Palliative radiotherapy in advanced metastatic and non-metastatic non-small cell lung cancer

Between 1986 and 1990, 180 patients with advanced stage non-small cell lung cancer (NSCLC) were treated with hypofractionated radiation schedules of 6 (6F scheme) or 3 fractions (3F scheme) for palliation of the intrathoracic tumor growth. In the 6F scheme six fractions of 5 Gy were given twice weekly, while in the 3F scheme three weekly fractions of 8 Gy were given. For the 121 patients with advanced (non-metastatic) tumors (stage IIIB) the median survival time was 6.7 months and for 59 patients with distant metastases (stage IV) it was 4.7 months. There were no significant differences in survival between the 3F and 6F schemes. In this non-randomized study, the 1-year survival rate was 30% for stage IIIB and 19% for stage IV patients. Local progression was observed in 71% of stage IIIB and in 48% of stage IV patients. Eighty-nine percent of patients remained free of local progression for more than half of their survival time and 69% at least three quarters of their survival time. It is concluded that the 3F scheme results in a good palliation with acceptable toxicity. For a subgroup of patients, single fraction schemes may be also be effective.