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Background To optimize palliation in incurable locally advanced non-small cell lung cancer (NSCLC), the International Atomic Energy Agency conducted a prospective randomized study (NCT00864331) comparing protracted palliative radiotherapy (RT) course with chemotherapy (CHT) followed by short-course palliative RT. Methods and materials Treatment-naive patients with histologically confirmed NSCLC, stage IIIA/IIIB, received either 39 Gy in 13 fractions as RT alone (arm A, n = 31) or 2–3 platinum-based CHT cycles followed by 10 Gy in a single fraction or 16 Gy in 2 fractions separated by one week (arm B, n = 34). Primary outcome was overall survival. Results Treatment groups were balanced with respect to various variables. Median survival for all 65 patients was 8 months, while median survival was 7.1 and 8.1 months for the two arms, respectively (log-rank p = 0.4 by study arm, and p = 0.6 by Cox regression and stratified by country and sub-stage). One and three year survival rates for the two arms were 29%, and 9% and 41%, and 6%, respectively. There were no differences in any of the following endpoints: any failure, local failure, regional failure, contralateral thoracic failure, and distant failure between the two arms. High-grade (⩾3) toxicity was similar between the two arms. Symptoms, adverse events of any kind, KPS and body-mass index, were not different during treatment and during follow-up. There was no grade 5 toxicity. Conclusions This incomplete and underpowered trial only hinted similar outcome between the treatment arms. Therefore, combined CHT-RT can perhaps be considered, in limited resource setting, where access to RT remains inadequate. [ABSTRACT FROM AUTHOR]

Background To determine the optimal single-dose radiotherapy schedule for pain from bone metastases in a multi-centre, international, randomised trial. Patients and methods 651 patients were randomised to either 8 Gy ( n = 325) or 4 Gy ( n = 326) radiotherapy. Pain at 4, 8, 12, 24 and 52 weeks was assessed using a Categorical Scale (CS) and a Visual Analogue Scale (VAS). The primary endpoint was response at 4 weeks. Results There was no significant difference in patient demographics and other co-variates. The complete response (CR) rate and ORR (complete or partial response) for all follow-up times were higher after 8 Gy ( p = 0.02). The Kaplan–Meier actuarial rate (categorical scale) at 4 weeks for ORR was 80% after 8 Gy compared to 68% after 4 Gy ( p = 0.0015). 117 re-treatments were given of which 72 were in the 4 Gy group and 45 in 8 Gy arm ( p = 0.01). Conclusions There was a marked consistent difference in pain relief at all time points in favour of 8 Gy. These data reinforce the case for single dose 8 Gy radiotherapy to be recommended for metastatic bone pain in all healthcare settings. [ABSTRACT FROM AUTHOR]