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

Md. Abdul Karim; Ashim Kumar Ghosh; Rawshan Ara Khatun; Julekha Khatun; Nishan Chakrabarty

doi:doi:10.11648/j.rst.20241003.12

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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

Md. Abdul Karim^*

, Ashim Kumar Ghosh

, Rawshan Ara Khatun

, Julekha Khatun

, Nishan Chakrabarty

Published in Radiation Science and Technology (Volume 10, Issue 3)

Received: 27 October 2024 Accepted: 12 November 2024 Published: 28 November 2024

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Abstract

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.

Published in	Radiation Science and Technology (Volume 10, Issue 3)
DOI	10.11648/j.rst.20241003.12
Page(s)	43-55
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

NSCLC, Palliative Radiotherapy, Palliation of Symptom

References

[1]	Wang, Z., Hu, L., Li, J., Wei, L., Zhang, J., and Zhou, J. Magnitude, temporal trends, and inequality in global burden of tracheal, bronchus, and lung cancer Findings from the Global Burden of Disease Study 2017. BMJ Global Health. 2020, 5(10), 1–10.
[2]	Casal-Mouriño, A., Ruano-Ravina, A., Lorenzo-González, M., Rodríguez-Martínez, Á., Giraldo-Osorio, A., Varela-Lema, L., Pereiro-Brea, T., Barros-Dios, J. M., Valdés-Cuadrado, L., and Pérez-Ríos, M. Epidemiology of stage III lung cancer frequency, diagnostic characteristics, and survival. Translational Lung Cancer Research. 2021, 10(1), 506–518.
[3]	Li, H., and Li, J. Effectiveness of palliative care for non-small cell lung cancer. Experimental and Therapeutic Medicine. 2016, 12(4), 2387–2389.
[4]	Lewis, T. S., Kennedy, J. A., Price, G. J., Mee, T., Woolf, D. K., Bayman, N. A., Chan, C., Coote, J. H., Faivre-Finn, C., Harris, M. A., Hudson, A. M., Pemberton, L. S., Salem, A., Sheikh, H. Y., Mistry, H. B., and Cobben, D. C. P. Palliative Lung Radiotherapy Higher Dose Leads to Improved Survival? Clinical Oncology. 2020, 32(10), 674–684.
[5]	Støchkel, F. M., Schou, N., Nygård, L., and Fredberg, P. G. Fractionated palliative thoracic radiotherapy in non-small cell lung cancer – futile or worthwhile. BMC Palliative Care. 2018, 17(1), 15.
[6]	Jin, C. J., Kong, W., and Mackillop, W. J. Estimating the need for palliative radiotherapy for non-small cell lung cancer A criterion-based benchmarking approach. Radiotherapy and Oncology. 2018, 128(3), 541–547.
[7]	Rodrigues, G., Macbeth, F., Burmeister, B., Kelly, K.-L., Bezjak, A., Langer, C., Hahn, C., Vichare, A., and Movsas, B. International Practice Survey on Palliative Lung Radiotherapy Third International Consensus Workshop on Palliative Radiotherapy and Symptom Control. Clinical Lung Cancer. 2012, 13(3), 225–235.
[8]	Rodrigues, G., Videtic, G. M. M., Sur, R., Bezjak, A., Bradley, J., Hahn, C. A., Langer, C., Miller, K. L., Moeller, B. J., Rosenzweig, K., and Movsas, B. Palliative thoracic radiotherapy in lung cancer An American Society for Radiation Oncology evidence-based clinical practice guideline. Practical Radiation Oncology. 2011, 1(2), 60–71.
[9]	Erridge, S. C., Gaze, M. N., Price, A., Kelly, C. G., Kerr, G. R., Cull, A., MacDougall, R. H., Howard, G. C. W., Cowie, V. J., and Gregor, A. Symptom control and quality of life in people with lung cancer a randomised trial of two palliative radiotherapy fractionation schedules. Clinical Oncology. 2005, 17(1), 61–67.
[10]	Fatma, M. F. A., Elzahaf, E. H., and Ali, R. E. Comparison of Two Palliative Radiotherapy Schedules for Locally Advanced Non-Small-Cell Lung Cancer (NSCLC). Journal of Cancer Therapy. 2012, 80(1), 169–173.
