Abstract
According to the literature, performance status, stage-tumor dimension and nodal status, weight loss, were the most important prognostic factors for survival in patients with locally advanced non-small cell lung cancer. To evaluate the treatment results and prognostic variables in our patients, study of 85 patients was randomly assigned to one of the two treatment arms. In the sequential arm, 45 patients had previously received sequential chemotherapy with 4 cycles of and etoposide followed by conformal radiotherapy (RT). In the second concurrent group, 40 patients received concomitant chemotherapy of cisplatine and etoposide and conformal RT, followed by two cycles of consolidation chemotherapy of carboplatine and etoposide. We described all phases of the conformal three dimensional (3-D) RT. From October 2005 to April 2008, 85 patients were enrolled. Eight patients were not eligible, seven had stage IV and one patient had pleural effusion. They were all initially considered to have stage IIIB disease. The median survival was 13 months for the patients in the sequential arm and 19 months for those in the concurrent treatment arm. The differences were statistically significant (log-rank test p=0.0039). The disease-free survival was 9 months in the sequential arm and 16 months in the concurrent treatment group. The differences were statistically significant (log-rank test p=0.0023). We found that the following prognostic factors significantly influenced the survival in lung cancer patients treated with conservative method: (1) age: p<0.05; (2) Performance status: p<0.001; (3) Weight loss: p<0.001; (4) Tumor dimension: p<0.05; (5) Nodal involvement: p<0.05 Conclusions: Given the higher toxicity in the concurrent-consolidation schedule, it should be reserved for patients younger than 70 years, having good performance status and minimal weight loss. Also we highly recommend precisely define the stage of disease and the prognostic factors in lung cancer patients for giving better treatment.
Highlights
We found that the following prognostic factors significantly influenced the survival in lung cancer patients treated with conservative method: (1) age: p
Given the higher toxicity in the concurrent-consolidation schedule, it should be reserved for patients younger than 70 years, having good performance status and minimal weight loss
We highly recommend precisely define the stage of disease and the prognostic factors in lung cancer patients for giving better treatment
Summary
1.2 million people die from lung cancer each year. NSCLC represents over 80% of all lung cancers and 60% to 70% of the patients with NSCLC suffer from stage III or IV disease. In the late 1980s, radiotherapy was the standard treatment for these patients [1]. Randomized trials showed that combination of chemoradiotherapy was superior to radiotherapy alone [2]. Many chemotherapeutic agents active in NSCLC possess radiosensitizing properties, thereby improving the probability of local control. Chemotherapy administered concurrently with thoracic radiation may act systemically and potentially eradicate distant micrometastases. Several studies showed the feasibility of the cisplatin-etoposide combination plus radiotherapy for patients with stage III disease [3]
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