Incidence and Impact of Pretreatment Tumor Cavitation on Survival Outcomes of Stage III Squamous Cell Lung Cancer Patients Treated With Radical Concurrent Chemoradiation Therapy

Abstract

To investigate the incidence and influence of tumor cavitation (TC) on survival outcomes of locally advanced squamous cell lung cancer (LA-SqCLC) patients treated with concurrent chemoradiation therapy (C-CRT). Records of 789 stages IIIA/B squamous cell lung cancer (SqCLC) patients treated with C-CRT who received 1 to 3 cycles of platinum-based doublet chemotherapy during 60 to 66Gy radiation therapy (RT) were analyzed retrospectively. Primary endpoint was the association between overall survival (OS) and pretreatment TC status. Secondary endpoints included locoregional progression-free survival (LRPFS), progression-free survival (PFS), and incidence of TC and correlated factors. Pretreatment TC occurred in 95 patients (12%), being significantly more common in those patients with ever-smoking history (12.6% vs 3.9%; P<.001), weight loss >5% (20.9% vs 7.1%; P<.001), and hemoptysis (27.1% vs 6.4%; P<.001). Rates of acute and late toxicities were similar in patients who presented with and without TC (P>.05 for each). For the whole cohort, at a median follow-up of 22.9months (range: 2.4-71.1), the respective median OS, LRPFS, and PFS estimates were 23.7, 14.7, and 10.7months. In multivariate analysis, stage IIIB disease (P<.001; hazard ratio [HR]: 1.33; 95% CI: 1.21-1.45), weight loss >5% (P<.001; HR: 2.10; 95% CI: 1.85-2.35), anemia (P<.001; HR: 1.82; 95% CI: 1.67-1.97), and presence of TC (P<.001; HR: 1.54; 95% CI: 1.37-1.71) appeared to be independently associated with poorer OS durations, likewise the LRPFS (P<.001 for each of these covariates), and PFS (P<.001 for each of these covariates), respectively. Present results showed that the TC occurred in 12% of LA-SqCLC patients, which was strongly associated with poorer PFS, LRPFS, and OS outcomes after definitive C-CRT.