Does radiotherapy improve survival in NSCLC patients with cachexia?

Palliative-intent radiation was performed more frequently in patients with advanced nonsmall-cell lung cancer (NSCLC) and cachexia than those without weight loss. Unfortunately, tumour-directed therapy, whether in a curative or a palliative approach, proves inadequate in improving cachexia patient survival across all stages of the disease.

A team of investigators identified and assessed all patients with NSCLC treated at a tertiary care system from 2006 to 2013 using an Institutional Tumour Registry. The international consensus definition for cachexia was adopted, with staging designated by the registry and positron emission tomography. In addition, the investigators retrospectively assessed radiotherapy delivery and intent.

Overall, 1,330 NSCLC patients were included in the analysis. Curative-intent radiotherapy was equally provided to patients with and without cachexia with NSCLC stages I to III. On the other hand, more patients with stage IV disease and cachexia received palliative radiotherapy compared to those without (74 percent vs 63 percent; p=0.006).

Despite having more cachexia patients receiving tumour-directed radiotherapy with curative or palliative intent, survival remained the same. Moreover, pretreatment cachexia was found to be associated with poorer survival for those with stage III NSCLC receiving curative-intent radiotherapy (median survival, 23.9 vs 15.0 months; p=0.009).

In multivariate analysis, pretreatment cachexia showed an independent correlation with reduced survival (hazard ratio, 1.31, 95 percent confidence interval, 1.14‒1.52).

“These findings offer critical information on the appropriate utilization of radiation in the management of patients with NSCLC with cachexia,” the investigators said.

“Cancer cachexia is a syndrome of unintentional weight loss resulting in progressive functional impairment,” according to the investigators.