Comparative Study of Two Thoracic External Beam Radiotherapy Regimen 30Gy in 10 Fractions Versus 20Gy in 5 Fractions for Palliation of Symptoms in Non-Small Cell Lung Cancer

Metastatic non-small cell lung cancer (NSCLC) frequently manifests with symptoms from the primary tumor within the chest, such as shortness of breath, chest pain, coughing, and hemoptysis. Thoracic palliative radiotherapy is a viable option for alleviating symptoms in these patients, who typically have a poor prognosis and are not candidates for curative treatment. Given their limited survival, a shorter treatment period that achieves adequate palliation is often preferred. Hypofractionated thoracic radiotherapy may meet this criterion. This quasi-experimental study, conducted at the Department of Radiotherapy, Rajshahi Medical College Hospital from January to December 2020, aimed to compare the response and acute toxicity of two thoracic external beam radiotherapy (EBRT) regimens—30 Gy in 10 fractions versus 20 Gy in 5 fractions—in the palliation of symptoms in NSCLC patients. Seventy-two diagnosed NSCLC patients with chest tumor-related symptoms (cough, dyspnea, hemoptysis, chest pain) unsuitable for radical treatment were enrolled and allocated into two groups by a non-randomized technique. Arm-A received 30 Gy in 10 fractions, while Arm-B received 20 Gy in 5 fractions. Patients were assessed before radiotherapy, at the end of treatment, and at 4 and 8 weeks post-treatment. The study found that both Arm-A and Arm-B showed highly significant improvement in all symptoms compared to pre-treatment status (p < 0.001), with no significant difference between the two arms (p > 0.05). In Arm-A, 22.22% of patients achieved complete symptomatic response and 44.44% showed improvement, while in Arm-B, 19.44% of patients achieved complete symptomatic response and 50% showed improvement. No statistically significant difference was observed between the two arms regarding clinical symptomatic response (p > 0.05) or treatment-related toxicities (p > 0.05), all of which were manageable. In conclusion, both treatment regimens were equally effective in symptom palliation and had comparable toxicity profiles, supporting the use of either regimen depending on patient needs and resource availability.