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Published in: Strahlentherapie und Onkologie 3/2014

01-03-2014 | Original article

Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer

Authors: Dr. B. van Oorschot, B. Assenbrunner, M. Schuler, G. Beckmann, M. Flentje

Published in: Strahlentherapie und Onkologie | Issue 3/2014

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Abstract

Background

Survival and prognostic variables in patients with advanced or metastatic non-small cell lung cancer (NSCLC) requiring thoracic palliative radiotherapy using a moderately hypofractionated regime (13–15 × 3 Gy) were evaluated.

Methods

From March 2006 to April 2012, 120 patients with a physician estimated prognosis of 6–12 months were treated with this regime using CT-based 3D conformal radiotherapy. We collected data on patient characteristics, comorbidities, toxicity, and treatment parameters.

Results

Radiotherapy was completed as prescribed in 114 patients (95.0 %, premature termination 5.0 %). Acute grade 3 toxicity was seen in 6.4 % of patients. The median survival of all patients was 5.8 months. Nonmetastatic patients survived significantly longer than patients with metastatic disease (median 11.7 months vs 4.7 months, p = 0.0001) and 18.6 % of nonmetastatic patients survived longer than 2 years. In 12.7 % radiotherapy started less than 30 days before death and 14.2 % of patients received radiotherapy within 14 days before death. In the multivariate analysis, good general condition, nonmetastatic disease, and a stable or improved general condition at the end of radiotherapy were significant. The treatment parameters, age, and comorbidities were not statistically significant.

Conclusion

Our data confirm considerable effectiveness of 13 × 3 Gy with conformal radiotherapy for patients with locally confined NSCLC not fit for radical treatment and raise doubt for this regimen in metastatic patients and ECOG ≥ 2 when burden, acute toxicity, and resources are considered.
Literature
1.
go back to reference Beli I, Koukourakis G, Platoni K et al (2010) Hypofractionated radiotherapy in non small cell lung cancer: a review of the current literature. Rev Recent Clin Trials 5(2):103–111PubMedCrossRef Beli I, Koukourakis G, Platoni K et al (2010) Hypofractionated radiotherapy in non small cell lung cancer: a review of the current literature. Rev Recent Clin Trials 5(2):103–111PubMedCrossRef
2.
go back to reference Berghmans T, Paesmans M, Sculier JP (2011) Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 3(3):127–138PubMedCentralPubMedCrossRef Berghmans T, Paesmans M, Sculier JP (2011) Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 3(3):127–138PubMedCentralPubMedCrossRef
3.
go back to reference Bleher M, Bratengeier K, Richter J (1991) Assessment of radiotherapy plans: dose–volume histograms, integral effects and tumor control. Strahlenther Onkol 167(4):220–226PubMed Bleher M, Bratengeier K, Richter J (1991) Assessment of radiotherapy plans: dose–volume histograms, integral effects and tumor control. Strahlenther Onkol 167(4):220–226PubMed
4.
go back to reference Campion FX, Larson LR, Kadlubek PJ et al (2011) Advancing performance measurement in oncology: quality oncology practice initiative participation and quality outcomes. J Oncol Pract 7(3 Suppl):31s–35sPubMedCentralPubMedCrossRef Campion FX, Larson LR, Kadlubek PJ et al (2011) Advancing performance measurement in oncology: quality oncology practice initiative participation and quality outcomes. J Oncol Pract 7(3 Suppl):31s–35sPubMedCentralPubMedCrossRef
5.
go back to reference Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRef
6.
go back to reference Chen AB, Cronin A, Weeks JC et al (2013) Palliative radiation therapy practice in patients with metastatic non-small-cell lung cancer: a Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Study. J Clin Oncol 31(5):558–564PubMedCentralPubMedCrossRef Chen AB, Cronin A, Weeks JC et al (2013) Palliative radiation therapy practice in patients with metastatic non-small-cell lung cancer: a Cancer Care Outcomes Research and Surveillance Consortium (CanCORS) Study. J Clin Oncol 31(5):558–564PubMedCentralPubMedCrossRef
7.
go back to reference Chow E, Abdolell M, Panzarella T et al (2009) Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 73(1):280–287PubMedCrossRef Chow E, Abdolell M, Panzarella T et al (2009) Validation of a predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 73(1):280–287PubMedCrossRef
8.
go back to reference Colinet B, Jacot W, Bertrand D et al (2005) A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson’s index. Br J Cancer 93(10):1098–1105PubMedCentralPubMedCrossRef Colinet B, Jacot W, Bertrand D et al (2005) A new simplified comorbidity score as a prognostic factor in non-small-cell lung cancer patients: description and comparison with the Charlson’s index. Br J Cancer 93(10):1098–1105PubMedCentralPubMedCrossRef
9.
go back to reference De Rijke JM, Schouten LJ, Velde GP ten et al (2004) Influence of age, comorbidity and performance status on the choice of treatment for patients with non-small cell lung cancer; results of a population-based study. Lung Cancer 46(2):233–245CrossRef De Rijke JM, Schouten LJ, Velde GP ten et al (2004) Influence of age, comorbidity and performance status on the choice of treatment for patients with non-small cell lung cancer; results of a population-based study. Lung Cancer 46(2):233–245CrossRef
10.
go back to reference Duncker-Rohr V, Nestle U, Momm F et al (2013) Stereotactic ablative radiotherapy for small lung tumors with a moderate dose. Favorable results and low toxicity. Strahlenther Onkol 189(1):33–40PubMedCrossRef Duncker-Rohr V, Nestle U, Momm F et al (2013) Stereotactic ablative radiotherapy for small lung tumors with a moderate dose. Favorable results and low toxicity. Strahlenther Onkol 189(1):33–40PubMedCrossRef
11.
go back to reference Earle CC, Park ER, Lai B et al (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21(6):1133–1138PubMedCrossRef Earle CC, Park ER, Lai B et al (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21(6):1133–1138PubMedCrossRef
12.
go back to reference Edge SB, Byrd DR, Compton CC et al (eds) (2010) AJCC Cancer Staging Manual, 7th edn. Springer, New York Edge SB, Byrd DR, Compton CC et al (eds) (2010) AJCC Cancer Staging Manual, 7th edn. Springer, New York
13.
go back to reference Enders CK (2010) Applied missing data analysis. Guilford, New York Enders CK (2010) Applied missing data analysis. Guilford, New York
14.
