Palliative Radiotherapy for Non-metastatic Non-small-cell Lung Cancer: Impact of Blood Test Results on Survival.

Abstract

Non-small-cell lung cancer (NSCLC) not amenable to curative treatment can be managed with palliative thoracic radiation or chemoradiation, however, with variable success. This study evaluated the prognostic impact of the LabBM score [serum lactate dehydrogenase (LDH), C-reactive protein, albumin, hemoglobin, platelets] in 56 patients who were scheduled to receive at least 10 fractions of 3 Gy. Uni- and multivariate analyses of prognostic factors for overall survival were employed in a retrospective single-institution study of stage II and III NSCLC. The first multivariate analysis showed that hospitalization in the month before radiotherapy (p<0.001), concomitant chemoradiotherapy (p=0.03), and LabBM point sum (p=0.09) were the leading predictors of survival. A second model with individual blood tests rather than the sum score suggested that concomitant chemoradiotherapy (p=0.002), hemoglobin (p=0.01), LDH (p=0.04), and hospitalization before radiotherapy (p=0.08) played important roles. Surprisingly long survival was seen in patients without prior hospitalization who received concomitant chemoradiotherapy and had favorable LabBM score (0-1 points): median 24 months, 5-year rate 46%. Blood biomarkers provide relevant prognostic information. The LabBM score has 1) previously been validated in patients with brain metastases and 2) demonstrated encouraging results in a cohort irradiated for different palliative non-brain indications, e.g., bone metastases. It might be helpful in predicting survival in patients with non-metastatic cancer, e.g., NSCLC stage II and III.