Purpose: Palliative radiotherapy for metastatic and locally advanced lung cancer is commonly used among veterans. We report our institutional experience using a split-course radiotherapy schedule, utilizing modern planning techniques.
Methods: All patients diagnosed with carcinoma of the lung between January 1, 2006, and December 31, 2012, were identified in our database. Of these, 35 patients received palliative radiation for stage IV and advanced stage IIIB disease, using a split-course treatment delivery with 3D planning and repeat CT simulation prior to the second half of their treatment course. Radiation was commonly delivered in 25 to 30 Gy in 10 fractions, followed by a 2- to 3-week break with an additional 25 to 30 Gy delivered in10 fractions delivered after a repeat 3D CT simulation.
Results: There was at least a 50% reduction in tumor volume at the time of second simulation (initial tumor volume range: 47 cm3-301 cm3) in 15/35 patients. These were designated as responders and the rest as nonresponders. The median survival in the responder group was 332 days and 340 days in the nonrapid responder group (P = .94). The local failure on imaging was seen in 47% of the responder population and 45% of the nonresponders. The overall 1-year survival for both groups was 34%.
Conclusions: Split-course palliative radiation is a reasonable option for veterans with metastatic and locally advanced lung cancer. Our retrospective review suggests that tumor shrinkage between courses of palliative radiation in a split-course model does not predict survival or local control. A prospective, randomized study would be needed to confirm our findings and make definitive recommendations.
