Survival and late toxicities following concurrent chemo-radiotherapy for locally advanced stage III non-small cell lung cancer: findings of a 10-year Australian single centre experience with long term clinical follow up

Abstract

Background: The preferred management of patients with unresectable locally advanced non-small cell lung cancer (LA-NSCLC) is concurrent chemo-radiotherapy (CRT). Acute CRT-related toxicities are well defined, however, less is known about late toxicities. The aim of the study was to examine the outcomes and late toxicities in Stage III NSCLC treated with CRT. Methods: A retrospective review of the data from patients with stage III NSCLC treated with CRT was performed between May 2000 and June 2010. Demographics, tumour and treatment characteristics, toxicities and survival data were examined from hospital records of the patients. Progression free survival (PFS) and overall survival (OS) were evaluated by standard Kaplan-Meier survival curves. The censor date was set on 31 October 2016. Results: Sixty-three patients were identified with a median age of 66.6 years [interquartile range (IQR) 57.2-72.1], two-third (n=41, 65.1%) were male, majority were current or ex-smokers (n=52, 82.5%), 42 (66.7%) patients had stage IIIB disease and 21 (33.3%) had stage IIIA disease. The most common histologic subtype was adenocarcinoma 30 (47.6%). The median PFS and OS of the whole population was 10.6 months (95% CI, 4.1-17.3 months) and 21 months (95% CI, 12.7-29.3 months) respectively.The 5-year OS rates for stage IIIA and IIIB were 24% and 16% respectively. The 1-, 3-and 5-year OS rates for all patients were 63.5%, 46% and 18.7% respectively. Acute grade 3 and 4 toxicities included 28 haematological and 17 non-haematological events. The incidence of late toxicities was 58.9%.Thirty-three events of late grade 3 and 4 toxicities were recorded. The most common late toxicity was symptomatic radiation-induced pulmonary fibrosis (39.3%), others include ototoxicity (7.1%), persistent dysphagia (7.1%) and one case of acute myeloid leukaemia. All patients that were alive at the censor date had developed radiation-induced fibrosis with associated symptoms of respiratory insufficiency. Conclusions:The 5-year OS of patients with stage III NSCLC treated with CRT was in keeping with survival figures reported from prospective clinical trials. There is, however, significant morbidity associated with long-term survival and this should be taken into account when making informed treatment decisions.

Neutrophil-lymphocyte ratio and platelet-lymphocyte ratio associations with heart and body dose and their effects on patient outcomes in locally advanced non-small cell lung cancer treated with definitive radiotherapy

“…The main progress of the treatment for NSCLC includes immunotherapy and targeted therapy. Historically, the standard treatment f o r p a t i e n t s w i t h u n r e s e c t a b l e l o c a l l y a d v a n c e d NSCLC (LA-NSCLC) was platinum-based concurrent chemoradiotherapy (2). However, prognosis has been poor, with a 5-year overall survival (OS) rate ranging from 15% to 25%, and the median OS time only 17-24 months (3,4).…”

Swallowing Disorders and Mortality in Adults with Advanced Cancer Outside the Head and Neck and Upper Gastrointestinal Tract: A Systematic Review

“…Another study was conducted across two continents simultaneously (North America and Europe) [27]. The rest of the studies were only conducted in one country on the following continents: one in North America [26], one in Europe [25], two in Asia [24,28], and one in Australia [22]. Eight studies were cohort studies [20-24, 26, 28, 29], whereas the others were randomized trials [2,25,27].…”

“…Seven articles did not report the settings of the studies [2,21,[23][24][25][26]29] but when cited, most were performed in hospitals. Two studies [20,28] were completed in and used data exclusively from hospital healthcare settings, while the other two [22,27] were conducted in two healthcare settings simultaneously (outpatient and hospital).…”

Relationship between the Functional Oral Intake Scale (FOIS) and the Self-Efficacy Scale among Cancer Patients: A Cross-Sectional Study

“…It can significantly impact physical and psychological wellbeing, and its management can become complex and multifactorial [ 3 ]. There are numerous reports of dysphagia and appetite loss in cancer patients (stomach, colorectal, lung, breast, and head/neck) [ 4 , 5 , 6 , 7 , 8 ]. Moreover, Jacqui et al reported the proportion of patients with 14 types of cancers who reported dysphagic symptoms as follows: any dysphagia (54%), dysphagia for liquids (20%), and dysphagia for solids (46%).…”