Best supportive care in non-small cell lung cancer: is there a role for radiotherapy and chemotherapy?

摘要: Best Supportive Care (BSC) is the treatment of choice when cure not achievable with anticancer treatments and involves management disease-related symptoms. In palliative non-small cell lung cancer (NSCLC) radiation therapy has for a long time been cornerstone symptom management, although best schedule still to be defined. Chemotherapy, on other hand, excluded from classical definitions BSC reserved only selected patient populations in which survival benefit was demonstrated using cisplatin-based regimens. We reviewed randomized trials both radiotherapy chemotherapy order assess impact quality life advanced NSCLC patients. While no compared control arm including it, several assessed use different schedules. Hypofractionated schedules seem have comparable activity standard fractionated regimens, at least metastatic, poor-prognosis locally advanced, inoperable higher doses administered conventional fractionation achieve better results terms local survival. The rate palliation symptoms high, being 60-80% chest pain hemoptysis, while breathlessness cough are controlled somewhat lower (50-70%). General (fatigue, anorexia, depression) affected minority Chemotherapy trials, some an analysis included. Results consistent favor its role and, assessed, rates similar those achieved by radiation. Benefits apply metastatic patients good performance status, low body weight loss, age below 70-75. However, studies support also poor prognostic features. A comparison between regimens object few trials. Both important should included programs. Future way combining these two approaches.