Clinical question:What is the optimal treatment approach for patients with stage III inoperable NSCLC who, because of patient or tumour factors, are not suitable for curative treatment with concurrent chemo-radiotherapy?/Table

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Randomised controlled trials comparing different palliative RT regimens in locally advanced NSCLC

Study N Performance status Stage Palliative RT regimens Results
Teo et al


291   Inoperable advanced A. 45Gy/18f (5f/week) v

B. 31.2Gy/4f (1f/week)

·         MS (nsig)

·         Symptom palliation

A 71%  v B 54% (p<0.02)

Abratt et al


84 0-2 Stage III, too extensive for radical RT A.      35Gy/10f(5f/week) v

B.      45Gy/15f(5f/week)

·         No stat sig difference in survival or symptom palliation


509 0-2 Inoperable advanced, not metastatic, too extensive for radical RT (F2)17Gy/2f (1f/week)




·         MS

(F2)7m v (F13)9m (p=0.03)

·         More rapid palliation in F2

Rees et al


216 0-3 Not suitable for radical therapy A.      17Gy/2f(1f/week)

B.      22.5/5f (5f/week)

·         Symptom palliation

No stat sig difference

Reinfuss et al


240   III unresectable


A.50Gy/25f (5f/week) v

B. 20Gy/5f x2 (4week break)

C. 20-25Gy/4-5f when symptoms developed


·         Ms

A 12m v B 9m v C 6m (sig)

·         2YrS

A 18% v B 6% v C 0% (sig)

Nestle et al


152   III/IV A.60Gy/30f (5f/week) v

B. 32Gy/16f (2f/day)

No stat sig difference in survival or symptom palliation.
Bezjak et al


230   III unsuitable for curative treatment, IV A.10Gy/1f v B. 20Gy/5f ·         Symptom palliation

B: Stat sig improvement in symptoms related to lung cancer, pain, ability to carry out normal activities and global quality of life.

·         MS

B: survived 2 m longer (p=.0305)


Sundstrom et al


421   Locally advanced Stage III/IV,

Not suitable for curative therapy

A.17Gy/2f (1/week)


C. 50Gy/25f (5f/week)

·         Symptom palliation

No stat sig diff between arms

·         MS

No stat sig difference

Erridge et al


149 0-3 Symptomatic lung cancer not amenable to curative therapy A.      10Gy/1f v

B.      30Gy/10f

Two regimens equivalent but sig more patients in B achieved complete resolution of symptoms and palliation
Kramer et al


297 ECOG PS 3-4+/- substantial weight loss Stage IIIA/B

Stage IV

A.      16Gy/2f v

B.      30Gy/10f

·         1yr S

A10.9%vB19.6% (p=0.03)

·         Symptom palliation more prolonged in B



100     A.20Gy/5f(5f/w) v B. 16Gy/2f ·         OS

A5.3m v B 8.0m (p=0.016)

·         Symptom palliation

Ns difference between arms


  1. Teo P, Tai TH, Choy D, Tsui KH. A randomized study on palliative radiation therapy for inoperable non small cell carcinoma of the lung. Int J Radiat Oncol Biol Phys 1988 May;14(5):867-71 Available from: