Site-Specific Symptom Management: Palliative Radiotherapy for Advanced and Metastatic Lung Cancer

Palliative radiation can be useful in numerous clinical scenarios with respect to primary or metastatic thoracic tumors. Extensive stage small cell lung cancer (SCLC) and locally advanced, unresectable nonsmall cell lung cancer (NSCLC) are the most common causes of symptoms that can be managed even in the setting of incurable underlying disease. Dyspnea, pain, hemoptysis, and superior vena cava syndrome are some manifestations of thoracic tumor invasion that compromise quality of life and survival. Multiple trials have been conducted to assess symptom relief and survival, with some conflicting evidence. Palliation of symptoms is reasonably achieved in most of these studies, and some show benefits in survival or tumor regression. Various fractionation schemas have been studied to determine the optimal symptom control. Metaanalyses have attempted to identify subsets of patients that benefit more, with performance status emerging as consistent predictor of benefit. Patient selection remains crucial to determining the risk-benefit ratio of any regimen.