When to combine?

Top Line: How do you manage patients with stage III NSCLC or those with stage IV, but primarily thoracic disease if they are not candidates for standard treatment?

The Study: In 2018, ASTRO updated their guidelines for palliative thoracic radiation after 2 randomized trials showed improved survival with combined palliative chemo and radiation for “incurable” stage III disease. One trial compared 30 Gy in 10 fractions with or without a platinum doublet while the other compared platinum doublet with or without 42 Gy in 15 fractions. Here’s another small randomized trial of 68 patients with stage III (43%) or IV (57%) disease with primarily thoracic symptom burden and deemed ineligible for standard therapy. In the palliative RT alone arm, patients received 36 Gy in 12 fractions. In the chemo arm, patients received 40 Gy in 20 fractions with cisplatin. There was no difference in symptom relief, but patients in the CRT arm actually had improved QoL. While there was no statistical difference in median OS, numerically it was 3 months longer with CRT.

TBL: Among patients with stage III/IV NSCLC who weren’t eligible for standard therapy, adding single-agent cisplatin to hypofractionated palliative RT didn’t dramatically improve symptom burden or survival. | Lehman, Pract Radiat Oncol 2020