go back to reference Erridge SC, Gaze MN, Price A et al (2005) Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol (R Coll Radiol) 17(1):61–67 Erridge SC, Gaze MN, Price A et al (2005) Symptom control and quality of life in people with lung cancer: a randomised trial of two palliative radiotherapy fractionation schedules. Clin Oncol (R Coll Radiol) 17(1):61–67
15.
go back to reference Fairchild A, Harris K, Barnes E et al (2008) Palliative thoracic radiotherapy for lung cancer: a systematic review. J Clin Oncol 26(24):4001–4011PubMedCrossRef Fairchild A, Harris K, Barnes E et al (2008) Palliative thoracic radiotherapy for lung cancer: a systematic review. J Clin Oncol 26(24):4001–4011PubMedCrossRef
16.
go back to reference Fromme EK, Smith MD, Bascom PB et al (2010) Incorporating routine survival prediction in a U.S. hospital-based palliative care service. J Palliat Med 13(12):1439–1444PubMedCentralPubMedCrossRef Fromme EK, Smith MD, Bascom PB et al (2010) Incorporating routine survival prediction in a U.S. hospital-based palliative care service. J Palliat Med 13(12):1439–1444PubMedCentralPubMedCrossRef
17.
go back to reference Gironés R, Torregrosa D, Gómez-Codina J et al (2011) Prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores. Lung Cancer 72(1):108–113PubMedCrossRef Gironés R, Torregrosa D, Gómez-Codina J et al (2011) Prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores. Lung Cancer 72(1):108–113PubMedCrossRef
18.
go back to reference Giroux Leprieur E, Lavole A, Ruppert AM et al (2012) Factors associated with long-term survival of patients with advanced non-small cell lung cancer. Respirology 17(1):134–142CrossRef Giroux Leprieur E, Lavole A, Ruppert AM et al (2012) Factors associated with long-term survival of patients with advanced non-small cell lung cancer. Respirology 17(1):134–142CrossRef
19.
go back to reference Glare PA, Sinclair CT (2008) Palliative medicine review: prognostication. J Palliat Med 11(1):84–103PubMedCrossRef Glare PA, Sinclair CT (2008) Palliative medicine review: prognostication. J Palliat Med 11(1):84–103PubMedCrossRef
20.
go back to reference Goeckenjan G, Sitter H, Thomas M et al (2011) Prevention, diagnosis, therapy, and follow-up of lung cancer: interdisciplinary guideline of the German Respiratory Society and the German Cancer Society. Pneumologie 65(1):39–59PubMedCrossRef Goeckenjan G, Sitter H, Thomas M et al (2011) Prevention, diagnosis, therapy, and follow-up of lung cancer: interdisciplinary guideline of the German Respiratory Society and the German Cancer Society. Pneumologie 65(1):39–59PubMedCrossRef
21.
go back to reference Graham JW (2009) Missing data analysis: making it work in the real world. Annu Rev Psychol 60:549–576PubMedCrossRef Graham JW (2009) Missing data analysis: making it work in the real world. Annu Rev Psychol 60:549–576PubMedCrossRef
22.
go back to reference Greer JA, Pirl WF, Jackson VA et al (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol 30(4):394–400PubMedCrossRef Greer JA, Pirl WF, Jackson VA et al (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol 30(4):394–400PubMedCrossRef
23.
go back to reference Gripp S, Moeller S, Bölke E et al (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 25(22):3313–3320PubMedCrossRef Gripp S, Moeller S, Bölke E et al (2007) Survival prediction in terminally ill cancer patients by clinical estimates, laboratory tests, and self-rated anxiety and depression. J Clin Oncol 25(22):3313–3320PubMedCrossRef
24.
go back to reference Gripp S, Mjartan S, Boelke E et al (2010) Palliative radiotherapy tailored to life expectancy in end-stage cancer patients. Cancer 116:3251–3256PubMedCrossRef Gripp S, Mjartan S, Boelke E et al (2010) Palliative radiotherapy tailored to life expectancy in end-stage cancer patients. Cancer 116:3251–3256PubMedCrossRef
25.
go back to reference Grose D, Devereux G, Milroy R (2011) Comorbidity in lung cancer: important but neglected. A review of the current literature. Clin Lung Cancer 12(4):207–211PubMedCrossRef Grose D, Devereux G, Milroy R (2011) Comorbidity in lung cancer: important but neglected. A review of the current literature. Clin Lung Cancer 12(4):207–211PubMedCrossRef
26.
go back to reference Guadagnolo BA, Liao KP, Elting L et al (2013) Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States. J Clin Oncol 31(1):80–87PubMedCentralPubMedCrossRef Guadagnolo BA, Liao KP, Elting L et al (2013) Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States. J Clin Oncol 31(1):80–87PubMedCentralPubMedCrossRef
27.
go back to reference Jacot W, Colinet B, Bertrand D et al (2008) Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients. Ann Oncol 19(8):1458–1464PubMedCrossRef Jacot W, Colinet B, Bertrand D et al (2008) Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients. Ann Oncol 19(8):1458–1464PubMedCrossRef
28.
