Title: Palliative Radiotherapy with Concomitant and Maintenance Gefitinib for the Management of Locally Advanced Adenocarcinoma Lung Patients Unfit For Radical Treatment
Authors: Vikas Verma, Paramjeet Kaur (MD), Ashok K. Chauhan (MD), Yashpal Verma (MD), Anil Khurana (MD), Meenakshi Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v5i6.210
Abstract
Purpose: To evaluate the feasibility and role of palliative radiotherapy and concomitant gefitinib and maintenance in locally advanced adenocarcinoma lung patients unfit for radical radiotherapy with respect to symptomatic relief with improvement in quality of life, local control, toxicity, progression free survival (PFS) & overall survival (OS).
Material and Methods: A total of thirty four (34) patients with stage III adenocarcinoma lung were accrued in the study who presented in the Department of Radiotherapy, PGIMS Rohtak from January 2015 to June 2016. Presenting symptoms were cough in 18, breathlessness in 23, expectoration with blood in 4 and chest pain in 24 patients. Male:female was 20:14. All accrued patients had KPS 40 to 60. These patients were treated with palliative EBRT 30 Gy in 10 fractions over 2 weeks and oral Gefitinib 250 mg once a day, from the first day of radiotherapy, concomitant & continued thereafter till disease progression. Median follow-up was 7 months (range 2-24 months). The patients were assessed for symptomatic relief, local control, toxicity, progression free survival & overall survival.
Results: All patients had tolerated the treatment well and no significant drug induced toxicity was observed. More than ≥25% relief in cough, chest pain, haemoptysis and dyspnoea was observed in 55%, 54%, 100% & 74% of patients respectively. Partial response was observed in 68% patients while remaining had stable disease at 1st follow up. At 6th follow up, 38% & 12% patients maintained their partial response and stable disease status respectively. Diarrhoea and skin rashes were two toxicities which were observed in 38% and 59% patients. Median PFS & OS were 6 months (range 2 – 24 months) and 7 months respectively. Prognostic factors like smoking, EGFR overexpression, pre and post treatment quality of life were statistically significant in improving the OS (p-value 0.0010, 0.0031, 0.006, 0.0001 respectively). EGFR overexpression status and post-treatment quality of life were also found to be statistically significant in improving the PFS (p-value<0.0001 and 0.0004 respectively).
Conclusion: The present study demonstrates the favourable safety profile, ease of administration and a promising outcome in terms of results attained with palliative radiotherapy concurrent with gefitinib, in adenocarcinoma lung patients presenting with locally advanced stage not amenable to radical radiotherapy. However, the results need to be warranted by future studies with the larger samples in order to recommend it as a standard protocol.
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