Second Cancers Occurring in Patients With Early Stage Non–Small-Cell Lung Cancer Treated With Chest Radiation Therapy Alone

Abstract

Long-term survivors after RT alone for early stage NSCLC carry the same risk of developing second cancer, either lung or nonlung, as their counterparts treated surgically when the results of this study are compared with those of the published literature.

Second primary cancer in survivors following concurrent chemoradiation for locally advanced non-small-cell lung cancer

“…In the patients who underwent rigorous follow-up detection of SPC was assured. Three primary lung cancers were detected during routine follow-up and The studies using the person-years method to calculate the incidences of SPC showed a range from 1.7 to 4.3 per 100 patientyears (Thomas and Rubinstein, 1993;Ginsberg and Rubinstein, 1995;Martini et al, 1995;Jeremic et al, 2001;Kawaguchi et al, 2006). In the present studies, the rate of SPC was 2.4 per 100 patient-years, in agreement with previous findings.…”

“…defined as the period from CRT treatment initiation to last followup evaluation or death. SPC rate was calculated as the ratio of SPC cases over 100 patient-years of follow-up (Thomas and Rubinstein, 1993;Jeremic et al, 2001).…”

Regular follow up for patients irradiated for early stage nonsmall cell lung cancer too!

“…In addition, there were neither RT-related treatment deaths, contrasting (30-day) preoperative mortality of 13% in the series of EGERMANN et al [1], nor significant (high-grade) acute or late toxicity, due to the "limited" RT treatment fields used in the patients with mSPLC [6]. RT results in this patient population are, therefore, at least comparable with those of surgical series [12][13][14][15][16] of second lung cancer, with a resectability rate ofy50%, median survival times of 1-2 yrs, and 5-yr survivals ranging from 4-32% [17].…”

“…Owing to pre-existing comorbidities, they are always treated the same way (with RT) [6]. While some of those patients relapsing locally may be treated palliatively [7,8], a number of them may be treated curatively, particularly those with recurrences confined to the bronchial stump [7][8][9][10].…”

“…Secondly, in contrast to surgical series where second curative resections in mSPLC are rare clinical events, a second RT course in mSPLC diagnosed using the same criteria by MARTINI and MELAMED [11] achieved 5-yr cause-specific and overall survival of 53 and 30% respectively, in patients with Stage I/II NSCLC [6]. In addition, there were neither RT-related treatment deaths, contrasting (30-day) preoperative mortality of 13% in the series of EGERMANN et al [1], nor significant (high-grade) acute or late toxicity, due to the "limited" RT treatment fields used in the patients with mSPLC [6].…”