For patients with more advanced NSCLC (stages III and IV), external beam radiation and/or chemotherapy are usually offered as treatment. Chest pain and hemoptysis are more effectively palliated than cough and dyspnea. Two multicenter randomized prospective controlled trials’ that were conducted in the United Kingdom were designed to assess the effects of different external beam radiation programs to the thoracic inlet and mediastinum on the relief of specific symptoms that are related to an intrathoracic tumor. In the first study, 369 patients were allocated to receive either two 8.5-Gy fractional doses (total dose, 17 Gy) administered 1 week apart or a conventional multifractionated regimen of either 30 Gy in 10 fractions or 27 Gy in 6 fractions (a biologically equivalent dose). canadian healthcare mall
In the second study, 235 patients were allocated to receive a single 10-Gy dose or two 8.5-Gy fractional doses. Cough was present at baseline in 93% of patients in the first study, and in 95% of patients in the second study. Significant relief of cough, as judged by the patients and their clinicians through a questionnaire technique, was achieved in 74% of patients for the multifractionated program and 82% of patients in the two-fraction program in the first study, and in 48% of patients in the two-fraction program and 56% of patients in the single-fraction program in the second study. Palliation of cough lasted for a median of 70 to 78 days in the first study, and for 56 to 61 days in the second study. Radiofrequency ablation has also been suggested as treatment for larger tumors that cause cough, but precise data are not available regarding the improvement of this symptom by such a treatment method. Some studies of newer chemotherapeutic agents like gemcitabine and cisplatin-based combination chemotherapy have concentrated on specific symptoms, including cough. Cough was assessed by the patients, using a visual analog scale, with improvement defined as two consecutive cycles of improvement over baseline. Most of the symptom control was achieved during the first three cycles of treatment.