Abstract
Pulmonologist plays an important role not just in getting tissue sampling for diagnosis and molecular testing and staging but also administer the treatment when there is no medical oncologist available on site in some centers in some part of the world. Hence, the treatment needed to be delivered promptly to the patient under the care of pulmonologist. We retrospectively included patients who undergone palliative chemotherapy and radiotherapy with non-small cell lung cancer histology. Data were collected from clinical notes and statistical analysis was done using SPSS statistic software. The aim of the study is to look at the outcome of advanced NSCLC patients treated with palliative chemotherapy and radiotherapy with the prognostic factors. In total, 86 patients were analyzed (56 male, 30 female, median age 59.36 ±12.08 with 53% of them were former and current smoker). Tissue diagnosis were obtained by endobronchial biopsy (34%), pleural biopsy (36%), CT guided (26%) and ultrasound guided transthoracic biopsy (4%). Majority tissue histology were adenocarcinoma (77.9%), squamous cell carcinoma (16.3%) and remaining was non-small cell carcinoma. Performance status of patients range from 0 to 2 (based on Eastern Cooperative Oncology Group). Among all adenocarcinoma cases,27 patients with epidermal growth factor receptor (EGFR) positive and 16 patient received oral tyrosine kinase inhibitor (TKI). The systemic chemotherapy used were Vinorelbin with Cisplatin/Carboplatin, Premetrexed, Docetaxel and Bevacizumab. All patients received first line chemotherapy(13 patients received oral TKI for first line), 24 patients received 2nd line, 6 patients on 3rd line and 3 patients on 4th line chemotherapy. 16 patients undergone concomitant radiotherapy. The median overall survival (OS) of all patients received chemotherapy was 5.16 months. The median OS were significantly longer in patients who received 2nd and 3rd line chemotherapy (12.88 month, p < 0.01 and 20.84 months, p <0.013) than 4th line chemotherapy (20.84 months, p< 0.89). Former and current smoker patient who undergone chemotherapy is 2.3 times higher risk (HR: 2.30; 95%CI: 1.35, 3.92) to die compare to nonsmoker. Patients who had increase in one unit of number of chemotherapy, will reduce 47% risk to die from advanced non-small cell lung cancer (HR: 0.53; 95% CI: 0.36, 0.76). Patient who undergo radiotherapy treatment is 66% less risk(HR:0.34,95% CI:0.17,0.69) to die compared to those who did not go for radiotherapy. There were clinical benefits for patients received more than first line chemotherapy and radiotherapy, smoking during treatment has negative impact on survival in our cohort of patients.
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