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LETTER TO EDITOR
Year : 2015  |  Volume : 32  |  Issue : 3  |  Page : 302-303  

Different fractionation regimes in palliative thoracic radiotherapy: Some facets


Department of Radiotherapy, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication5-May-2015

Correspondence Address:
Mukesh Sharma
Department of Radiotherapy, Regional Cancer Centre, Indira Gandhi Medical College, Shimla, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0970-2113.156265

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How to cite this article:
Sharma M, Thakur P, Fotedar V, Gupta M. Different fractionation regimes in palliative thoracic radiotherapy: Some facets. Lung India 2015;32:302-3

How to cite this URL:
Sharma M, Thakur P, Fotedar V, Gupta M. Different fractionation regimes in palliative thoracic radiotherapy: Some facets. Lung India [serial online] 2015 [cited 2019 Sep 15];32:302-3. Available from: http://www.lungindia.com/text.asp?2015/32/3/302/156265

Sir,

Despite much research, carcinoma lung remains an important scourge of mankind. The study by Saurav Sau et al. [1] was a welcome refreshment to our knowledge on palliative radiotherapy regimes in metastatic carcinoma lung. However, we would like to mark certain important inadequacies in the study.

  • The inclusion criteria included 'patients who had intrathoracic symptoms'. Thoracic external beam radiotherapy was indicated in a variety of symptoms: Hemoptysis, cough, chest pain, dyspnea, obstructive pneumonia, dysphagia related to esophageal compression, superior vena cava syndrome, hoarseness, and so on. It would be interesting if the different thoracic symptoms, besides pain, were also evaluated in the different study arms. There was an important group of patients in whom pain was not a symptom even in advanced disease. The benefit of different interventions in such patients needs to be detailed
  • Another inclusion criterion that was mentioned in the study was, 'expected survival of more than three months'. As this was a subjective criterion it was likely to differ among evaluators, and other objective criteria would definitely have been better
  • Bronchoscopy is an important examination, which had not been mentioned. The diagnostic yield of bronchoscopy for visible lesions exceeded 80% [2] and it definitely deserved to be an important part of the workup of patients
  • The standard treatment of advanced non-small-cell carcinoma lung was platinum-based chemotherapy, [3] with proven benefits, both in the overall survival as well as quality of life. As the performance score of eligible patients in this study was good (Performance status ≤ Eastern Cooperative Oncology Group (ECOG) 3), the standard chemotherapeutic regimes that were started upfront could also have provided valuable symptom relief to patients and at the same time would have been effective in controlling the systemic metastasis. Palliative radiotherapy could have been administered when symptom relief was not adequate. The rationale of providing upfront radiotherapy to good performance score patients also needs to be detailed
  • Overall survival of patients was definitely impacted by the site of the metastasis. Did the site or number of metastases impact survival? The answer would be important for the readers
  • An important side effect of hypofractionated regimes in thoracic radiotherapy was radiation myelitis, which was noticed with hypofractionated regimes. [4] It had devastating consequences for the patients. It needs to be stressed that even though it was a fairly large study this side effect was not seen in patients treated with hypofractionated regime.


Thus, this study has some limitations. However, it still manages to emphasize the value of shorter radiotherapy regimes in the palliative setting and the consequential benefits to the already ill patients.

 
   References Top

1.
Sau S, Sau S, Dutta P, Gayen GC, Banerjee S, Basu A. A comparative study of different dose fractionations schedule of thoracic radiotherapy for pain palliation and health-related quality of life in metastatic NSCLC. Lung India 2014;31:348-53.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
British Thoracic Society Bronchoscopy Guidelines Committee, a Subcommittee of Standards of Care Committee of British Thoracic Society. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax 2001;56 Suppl 1:i1-21.  Back to cited text no. 2
[PUBMED]    
3.
Schrump DS, Giaccone G, Kelsey CR, Marks LB. Non Small-Cell Lung Cancer. In: DeVita VT, Lawrence TS, Rosenberg SA, editors.Devita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology. 8 th ed. Philadelphia; Lippincott Williams and Wilkins: 2008. p. 933.  Back to cited text no. 3
    
4.
A medical research council (MRC) randomised trial of palliative radiotherapy with two fractions or a single fraction in patients with inoperable non small-cell lung cancer (NSCLC) and poor performance status. Medical research council lung cancer working party. Br J Cancer 1992;65:934-41.  Back to cited text no. 4
    




 

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