Radiation dose and survival of patients with stage IV non-small cell lung cancer undergoing concurrent chemotherapy and thoracic three-dimensional radiotherapy: reanalysis of the findings of a single-center prospective study

Abstract

BackgroundThe objective of this study was to evaluate the radiation dose and response in terms of local-regional progression-free survival (LRPFS) and overall survival (OS) of patients with stage IV non-small cell lung cancer (NSCLC) undergoing concurrent chemotherapy and thoracic three-dimensional radiotherapy.MethodsIn all, we enrolled 201 patients with stage IV NSCLC in this study and analyzed OS in 159 patients and LRPFS in 120.ResultsThe 1-, 2-, 3-, and 5-year OS rates were 46.2%, 19.5%, 11.7%, and 5.8%, respectively, the median survival time being 12 months. The median survival times in differential treatment response of primary tumors were 19 of complete response, 13 of partial response, 8 of stable disease, and 6 months of progressive disease, respectively (P = 0.000). The 1-, 2-, 3-, and 5-year LRPFS rates of patients undergoing four to five cycles with doses ≥63 Gy and <63 Gy were 77.4% and 32.6%, 36.2% and 21.7%, 27.2% and 0, and 15.9% and 0, respectively (P = 0.002). According to multivariate analyses, four to five cycles of chemotherapy, gross tumor volume <175.00 cm3 and post-treatment Karnofsky Performance Status score stable or increased by at least 10 units were independent prognostic factors for better OS (P = 0.035, P = 0.008, and P = 0.000, respectively). Radiation dose to the primary tumor ≥63 Gy resulted in better OS (P = 0.057) and LRPFS (P = 0.051), both findings being of borderline significance.ConclusionsTreatment of IV NSCLC with joint administration of four to five cycles of chemotherapy and three-dimensional radiotherapy may prolong survival, particularly in patients receiving ≥63 Gy radiotherapy, with gross tumor volume <175.00 cm3 and post-treatment Karnofsky Performance Status score not lower than pretreatment values.

Concurrent chemoradiotherapy with weekly nedaplatin versus radiotherapy alone in elderly patients with non-small-cell lung cancer

“…Su et al suggested that concurrent chemotherapy with aggressive thoracic radiotherapy (TRT) was shown to play an important role in improving OS for stage IV NSCLC [20]. Ouyang et al pointed out that treatment of IV NSCLC undergoing concurrent chemotherapy and RT might prolong survival in a single-center prospective study [21]. These two investigations are supporting our results in some extent for stage IV survival of two therapies.…”

Surgery Combined with Radiotherapy Improved Survival in Metastatic Esophageal Cancer in a Surveillance Epidemiology and End Results Population-based Study

“…Studies with small sample sizes have shown that local treatments including surgery could prolong survival in metastatic EC10111213. Studies have shown that surgery and/or radiotherapy can improve survival in patients with stage IV malignant tumors1415. In this study, we analyzed the metastatic EC using a population-based national registry (Surveillance Epidemiology and End Results, SEER) to determine the impact of local treatment strategies on survival in metastatic EC.…”

miR-15b/16-2 Regulates Factors That Promote p53 Phosphorylation and Augments the DNA Damage Response following Radiation in the Lung

“…Acute radiation pneumonitis and chronic radiation fibrosis represent common consequences of radiation exposure in the setting of treatment of various cancers (22), including non-small cell lung cancer, small cell lung cancer (23), breast cancer (24), esophageal cancer (25), mediastinal tumors (26), and head and neck tumors (27). Although the underlying biology of radiation-induced injury to the lung is becoming increasingly known, few actionable targets exist for the purposes of therapy.…”