[Palliative accelerated irradiation for advanced non-small-cell lung bronchial carcinoma: results of a pilot study]

In order to reduce the aggressivity of radiotherapy of very advanced non-small-cell lung cancer (NSCLC), and to shorten treatment time, a palliative accelerated irradiation regimen (PAIR) was developed. Before the onset of a randomised study, we performed a one-year pilot study, of which the paper presented here gives the results after complete follow-up. 34 patients (S) with locally inoperable advanced NSCLC stage III (74%) and IV (26%) were irradiated with accelerated fractionation schedule, focussing on tumour and mediastinum, with a total dose of 32 Gy (PAIR, 2 x 2 Gy/d). Treatment results were compared to those of a group of 178 controls (K) treated conventionally, who were selected from a preexisting database according to study inclusion criteria (tab. 2-5 stage III 65%, IV 35%). 105 of them had been treated with a total dose of 60 Gy (K60). After complete follow-up a final evaluation was made. Local control did not differ significantly between both groups, and not between groups S and K60 (tab. 6, fig. 2). Median survival for all patients (S + K) was 6 months. With 8.7 months, that of the study patients (S) was significantly longer than that of the controls (K, fig. 1). This was also true of stage III. Comparison with the 60-Gy-controls (K60) did not reveal significant survival differences. In Cox regression analysis independent prognostic factors were: Karnofsky index, UICC stage, and N stage. Concerning the palliation of tumour-related symptoms, both therapies were comparable (tab. 7). The side-effects were moderate and also comparable. These results induced us start a randomized study comparing both regimens in respect of prognosis and palliation.