go back to reference Kramer GW, Wanders SL, Noordijk EM et al (2005) Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancer. J Clin Oncol 23(13):2962–2970PubMedCrossRef Kramer GW, Wanders SL, Noordijk EM et al (2005) Results of the Dutch National study of the palliative effect of irradiation using two different treatment schemes for non-small-cell lung cancer. J Clin Oncol 23(13):2962–2970PubMedCrossRef
29.
go back to reference Lester JF, Macbeth FR, Toy E et al (2006) Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev 18:(4):CD002143 Lester JF, Macbeth FR, Toy E et al (2006) Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev 18:(4):CD002143
30.
go back to reference n A (1991) Inoperable non-small-cell lung cancer (NSCLC): a Medical Research Council randomised trial of palliative radiotherapy with two fractions or ten fractions. Report to the Medical Research Council by its Lung Cancer Working Party. Br J Cancer 63(2):265–270CrossRef n A (1991) Inoperable non-small-cell lung cancer (NSCLC): a Medical Research Council randomised trial of palliative radiotherapy with two fractions or ten fractions. Report to the Medical Research Council by its Lung Cancer Working Party. Br J Cancer 63(2):265–270CrossRef
31.
go back to reference Lutz T, Chow L, Hartsell W et al (2007) A review of hypofractionated palliative radiotherapy. Cancer 109(8):1463–1469CrossRef Lutz T, Chow L, Hartsell W et al (2007) A review of hypofractionated palliative radiotherapy. Cancer 109(8):1463–1469CrossRef
32.
go back to reference Mac Manus MP, Matthews JP, Wada M et al (2001) Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev 3:CD002143 (Review. Update in: Cochrane Database Syst Rev 2006) Mac Manus MP, Matthews JP, Wada M et al (2001) Palliative radiotherapy regimens for non-small cell lung cancer. Cochrane Database Syst Rev 3:CD002143 (Review. Update in: Cochrane Database Syst Rev 2006)
33.
go back to reference Maltoni M, Caraceni A, Brunelli C et al (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23(25):6240–6248PubMedCrossRef Maltoni M, Caraceni A, Brunelli C et al (2005) Prognostic factors in advanced cancer patients: evidence-based clinical recommendations—a study by the Steering Committee of the European Association for Palliative Care. J Clin Oncol 23(25):6240–6248PubMedCrossRef
34.
go back to reference Maurer J, Hipp M, Schäfer C et al (2011) Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol 187(11):744–749PubMedCrossRef Maurer J, Hipp M, Schäfer C et al (2011) Dysphagia. Impact on quality of life after radio(chemo)therapy of head and neck cancer. Strahlenther Onkol 187(11):744–749PubMedCrossRef
35.
go back to reference National Comprehensive Cancer Network (NCCN) Guidelines Non-Small Cell Lung Cancer, Version 2.2013. http://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. Accessed 31 December 2013 National Comprehensive Cancer Network (NCCN) Guidelines Non-Small Cell Lung Cancer, Version 2.2013. http://​www.​nccn.​org/​professionals/​physician_​gls/​pdf/​nscl.​pdf.​ Accessed 31 December 2013
36.
go back to reference Nestle U, Nieder C, Walter K et al (2000) A palliative accelerated irradiation regimen for advanced non-small-cell lung cancer vs. conventionally fractionated 60 Gy: results of a randomized equivalence study. Int J Radiat Oncol Biol Phys 48(1):95–103PubMedCrossRef Nestle U, Nieder C, Walter K et al (2000) A palliative accelerated irradiation regimen for advanced non-small-cell lung cancer vs. conventionally fractionated 60 Gy: results of a randomized equivalence study. Int J Radiat Oncol Biol Phys 48(1):95–103PubMedCrossRef
37.
go back to reference Numico G, Russi E, Merlano M (2001) Best supportive care in non-small cell lung cancer: is there a role for radiotherapy and chemotherapy? Lung Cancer 32(3):213–226PubMedCrossRef Numico G, Russi E, Merlano M (2001) Best supportive care in non-small cell lung cancer: is there a role for radiotherapy and chemotherapy? Lung Cancer 32(3):213–226PubMedCrossRef
38.
go back to reference Read WL, Tierney RM, Page NC et al (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22(15):3099–3103PubMedCrossRef Read WL, Tierney RM, Page NC et al (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22(15):3099–3103PubMedCrossRef
39.
go back to reference Reinfuss M, Mucha-Małecka A, Walasek T et al (2011) Palliative thoracic radiotherapy in non-small cell lung cancer. An analysis of 1250 patients. Palliation of symptoms, tolerance and toxicity. Lung Cancer 71(3):344–349PubMedCrossRef Reinfuss M, Mucha-Małecka A, Walasek T et al (2011) Palliative thoracic radiotherapy in non-small cell lung cancer. An analysis of 1250 patients. Palliation of symptoms, tolerance and toxicity. Lung Cancer 71(3):344–349PubMedCrossRef
40.
go back to reference Rodrigues G, Macbeth F, Burmeister B et al (2012) International practice survey on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control. Clin Lung Cancer 13(3):225–235PubMedCrossRef Rodrigues G, Macbeth F, Burmeister B et al (2012) International practice survey on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control. Clin Lung Cancer 13(3):225–235PubMedCrossRef
