From February 1993 to October 1997, 91 consecutive patients with inoperable (stage IIIB-IV) histologically confirmed
non-small-cell lung cancer underwent palliative hypofractionated
radiotherapy. Recently, the Medical Research Council studies on hypofractionated short-course
radiotherapy (8.5 Gy x 2) have reported high control of symptoms caused by
thoracic disease without toxicity. Based on these experiences and our previous positive trial on short-course
radiotherapy (8 Gy x 2) in metastatic
spinal cord compression, a prospective study of short-course palliative
radiotherapy in
non-small-cell lung cancer was carried out. The regimen was 16 Gy given in two 8-Gy fractions, 1 week apart. Eighty-one patients were evaluable for response to treatment. Forty-eight (59%) patients were 65 years or older. Forty (49%) patients were naive to
radiotherapy, whereas 41 (51%) had previous
cisplatin-based
chemotherapy. All but four stage IV patients (95%) had poor Eastern Cooperative Oncology Group performance status (i.e., 2-3). Clinical palliation was achieved in 62 (77%) patients. Performance status improved in 59 (73%) patients. The median palliation time ranged from 28% to 57% of patient survival. The median survival from the beginning of treatment was 148 days (range, 5-681 days). No difference in overall survival according to stage and previous
chemotherapy was observed. Only performance status conditioned survival (performance status 1-2 vs. performance status 3; p = 0.0289). Short-course
radiotherapy gave good results in terms of clinical palliation for thoracic symptoms, even in patients with poor performance status and pretreated with
chemotherapy. The median palliation time was approximately 50% of patient survival time. Treatment was generally well tolerated-only 4 (5%) patients experienced World Health Organization grade III
dysphagia. No late toxicity was recorded. The two-fraction regimen had social and economic advantages compared with the conventional ones.