Palliative External Beam Thoracic Radiation Therapy of Non-Small Cell Lung Cancer

Abstract

About two-thirds of patients with non-small cell lung cancer are diagnosed with incurable disease and are usually treated with a palliative intent. Palliative radiotherapy is defined as radiotherapy given with less than radical doses. Although a large variation in treatment schedules considering dose, fractionation, and overall treatment time are used, usually a dose 50 Gy is considered as palliative. Given the palliative intent of the radiotherapy with the goal of reducing tumour-related symptoms, the radiotherapy should be simple to set up, to perform, and less time-consuming for the patient. If high-dose palliative fractionated radiotherapy is planned a normal setup margin defining GTV and CTV/PTV is recommended including the tumour and disease-related nodes. When low-dose radiotherapy is planned, the treated volume should include the symptomatic part of the tumour.Most studies show that the effect on symptoms and palliative effect is similar regardless of dose and fractionation. A trend of more rapid relief of symptoms in favour of hypofractionation is observed. Though no major difference in median survival is observed, some patients with localised stage III disease may have better survival with a protracted high-dose schedule. Acute toxicity with dysphagia is mild, temporary, and manageable. Late toxicity is rare and sporadic with low severity. Palliative thoracic radiotherapy should not be administrated to patients without symptoms present.