J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 9, Number 6, June 2017, pages 482-487

Palliative Thoracic Radiotherapy for Lung Cancer: What Is the Impact of Total Radiation Dose on Survival?

Figure 1. Overall survival (Kaplan-Meier method, intention to treat analysis). Median survival was 2.5 months in patients treated with 2 fractions of 8.5 Gy (group 0). The corresponding figures were 2.2 months (20 - 24 Gy, group 1), 5.0 months (30 Gy, group 2) and 7.5 months (> 30 Gy, group 3), respectively (P = 0.0001, pooled over strata). The 2-year survival rates were 0%, 0%, 7% and 11%, respectively. For individual comparisons, significance level was 0.34 (0 vs. 1), 0.085 (2 vs. 3), 0.009 (0 vs. 2), 0.009 (1 vs. 2), 0.001 (1 vs. 3), and 0.0001 (0 vs. 3).

**Table 1.** Baseline Parameters in 232 Patients
Parameter	Number of patients	Percentage
^aSeventh edition of the TNM classification (based on imaging).
Sex
Male	140	60
Female	92	40
Age
≤ 69 years	105	45
≥ 70 years	127	55
ECOG performance score
0 - 1	76	33
2	89	38
3 - 4	67	29
Histology
Small cell lung cancer	26	11
Non-small cell lung cancer	206	89
Smoking history
No	15	6
Yes	199	86
Unknown	18	8
Timing of radiotherapy
Upfront (within 3 months)	110	47
Delayed (> 3 months from diagnosis)	122	53
Fractionation
8.5 Gy × 2	79 (eight incomplete)	34
3 Gy × 10 (or equivalent)	69 (nine incomplete)	30
2.8 Gy × 15 (or equivalent)	68 (four incomplete)	29
4 Gy × 5 - 6	16 (four incomplete)	7
Serum hemoglobin
Low	126	54
Normal	98 (eight unknown)	42
Serum lacate dehydrogenase
High	53	23
Normal	108 (71 unknown)	47
N stage^a
N0-N1	45	19
N2-N3	187	81
M stage^a
M0	91	39
M1	141	61
Pleural effusion
Absent	177	76
Present	53 (two unknown)	23
Previous systemic therapy
No	131	56
Yes	99 (two unknown)	43
Extrathoracic disease status
Absent/stable	163	70
Progression	67 (two unknown)	29

Table 1. Baseline Parameters in 232 Patients

Parameter

Number of patients

Percentage

^aSeventh edition of the TNM classification (based on imaging).

Sex

Male

140

Female

Age

≤ 69 years

105

≥ 70 years

127

ECOG performance score

0 - 1

3 - 4

Histology

Small cell lung cancer

Non-small cell lung cancer

206

Smoking history

Yes

199

Unknown

Timing of radiotherapy

Upfront (within 3 months)

110

Delayed (> 3 months from diagnosis)

122

Fractionation

8.5 Gy × 2

79 (eight incomplete)

3 Gy × 10 (or equivalent)

69 (nine incomplete)

2.8 Gy × 15 (or equivalent)

68 (four incomplete)

4 Gy × 5 - 6

16 (four incomplete)

Serum hemoglobin

Low

126

Normal

98 (eight unknown)

Serum lacate dehydrogenase

High

Normal

108 (71 unknown)

N stage^a

N0-N1

N2-N3

187

M stage^a

141

Pleural effusion

Absent

177

Present

53 (two unknown)

Previous systemic therapy

131

Yes

99 (two unknown)

Extrathoracic disease status

Absent/stable

163

Progression

67 (two unknown)

**Table 2.** Comparison of Different Results From the Literature of the Last 15 Years [2, 6, 9, 10, 13-17]
Authors	Equivalent dose EQD2	Percentage of 2-year survival
*Randomized study.
Kramer et al* [13]	24	3
Present study	26	0
Sundstrom et al* [6]	26	8
Schroder et al [14]	31	2
Kramer et al* [13]	33	7
Present study	33	7
Nawrocki et al* [15]	33	6
Erridge et al* [2]	33	8
Jeremic et al* [16]	42	9
Present study	45	11
Sundstrom et al* [6]	45	13
Sundstrom et al* [6]	50	10
Schroder et al [14]	52	5
Janssen et al [9]	31 - 46	15
Janssen et al [9]	47 - 52	20
Van Oorschot et al [10]	42 - 49	10
Jeremic et al* [16]	17 or 24 (+platinum-based chemo)	12 (no stage IV in this study)
Nawrocki et al* [15]	33 (+cisplatin/vinorelbine)	24 (no stage IV in this study)
Strom et al* [17]	45 (+carboplatin/vinorelbine)	28 (no stage IV in this study)

Table 2. Comparison of Different Results From the Literature of the Last 15 Years [2, 6, 9, 10, 13-17]

Authors

Equivalent dose EQD2

Percentage of 2-year survival

*Randomized study.

Kramer et al* [13]

Present study

Sundstrom et al* [6]

Schroder et al [14]

Kramer et al* [13]

Present study

Nawrocki et al* [15]

Erridge et al* [2]

Jeremic et al* [16]

Present study

Sundstrom et al* [6]

Schroder et al [14]

Janssen et al [9]

31 - 46

Janssen et al [9]

47 - 52

Van Oorschot et al [10]

42 - 49

Jeremic et al* [16]

17 or 24 (+platinum-based chemo)

12 (no stage IV in this study)

Nawrocki et al* [15]

33 (+cisplatin/vinorelbine)

24 (no stage IV in this study)

Strom et al* [17]

45 (+carboplatin/vinorelbine)

28 (no stage IV in this study)