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Palliative lung radiotherapy at the Christie: audit of prescribing practice and survival analysis
Lewis, T Kennedy, Jason Price, Gareth J Mee, Thomas Woolf, David K Chan, Clara Coote, Joanna H Harris, Maggie A
Lewis, T
Kennedy, Jason
Price, Gareth J
Mee, Thomas
Woolf, David K
Chan, Clara
Coote, Joanna H
Harris, Maggie A
Citations
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Abstract
Introduction: Choosing the optimal palliative lung radiotherapy
(RT) regimen is challenging. The Royal College of Radiologists
(RCR) guidance recommends treatment stratification based on
patients' performance status (PS). The aim of palliative treatment
is to alleviate symptoms, but evidence suggests higher radiotherapy
doses are associated with survival benefits. Here, we present
the effects of fractionation regimen and additional factors on the
survival of palliative lung cancer radiotherapy patients.
Methods: An audit comparing palliative non-small cell lung
cancer (NSCLC) radiotherapy prescription with RCR guidance
was conducted in a retrospective patient cohort (n=422) treated
between 2013 and 2018 at the Christie. Multivariable analysis of
the prognostic significance of baseline patient characteristics and
treatment prescription on overall survival was performed on a
combined NSCLC and small cell lung cancer patient cohort (n=422).
The percentage of patients dying within 30 days of treatment was
calculated. Covariates investigated included: sex, age, PS, histology,
comorbidities, stage, tumour location, tumour side, smoking status,
pack year history, primary RT technique and fractionation scheme (8
Gy/1 F, 10 Gy/1 F, 20 Gy/5 F, 30 Gy/10 F).
Results: 80.8% of patients were treated according to RCR guidance.
2.6% good PS patients were under-dosed (i.e. lower dose and/or
fractionation compared to RCR recommendations) and 16.6% poor
PS patients were over-dosed. 85 patients (9.2%) died within 30 days
of treatment. Univariable analysis revealed that PS (p<0.0001),
fractionation scheme (p<0.0001) and comorbidities (p=0.03) were
significantly associated with survival. Univariable subset analysis results are displayed in Fig. 1. Multivariable analysis: better PS
(p=0.003) and increased dose/fractionation regimens of up to
30Gy/10F (p<0.0001) were the only covariates that significantly
correlated with increased survival.
Conclusion: RCR guidance for palliative lung radiotherapy was
followed for the majority of patients. Increased fractionation
regimens (up to and including 30Gy/10F) were associated with
better survival regardless of performance status.
Description
Date
2019
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Lewis T, Kennedy J, Price G, Mee T, Woolf D, Bayman N, et al. Palliative lung radiotherapy at the Christie: audit of prescribing practice and survival analysis. Lung Cancer. 2019;127:S81-S2.