Palliative percutaneous radiotherapy in non-small-cell lung cancer

Percutaneous radiotherapy is an effective tool for the palliative treatment of patients with non-small-cell lung cancer (NSCLC). About two thirds of patients experience a notably improvement of symptoms after palliative radiotherapy. A whole variety of very different radiation schedules like a single fraction of 10 Gy, 2 fractions of 8.5 Gy, 10 fractions of 3 Gy, 25 fractions of 2 Gy, and others have been used for palliation. The effects of these different schedules have been compared in a total of 11 randomized trials of which 10 reported survival data and form subject of this review. According to these studies, an increase in total irradiation dose does not substantially prolong median survival, but results in a significant better 1-year survival. A comprehensive review of the data reveals that patients with poor performance status (ECOG score > or = 3) do not benefit from higher doses, but patients with good performance status do benefit. Patients with poor performance status, and patients with large distant tumour burden regardless of their performance status, are efficiently treated by a short course of relatively low dose radiotherapy. Schedules like 2 x 8.5 Gy and 4 x 5 Gy are most appropriate in this situation. For patients with good performance status the choice of the optimal radiation schedule is less clear. Schedules with total doses between 30 and 45 Gy in 2.5-3.0 Gy fractions should be preferred in these situations.