[11]	Ma, J. T., Zheng, J. H., Han, C. B., and Guo, Q. Y. Meta-analysis comparing higher and lower dose radiotherapy for palliation in locally advanced lung cancer. Cancer Science. 2014, 105(8), 1015–1022.
[12]	Kramer, G. W. P. M., Wanders, S. L., Noordijk, E. M., Vonk, E. J. A., van Houwelingen, H. C., van den Hout, W. B., Geskus, R. B., Scholten, M., and Leer, J.-W. H. Results of the Dutch National Study of the Palliative Effect of Irradiation Using Two Different Treatment Schemes for Non–Small-Cell Lung Cancer. Journal of Clinical Oncology. 2005, 23(13), 2962–2970.
[13]	Sau, S., Dutta, P., Gayen, G., Banerjee, S., and Basu, A. A comparative study of different dose fractionations schedule of thoracic radiotherapy for pain palliation and health-related quality of life in metastatic NSCLC. Lung India. 2014, 31(4), 348–353.
[14]	Lotayef, M., Elkader, Y. A., Amin, A., Taher, A., El-Kest, E., and Abdelall, M. A Prospective Study of the Effect of Different Palliative Radiotherapy Fractionation Schedules on Tumor Response and Toxicity in Advanced Non-Small Cell Lung Cancer (NSCLC) Patients. Journal of Cancer Therapy. 2016, 7(12), 924–938.
[15]	Simpson, J. R., Francis, M. E., Perez-Tamayo, R., Marks, R. D., and Rao, D. V. Palliative radiotherapy for inoperable carcinoma of the lung final report of a RTOG multi-institutional trial. International Journal of Radiation Oncology Biology Physics. 1985, 11(4), 751–758.
[16]	Van den Hout, W. B., Kramer, G. W. P. M., Noordijk, E. M., and Leer, J.-W. H. Cost–Utility Analysis of Short-Versus Long-Course Palliative Radiotherapy in Patients With Non–Small-Cell Lung Cancer. Journal of the National Cancer Institute. 2006, 98(24), 1786–1794.
[17]	Bezjak, A., Dixon, P., Brundage, M., Tu, D. S., Palmer, M. J., Blood, P., Grafton, C., Lochrin, C., Leong, C., Mulroy, L., Smith, C., Wright, J., and Pater, J. L. Randomized phase III trial of single versus fractionated thoracic radiation in the palliation of patients with lung cancer (NCIC CTG SC.15). International Journal of Radiation Oncology Biology Physics. 2002, 54(3), 719–728.
[18]	Eldeeb, N. A., Bela, A. M., Eganady, A. A., and Radwan, A. S. Comparative study of two radiotherapy regimens for palliation of symptomatic advanced non-small cell lung cancer. Egyptian Journal of Chest Diseases and Tuberculosis. 2014, 63(2), 423–434.
[19]	Senkus-Konefka, E., Dziadziuszko, R., Bednaruk-Młyński, E., Pliszka, A., Kubrak, J., Lewandowska, A., Małachowski, K., Wierzchowski, M., Matecka-Nowak, M., and Jassem, J. A prospective, randomised study to compare two palliative radiotherapy schedules for non-small-cell lung cancer (NSCLC). British Journal of Cancer. 2005, 92(6), 1038–1045.

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APA Style

Karim, M. A., Ghosh, A. K., Khatun, R. A., Khatun, J., Chakrabarty, N. (2024). 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. Radiation Science and Technology, 10(3), 43-55. https://doi.org/10.11648/j.rst.20241003.12

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ACS Style

Karim, M. A.; Ghosh, A. K.; Khatun, R. A.; Khatun, J.; Chakrabarty, N. 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. Radiat. Sci. Technol. 2024, 10(3), 43-55. doi: 10.11648/j.rst.20241003.12

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AMA Style

Karim MA, Ghosh AK, Khatun RA, Khatun J, Chakrabarty N. 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. Radiat Sci Technol. 2024;10(3):43-55. doi: 10.11648/j.rst.20241003.12

