Shailley Arora Sehgal, Anil Khurana, Paramjeet Kaur, Ashok Chauhan
BACKGROUND Lung cancer is presently the leading cause of cancer death and most of the patients present in advanced stage where symptom palliation is the main aim. However, there is no well-defined recommendation regarding optimal dose and schedule of palliative radiotherapy. This article is a retrospective review of data from single institute to evaluate the effectiveness of palliative radiotherapy and best supportive care (BSC) in locally advanced carcinoma lung and to analyse the association between patients, and treatment related factors to the response to treatment. MATERIALS AND METHODS Histopathologically/Radiologically proven 191 patients with lung cancer, registered at PGIMS Rohtak, from January 2015 to June 2017 were retrospectively analysed. Treatment given was either hypo-fractionated radiation regimes with or without concurrent chemotherapy or best supportive care. The patients were divided into 4 groups based on dose schedules i.e. Group I: 8 Gy in single fraction, Group II: 20 Gy in 5 fractions over 5 days, Group III: 30 Gy in 10 fractions over 2 weeks and Group IV: best supportive care. They were compared with respect to survival, symptom palliation and quality of life. The risk factors assessed were performance status (PS), histopathology, stage and frequency and duration of smoking. Lost to follow up and time of death was taken as end point. RESULTS Median overall survival was 5 months. However, there were patients who survived less than 2 months, even prior to the effect of radiation. Median survival for treatment schedule groups- I to IV was 3 months, 5 months, 6 months and 2 months respectively. Out of assessable 179 patients (12 patients died or defaulted) 96 (53.6%) showed ≥ 50% response in symptom palliation, although maximum palliation was achieved in Group- III. Symptomatic response evaluation was significantly associated with treatment schedule (p=0.001). Eastern Cooperative Oncology Group and age didn’t achieve statistically significant association with symptom palliation response. CONCLUSION Our study concludes that all patient and treatment related parameters should be assessed prior to treatment commencement. Short course Palliative Radiotherapy is a good option in terms of symptom palliation in patients with life expectancy of more than 2 months in advanced stage disease. Best supportive care as an option should be offered to the patients/attendants who are with poor PS, but its recommendation as a guideline must be validated by randomized controlled trial.
