Patient selection: Stage IIIB or IV NSCLC following first-line chemotherapy
Development of lobar collapse secondary to bronchial obstruction is an indication for palliative thoracic radiation therapy.
Parameters associated with a need for palliative radiation therapy from the multivariate analysis:
(1) diameter of hilar disease in cm
(2) obstructive pneumonia at presentation (prior to chemotherapy)
|
Parameter
|
Finding
|
Points
|
|
diameter of hilar disease
|
<= 3 cm
|
0
|
|
|
> 3 cm
|
1
|
|
obstructive pneumonia
|
absent
|
0
|
|
|
present
|
1
|
number of risk factors =
= SUM(points for the 2 parameters)
Interpretation:
• minimum number of risk factors: 0
• maximum number of risk factors: 2
• The need for palliatrive radiation therapy increased with the number of risk factors.
• A patient with no hilar disease is least likely to require an intervention for a pulmonary event.
|
Number of Risk Factors
|
Risk for Palliative RT
|
Median Overall Survival
|
|
0
|
low to moderate
|
11.3 months
|
|
1
|
moderate
|
7.4 months
|
|
2
|
high
|
5 months
|
Additional risk factors from the univariate analysis:
(1) bronchial or vascular obstruction
(2) cough or chest pain