41.
go back to reference Salvo N, Hadi S, Napolskikh J et al (2009) Quality of life measurement in cancer patients receiving palliative radiotherapy for symptomatic lung cancer: a literature review. Curr Oncol 16(2):16–28PubMedCentralPubMed Salvo N, Hadi S, Napolskikh J et al (2009) Quality of life measurement in cancer patients receiving palliative radiotherapy for symptomatic lung cancer: a literature review. Curr Oncol 16(2):16–28PubMedCentralPubMed
42.
go back to reference Schröder C, Ivo M, Buchali A (2013) Does high-dose radiotherapy benefit palliative lung cancer patients? An intradepartmental comparison of two dose regimens. Strahlenther Onkol 189(9):771–776PubMedCrossRef Schröder C, Ivo M, Buchali A (2013) Does high-dose radiotherapy benefit palliative lung cancer patients? An intradepartmental comparison of two dose regimens. Strahlenther Onkol 189(9):771–776PubMedCrossRef
43.
go back to reference Smith SL, Palma D, Parhar T et al (2011) Inoperable early stage non-small cell lung cancer: comorbidity, patterns of care and survival. Lung Cancer 72(1):39–44PubMedCrossRef Smith SL, Palma D, Parhar T et al (2011) Inoperable early stage non-small cell lung cancer: comorbidity, patterns of care and survival. Lung Cancer 72(1):39–44PubMedCrossRef
44.
go back to reference Tang JI, Shakespeare TP, Lu JJ et al (2008) Patients’ preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancerdagger. J Med Imaging Radiat Oncol 52(5):497–502PubMedCrossRef Tang JI, Shakespeare TP, Lu JJ et al (2008) Patients’ preference for radiotherapy fractionation schedule in the palliation of symptomatic unresectable lung cancerdagger. J Med Imaging Radiat Oncol 52(5):497–502PubMedCrossRef
45.
go back to reference Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742PubMedCrossRef Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 363(8):733–742PubMedCrossRef
46.
go back to reference Timothy AR, Girling DJ, Saunders MI et al (2001) Radiotherapy for inoperable lung cancer. Clin Oncol (R Coll Radiol) 13(2):86–87 Timothy AR, Girling DJ, Saunders MI et al (2001) Radiotherapy for inoperable lung cancer. Clin Oncol (R Coll Radiol) 13(2):86–87
47.
go back to reference Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181PubMedCrossRef Trotti A, Colevas AD, Setser A et al (2003) CTCAE v3.0: development of a comprehensive grading system for the adverse effects of cancer treatment. Semin Radiat Oncol 13(3):176–181PubMedCrossRef
48.
go back to reference Toole M, Lutz S, Johnstone PA (2012) Radiation oncology quality: aggressiveness of cancer care near the end of life. J Am Coll Radiol 9(3):199–202PubMedCrossRef Toole M, Lutz S, Johnstone PA (2012) Radiation oncology quality: aggressiveness of cancer care near the end of life. J Am Coll Radiol 9(3):199–202PubMedCrossRef
49.
go back to reference Turner NJ, Muers MF, Haward RA, Mulley GP (2005) Do elderly people with lung cancer benefit from palliative radiotherapy? Lung Cancer 49(2):193–202PubMedCrossRef Turner NJ, Muers MF, Haward RA, Mulley GP (2005) Do elderly people with lung cancer benefit from palliative radiotherapy? Lung Cancer 49(2):193–202PubMedCrossRef
50.
go back to reference Oorschot B van, Rades D, Schulze W et al (2011) Palliative radiotherapy: new approaches. Semin Oncol 38(3):443–449PubMedCrossRef Oorschot B van, Rades D, Schulze W et al (2011) Palliative radiotherapy: new approaches. Semin Oncol 38(3):443–449PubMedCrossRef
51.
go back to reference Oorschot B van, Schuler M, Simon A et al (2011) Patterns of care and course of symptoms in palliative radiotherapy: a multicenter pilot study analysis. Strahlenther Onkol 187(8):461–466PubMedCrossRef Oorschot B van, Schuler M, Simon A et al (2011) Patterns of care and course of symptoms in palliative radiotherapy: a multicenter pilot study analysis. Strahlenther Onkol 187(8):461–466PubMedCrossRef
52.
go back to reference Wang T, Nelson RA, Bogardus A, Grannis FW Jr (2010) Five-year lung cancer survival: which advanced stage nonsmall cell lung cancer patients attain long-term survival? Cancer 116(6):1518–5125PubMedCrossRef Wang T, Nelson RA, Bogardus A, Grannis FW Jr (2010) Five-year lung cancer survival: which advanced stage nonsmall cell lung cancer patients attain long-term survival? Cancer 116(6):1518–5125PubMedCrossRef
Metadata
Title
Survival and prognostic factors after moderately hypofractionated palliative thoracic radiotherapy for non-small cell lung cancer
Authors
Dr. B. van Oorschot
B. Assenbrunner
M. Schuler
G. Beckmann
M. Flentje
Publication date
01-03-2014
Publisher
Springer-Verlag
Published in
Strahlentherapie und Onkologie / Issue 3/2014
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-013-0507-y

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