walter, Ket al. A palliative accelerated irradiation regimen for advanced non-small cell lung cancer vs. conventionally fractionated 60 Gy: results of a randomized equivalence study. Int J Radiat Oncol Biol Phys 2000; 48: 95–103.Google Scholar
19.Rees, G J, Devrell, C E, Barley, V Let al. Palliative radiotherapy for lung cancer; two versus five fractions. Clin Oncol 1997; 9: 90–95.Google Scholar
20.Reinfuss, M, Glinski, B, Kowalska, Tet al. Radiotherapy in stage III, unresectable, asymptomatic non-small cell lung cancer. Final results of a prospective randomized study of 240 patients [Radiotherapie du cancer bronchique non a petites cellules de stade III, inoperable, asymptomatique. Resultats definitifs d'un essai prospectif randomise (240 patients)]. Cancer Radiother 1999; 3: 475–479.Google Scholar
21.Senkus-Konefka, E, Dziadziuszko, R, Bednaruk-Mlynski, Eet al. A prospective randomised study to compare two palliative radiotherapy schedules for non-small cell lung cancer (NSCLC). Br J Cancer 2005; 92: 1038–1045.Google Scholar
22.Simpson, J R, Francis, M E, Perez-Tamayo, Ret al. Palliative radiotherapy for inoperable carcinoma of the lung: final report of a RTOG multi-institutional trial. Int J Radiat Oncol Biol Phys 1985; 11: 751–758.Google Scholar
23.Sundström, S, Bremnes, R, Aasebo, Uet al. Hypofractionated palliative radiotherapy (17Gy per 2 fractions) in advanced non-small cell lung carcinoma is comparable to standard fractionation for symptom control and survival: a national phase III trial. J Clin Oncol 2004; 22: 801–810.Google Scholar
24.Cross, C K, Berman, S, Buswell, Let al. Prospective study of palliative hypofractionated radiotherapy (8.5 Gy × 2) for patients with symptomatic non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004; 58: 1098–1105.Google Scholar
25.Koutaïssoff, S, Wellmann, D, Coucke, Pet al. Hyperfractionated accelerated radiotherapy (HART) for inoperable, nonmetastatic non-small cell lung carcinoma of the lung (NSCLC): results of a phase II study for patients ineligible for combination radiochemotherapy. Int J Radiat Oncol Biol Phys 1999; 45: 1151–1156.Google Scholar
26.Nestle, U, Nieder, C, Abel, Uet al. A palliative accelerated irradiation regimen (PAIR) for advanced non-small-cell lung cancer (NSCLC). Radiother Oncol 1996; 38: 195–203.Google Scholar
27.Lupattelli, M, Maranzano, E, Bellavita, Ret al. Short-course palliative radiotherapy in non-small-cell lung cancer: results of a prospective study. Am J Clin Oncol 2000; 23: 89–93.Google Scholar
28.Teo, P, Tai, T H, Choy, Det al. A randomized study on palliative radiation therapy for inoperable non small cell carcinoma of the lung. Int J Radiat Oncol Biol Phys 1988; 14: 867–871.Google Scholar
29.Appold, S, Baummann, M, Neidt, Fet al. Results of irradiation of inoperable stage III non-small cell lung cancer with 25Gy in five fractions [Ergebnisse der Bestrahlung inoperabler nichtkleinzelliger Bronchialkarzinome im Stadium III mit 25 Gy in fünf Fraktionen]. Strahlenther Onkol 1999; 175: 267–270.Google Scholar
30.Mavroidis, P, Lind, B K, Theodorou, Ket al. Statistical methods for clinical verification of dose–response parameters related to esophageal stricture and AVM obliteration from radiotherapy. Phys Med Biol 2004; 49: 3797–3816.CrossRefGoogle ScholarPubMed
31.Cox, J D, Pajak, T F, Asbell, Set al. Interruptions of high-dose radiation therapy decrease long-term survival of favorable patients with unresectable non-small cell carcinoma of the lung: analysis of 1244 cases from 3 Radiation Therapy Oncology Group (RTOG) trials. Int J Radiat Oncol Biol Phys 1993; 27: 493–498.Google Scholar
32.Koukourakis, M, Hlouverakis, G, Kosma, Let al. The impact of overall treatment time on the results of radiotherapy for nonsmall cell lung carcinoma. Int J Radiat Oncol Biol Phys 1996; 34: 315–322.Google Scholar
33.Palmer, J, O'Sullivan, B, Steele, R, Mackillop, W J. Controversies in the management of non-small cell lung cancer. The results of an expert surrogate study. Radiother Oncol 1990; 19: 17–28.Google Scholar
34.Coia, L R, Laurence, R, Hanks, Get al. Practice patterns of palliative care for the United States 1984–1985. Int J Radiat Oncol Biol Phys 1988; 14: 1261–1269.Google Scholar
35.Priestman, T, Bullimore, J A, Godden, T Pet al. The Royal College of Radiologists fractionation survey. Clin Oncol 1989; 1: 39–46.Google Scholar
36.Bleehen, N M, Fayers, P M, Girling, D J. Controlled trial of palliative radiotherapy given in 2 fractions or conventionally fractionated for inoperable NSCLC. Lung Cancer 1988; 4 (suppl.): A144–A148.Google Scholar
37.Maher, E J, Jefferis, A F. Decision making in advanced cancer of the head and neck: variation in the news of medical specialists. J R Soc Med 1990; 83: 356–359.Google Scholar