The quality of evidence is downgraded by inconsistency (variability in results).
A Cochrane review [Abstract] 1 included 14 studies with a total of 3 576 subjects. There were important differences in the doses of radiotherapy investigated, the patient characteristics and the outcome measures. All 13 studies that investigated symptoms reported that major thoracic symptoms improved following radiotherapy. There was no strong evidence that any regimen gives greater palliation. Higher dose regimens give more acute toxicity, in particular radiation oesophagitis, and some regimens were associated with an increased risk of radiation myelitis.
The meta-analysis showed no significant difference in 1-year overall survival between regimens with fewer radiotherapy fractions compared with regimens with more when patients were stratified by performance status. The results of the meta-analysis of 1-year overall survival for patients with good performance status (WHO performance status 0-1) showed moderately high heterogeneity and a summary result was not thought meaningful. The results of 1-year overall survival for patients with poor performance status was RR 0.96 (95% CI 0.91 to 1.02; 7 studies, n=911).
Authors' conclusion: The majority of patients with locally advanced non-small cell lung cancer and thoracic symptoms, especially those with poor performance status should be treated with short courses of palliative radiotherapy. Care should be taken with the dose to the spinal cord. If it is felt acceptable to offer more fractionated palliative regimens for selected patients with good performance status, an informed discussion should make clear the very modest possible effect on survival balanced against the extra visits to hospital and the increased risk of toxicity (especially oesophagitis).
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