A Survival Score for Patients Receiving Palliative Irradiation for Locally Advanced Lung Cancer

Many patients with locally advanced lung cancer cannot withstand aggressive curative treatment and are referred for palliative irradiation. The goals of palliative radiotherapy are control of local disease and symptoms. Treatment should be tailored to each patient's situation and remaining lifespan. The present study aimed to create a survival score for patients requiring palliative irradiation for locally advanced lung cancer.

The data from 125 patients receiving palliative irradiation for locally advanced lung cancer were evaluated for survival. To identify the predictors of survival, 9 factors were investigated, including gender, age, performance status, smoking history, T stage, N stage, M stage, histologic type, and tumor location. Factors showing significant or borderline significant association with survival on multivariate analysis were included in the score. The 6-month survival rates were divided by 10 to calculate the points associated with the individual prognostic factors. The points obtained from each prognostic factor were summed to compile the patient's total score.

On multivariate analysis, N stage (P = .005) and M stage (P = .033) were significantly associated with survival, and the Karnofsky performance score achieved borderline significance (P = .052). The patient scores ranged from 10 to 17 points for the 6-month survival rates. Using the patient scores, 3 survival groups were designed: 10 to 11, 12 to 14, and 15 to 17 points. The corresponding 6-month survival rates were 13%, 47% and 82% (P < .001). The corresponding 12-month survival rates were 8%, 19%, and 69%.

With this new score, physicians can estimate the remaining lifespan of patients requiring palliative irradiation for locally advanced lung cancer. This score should ideally be validated in an independent cohort of patients.