Topkan, E., Yildirim, B.A., Guler, O.C., Parlak, C., Pehlivan, B., & Selek, U. (2015). Safety and palliative efficacy of single-dose 8-Gy reirradiation for painful local failure in patients with stage IV non-small cell lung cancer previously treated with radical chemoradiation therapy. International Journal of Radiation Oncology, Biology, Physics, 91, 774–780. 

To investigate the safety and efficacy of single-dose palliative chest reirradiation for pain control

Patients who had been treated with three-dimensional conformal radiation therapy (RT) and concurrent cisplatin-based therapy were given reirradiation to the chest area previously included in the > 90% prescribed dose region. Pain management was evaluated according to the World Health Organization step ladder.

• N = 78  
• MEDIAN AGE = 67.3 years (range = 37–88 years)
• MALES: 70.5%, FEMALES: 29.5%
• KEY DISEASE CHARACTERISTICS: 76% of participants had local tumor recurrence.

• SITE: Single site  
• SETTING TYPE: Outpatient    
• LOCATION: Turkey

• PHASE OF CARE: Late effects and survivorship
• APPLICATIONS: Palliative care 

Retrospective, descriptive study

• 10-point Visual Analog Scale (VAS) for pain
• National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v3.0
• Response evaluation criteria in solid tumors

There were no radiation-associated toxicities greater than grade 2. The median VAS score before reirradiation was 7 (range = 4–9), and the median score after reirradiation was 3 (range = 0–8, p < 0.001). Thoracic disease was stabilized in 33.3% of patients and partially regressed in 21.1%. No factors predicting better pain responses were identified.

Reirradiation to the chest area was effective for most patients in reducing pain associated with non-small cell lung cancer. It was not associated with severe adverse effects. Two patients developed esophagitis, and three developed pneumonitis. The median time to the lowest pain score was 27 days, and the mean duration of relief was 6.1 months.

• Small sample (< 100)
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment) 
• Unintended interventions or applicable interventions not described that would influence results
• Measurement/methods not well described
• Findings not generalizable
• Subject withdrawals ≥ 10% 
• Other limitations/explanation: This study had a retrospective design. The timing of VAS measurements was not mentioned. No information about other interventions for pain relief or medication alterations within the duration of study observations was recorded.

Locoregional failures at the margins of previous RT fields can be associated with severe pain in patients with lung cancer. This study suggested that single-dose reirradiation may reduce pain.