PMID- 18711191
OWN - NLM
STAT- MEDLINE
DCOM- 20080902
LR  - 20220330
IS  - 1527-7755 (Electronic)
IS  - 0732-183X (Linking)
VI  - 26
IP  - 24
DP  - 2008 Aug 20
TI  - Palliative thoracic radiotherapy for lung cancer: a systematic review.
PG  - 4001-11
LID - 10.1200/JCO.2007.15.3312 [doi]
AB  - PURPOSE: The optimal dose of radiotherapy (RT) to palliate symptomatic advanced 
      lung cancer is unclear. We systematically reviewed randomized controlled trials 
      (RCTs) of palliative thoracic RT. METHODS: RCTs comparing two or more dose 
      fractionation schedules were reviewed using the random-effects model of a freely 
      available information management system. The relative risk and 95% CI for each 
      outcome were presented in Forrest plots. Exploratory analysis comparing dose 
      schedules after conversion to the time-adjusted biologically equivalent dose 
      (BED) was performed to investigate for a dose-response relationship. RESULTS: A 
      total of 13 RCTs involving 3,473 randomly assigned patients were identified. 
      Outcomes included symptom palliation, overall survival, toxicity, and 
      reirradiation rate. For symptom control in assessable patients, lower-dose (LD) 
      RT was comparable with higher-dose (HD), except for the total symptom score 
      (TSS): 65.4% of LD and 77.1% of HD patients had improved TSS (P = .003). Greater 
      likelihood of symptom improvement was seen with schedules of 35 Gy(10) versus 
      lower BED. At 1 year after HD and LD RT, 26.5% versus 21.7% of patients were 
      alive, respectively (P = .002). Sensitivity analysis suggests this survival 
      improvement was seen with 35 Gy(10) BED schedules compared with LDs. 
      Physician-assessed dysphagia was significantly greater in the HD arm (20.5% v 
      14.9%; P = .01), and the likelihood of reirradiation was 1.2-fold higher after LD 
      RT. CONCLUSION: No significant differences were observed for specific 
      symptom-control end points, although improvement in survival favored HD RT. 
      Consideration of palliative thoracic RT of at least 35 Gy(10) BED may therefore 
      be warranted, but must be weighed against increased toxicity and greater time 
      investment.
FAU - Fairchild, Alysa
AU  - Fairchild A
AD  - Department of Radiation Oncology, Cross Cancer Institute, 11560 University 
      Avenue, Edmonton, AB T6G 1Z2 Canada. alysafai@cancerboard.ab.ca
FAU - Harris, Kristin
AU  - Harris K
FAU - Barnes, Elizabeth
AU  - Barnes E
FAU - Wong, Rebecca
AU  - Wong R
FAU - Lutz, Stephen
AU  - Lutz S
FAU - Bezjak, Andrea
AU  - Bezjak A
FAU - Cheung, Patrick
AU  - Cheung P
FAU - Chow, Edward
AU  - Chow E
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - J Clin Oncol
JT  - Journal of clinical oncology : official journal of the American Society of 
      Clinical Oncology
JID - 8309333
SB  - IM
CIN - J Clin Oncol. 2008 Aug 20;26(24):3920-2. PMID: 18711179
MH  - Aged
MH  - Dose Fractionation, Radiation
MH  - Female
MH  - Humans
MH  - Lung Neoplasms/*radiotherapy
MH  - Male
MH  - Middle Aged
MH  - Palliative Care/*methods
MH  - Randomized Controlled Trials as Topic
RF  - 34
EDAT- 2008/08/20 09:00
MHDA- 2008/09/03 09:00
CRDT- 2008/08/20 09:00
PHST- 2008/08/20 09:00 [pubmed]
PHST- 2008/09/03 09:00 [medline]
PHST- 2008/08/20 09:00 [entrez]
AID - 26/24/4001 [pii]
AID - 10.1200/JCO.2007.15.3312 [doi]
PST - ppublish
SO  - J Clin Oncol. 2008 Aug 20;26(24):4001-11. doi: 10.1200/JCO.2007.15.3312.