Abstract
BACKGROUND: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.AIM:To evaluate the treatment results and the prognostic variables in our patients treated with sequential and concurrent chemoradiotherapy.MATERIAL AND METHODS:In the study 85 patients were 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.RESULTS:From October 2005 to March 2008, 93 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: - age, p<0.05; - performant status, p<0.001; - weight loss, p<0.001; tumor dimension, p<0.05; and - nodal involvement, p<0.05.CONCLUSION:In our study, the dose-limiting toxicity, esophagitis was reduced by performing conformal radiotherapy. Conformal thoracic radiotherapy and new radiotherapy technics, such as respiratory gated radiotherapy, allow dose escalating and may probably improve survival and local control in lung cancer patients.
Highlights
We found that the following prognostic factors significantly influenced the survival in lung cancer patients treated with conservative method: - age, p
In our study, the dose-limiting toxicity, esophagitis was reduced by performing conformal radiotherapy
85 patients were eligible for this study, aged between 18 and 70 years, had an Eastern Cooperative Oncology Group (ECOG) Score ≤ 1, and had ≤ 10 % weight loss in the period of 3 months before inclusion
Summary
1.2 million people die from lung cancer each year. NSCLC represents >80% of all lung cancers. 60%-70% of the patients with NSCLC suffer stage III or IV disease. In the late 1980s, radiotherapy was the standard treatment for these patients [1]. Randomized trials and a 1995 overview subsequently showed that combination/combined chemoradiotherapy was superior to radiotherapy alone [2]. Many chemotherapeutic agents active in NSCLC possess radiosensitizing properties, thereby improving the probability of local control. Several studies showed the feasibility of the cisplatin-etoposide combination plus radiotherapy for patients with stage III disease [3]. 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
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