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@article{10.11648/j.rst.20241003.12,
  author = {Md. Abdul Karim and Ashim Kumar Ghosh and Rawshan Ara Khatun and Julekha Khatun and Nishan Chakrabarty},
  title = {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
},
  journal = {Radiation Science and Technology},
  volume = {10},
  number = {3},
  pages = {43-55},
  doi = {10.11648/j.rst.20241003.12},
  url = {https://doi.org/10.11648/j.rst.20241003.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.rst.20241003.12},
  abstract = {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  0.05). 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.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - 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

AU  - Md. Abdul Karim
AU  - Ashim Kumar Ghosh
AU  - Rawshan Ara Khatun
AU  - Julekha Khatun
AU  - Nishan Chakrabarty
Y1  - 2024/11/28
PY  - 2024
N1  - https://doi.org/10.11648/j.rst.20241003.12
DO  - 10.11648/j.rst.20241003.12
T2  - Radiation Science and Technology
JF  - Radiation Science and Technology
JO  - Radiation Science and Technology
SP  - 43
EP  - 55
PB  - Science Publishing Group
SN  - 2575-5943
UR  - https://doi.org/10.11648/j.rst.20241003.12
AB  - 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  0.05). 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.

VL  - 10
IS  - 3
ER  -

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Author Information

Md. Abdul Karim

Department of Radiotherapy, Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Contact Email

http://orcid.org/0009-0002-2577-1234
Ashim Kumar Ghosh

Department of Radiotherapy, Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Contact Email

http://orcid.org/0009-0006-5499-8197
Rawshan Ara Khatun

Department of Radiotherapy, Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Contact Email

http://orcid.org/0009-0000-5831-5257
Julekha Khatun

Department of Radiotherapy, Rajshahi Medical College Hospital, Rajshahi, Bangladesh

Contact Email

http://orcid.org/0009-0007-9228-3616
Nishan Chakrabarty

Department of Pharmacy, Jagannath University, Dhaka, Bangladesh

Contact Email

http://orcid.org/0000-0002-4060-7275

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Plain Text BibTeX RIS

APA Style

Karim, M. A., Ghosh, A. K., Khatun, R. A., Khatun, J., Chakrabarty, N. (2024). 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. Radiation Science and Technology, 10(3), 43-55. https://doi.org/10.11648/j.rst.20241003.12

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ACS Style

Karim, M. A.; Ghosh, A. K.; Khatun, R. A.; Khatun, J.; Chakrabarty, N. 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. Radiat. Sci. Technol. 2024, 10(3), 43-55. doi: 10.11648/j.rst.20241003.12

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AMA Style

Karim MA, Ghosh AK, Khatun RA, Khatun J, Chakrabarty N. 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. Radiat Sci Technol. 2024;10(3):43-55. doi: 10.11648/j.rst.20241003.12

Copy | Download

@article{10.11648/j.rst.20241003.12,
  author = {Md. Abdul Karim and Ashim Kumar Ghosh and Rawshan Ara Khatun and Julekha Khatun and Nishan Chakrabarty},
  title = {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
},
  journal = {Radiation Science and Technology},
  volume = {10},
  number = {3},
  pages = {43-55},
  doi = {10.11648/j.rst.20241003.12},
  url = {https://doi.org/10.11648/j.rst.20241003.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.rst.20241003.12},
  abstract = {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  0.05). 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.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - 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

AU  - Md. Abdul Karim
AU  - Ashim Kumar Ghosh
AU  - Rawshan Ara Khatun
AU  - Julekha Khatun
AU  - Nishan Chakrabarty
Y1  - 2024/11/28
PY  - 2024
N1  - https://doi.org/10.11648/j.rst.20241003.12
DO  - 10.11648/j.rst.20241003.12
T2  - Radiation Science and Technology
JF  - Radiation Science and Technology
JO  - Radiation Science and Technology
SP  - 43
EP  - 55
PB  - Science Publishing Group
SN  - 2575-5943
UR  - https://doi.org/10.11648/j.rst.20241003.12
AB  - 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  0.05). 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.

VL  - 10
IS  - 3
ER  -

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