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When to Give Palliative Radiotherapy to Patients with Non-Small-Cell Lung Cancer

Findings suggest that palliative radiotherapy should be delayed until symptoms occur in such patients.

Clinicians might attempt cure or palliation with radiotherapy in some patients who have unresectable non-small-cell lung cancer. In patients who are not curable but who are free of thoracic symptoms, the best course of treatment remains uncertain: Should such patients receive immediate palliative radiotherapy, or should therapy be delayed until symptoms occur? In this trial, 230 patients with previously untreated, non-small-cell lung cancer (too advanced locally for cure) and minimal thoracic symptoms were randomized to receive either immediate or delayed palliative radiotherapy.

A total of 104 patients in the immediate-therapy group and 48 in the delayed-therapy group actually received radiotherapy (median time to treatment, 15 vs. 125 days, respectively). By 6 months, 28% of immediate-therapy patients and 26% of delayed-therapy patients were alive and free of moderate and severe chest symptoms. Rates of survival and incidence of symptoms did not differ significantly between groups; however, more immediate-therapy patients experienced adverse events from radiotherapy (24 vs. 12).

Comment: It's quite clear from these results that palliative treatment should be delayed until symptoms occur. Immediate therapy offered no advantage over delayed therapy and subjected many patients to treatment that turned out to be unnecessary. At the time of publication, the full text of the original article was available at http://bmj.com/cgi/content/full/325/7362/465 free of charge.

— Keith I. Marton, MD

Published in Journal Watch General Medicine October 4, 2002

Citation(s):

Falk SJ et al. Immediate versus delayed palliative thoracic radiotherapy in patients with unresectable locally advanced non-small cell lung cancer and minimal thoracic symptoms: Randomised controlled trial. BMJ 2002 Aug 31; 325:465-8.

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