Short summary

The aim of the study is to examine the short term side effects to PTR in NSCLC patients and its impact overall QoL and symptom relief after VMAT or conventional palliative radiotherapy. Furthermore, the study will investigate the association between the treatment response and specific factors such as age, performance status and comorbidity. The study population will be patients referred to PTR at the Department of Oncology at Odense University Hospital. QoL and respiratory symptoms will be assessed by the EORCT QLQ-C15-PAL and EORCT QLQ-LC13 questionnaires. 

Rationale

Lung cancer is the most frequent cause of cancer death in Denmark. At the time of diagnosis more than 50 % of all patients have lung cancer in an advanced stage (cTNM-stage IIIb-IV). A large proportion of these patients will at some point in their course of disease be treated with palliative thoracic radiotherapy. Due to poor prognosis in these patients, the aims of palliative treatment are to achieve symptom control and improve overall QoL. The side effects to PTR include among others dyspnea, cough, esophagitis, and nausea. These side effects may be quite troublesome for the patients, and may impact their QoL. Previous studies examining the impact of PTR on QoL in have found that PTR offers palliation of respiratory symptoms and improved QoL. However, these studies are more than ten years old, and since the techniques of radiotherapy have evolved, it is relevant to perform a contemporary study.

During the last decade there have been significant advances in the techniques of radiotherapy with inclusion of sophisticated planning techniques, yet the preferred setup for PTR is still kept rather simple as there is limited data available that indicate that more extensive planning improves outcome compared with simple treatment techniques. Modern radiotherapy technique such as Volumetric modulated arc therapy (VMAT) may reduce the irradiated volume of normal tissue and thereby reduce the toxicity. This technique is more complicated and is therefore not used as a standard technique, but is used in selected cases. 

The aim of the study is to examine the short term side effects to PTR in NSCLC patients and its impact overall QoL and symptom relief after VMAT conventional palliative radiotherapy. The results from the two different approaches cannot be directly compared. However, the results of this study will provide basic data on side effects and QoL and may form the basis of future studies comparing the two approaches for palliative radiotherapy to lung cancer. QoL will be assed using The European Organization for Research and Treatment of Cancers (EORTC) QLQ-C15-PAL and QLQ-LC13 questionnaires. These are both validated and widely used tools to asses QoL in lung cancer patients.

Furthermore, the study will investigate if elderly patients with lung cancer benefit from PTR to the same extend as younger patients. More than 70% of lung cancer patients are +70 years at the time of diagnosis. Yet elderly patients seem to be underrepresented in cancer trials. A single study from 2005 finds that elderly lung cancer patients gain equivalent palliation of PTR as younger patients. In spite of this there seem to be an age disparity in patients treated with PTR. Other studies have questioned whether patients with poor performance status and severe comorbidities benefit from PTR, or whether they should rather be treated with modern supportive care due to short remaining life expectancy. Consequently, this will further be taken in to consideration in the analysis.

Description of the cohort

All patients with advanced NSCLC referred to palliative thoracic radiotherapy at the Department of Oncology at OUH will be asked to participate in the study.

Data and biological material

Questionnaire data using the EORTC QLQ-C15-PAL and QLQ-LC13 questionnaires. Data about gender, age, performance status, radiation dose, stage of disease, pathology and comorbidity will be obtained from the patients' medical reports after their informed consent.

Collaborating researchers and departments

Department of Oncology, Odense University Hospital

• Professor and consultant Olfred Hansen
• Consultant Tine Schytte