Prospective evaluation of a watch policy in patients with inoperable non-small cell lung cancer

The requirement for palliative chest radiotherapy in patients with non-small cell lung cancer (NSCLC) was assessed in a study of 134 inoperable patients not suitable for radical radiotherapy. Immediate chest radiotherapy was judged necessary in 86 (64%) because of significant symptoms from intrathoracic tumour or involvement of proximal airways. Forty-eight patients were monitored regularly without initial radiotherapy and of these, 26 (54%) required later chest irradiation because of progressive and significant symptoms due to intrathoracic disease. Median symptom-free survival in this group was 10 months. The requirement for immediate or delayed chest irradiation could not be predicted from either patient or tumour characteristics. The proportion of patients with NSCLC requiring palliative chest irradiation may have been overestimated from this study population; even so 22 of 134 patients (16%) did not at any stage in their illness require radiotherapy for chest symptoms.