Comparison of outcomes in patients with stage III versus limited stage IV non-small cell lung cancer

Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York, USA.
Radiation Oncology (Impact Factor: 2.55). 06/2011; 6(1):80. DOI: 10.1186/1748-717X-6-80
Source: PubMed


Standard therapy for metastatic non small cell lung cancer (NSCLC) includes palliative systemic chemotherapy and/or radiotherapy. Recent studies of patients with limited metastases treated with curative-intent stereotactic body radiation therapy (SBRT) have shown encouraging survival. We hypothesized that patients treated with SBRT for limited metastases have comparable outcomes with those treated with curative-intent radiation for Stage III NSCLC.
We retrospectively reviewed the records of NSCLC patients treated with curative-intent radiotherapy at the University of Rochester from 2000-2008. We identified 3 groups of patients with NSCLC: stage III, stage IV, and recurrent stage IV (initial stage I-II). All stage IV NSCLC patients treated with SBRT had ≤ 8 lesions.
Of 146 patients, 88% had KPS ≥ 80%, 30% had > 5% weight loss, and 95% were smokers. The 5-year OS from date of NSCLC diagnosis for stage III, initial stage IV and recurrent stage IV was 7%, 14%, and 27% respectively. The 5-year OS from date of metastatic diagnosis was significantly (p < 0.00001) superior among those with limited metastases (≤ 8 lesions) versus stage III patients who developed extensive metastases not amenable to SBRT (14% vs. 0%).
Stage IV NSCLC is a heterogeneous patient population, with a selected cohort apparently faring better than Stage III patients. Though patients with limited metastases are favorably selected by virtue of more indolent disease and/or less bulky disease burden, perhaps staging these patients differently is appropriate for prognostic and treatment characterization. Aggressive local therapy may be indicated in these patients, though prospective clinical studies are needed.

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    • "Our findings are also in line with a recent observation that the concurrent chemotherapy and thoracic RT resulted in a median survival of 10.0 months, and the 2-year OS rates of 16.4% for stage IV NSCLC patients, although the median RT dose for primary tumor is 63 Gy[30]. Several studies have also demonstrated that patients of stage IV NSCLC with oligometastasis can benefit survival from radical treatment to all macroscopic tumor sites, including primary thoracic gross lesions10111231,32]. These findings suggest that once metastatic tumor volume is reduced by systemic chemotherapy, additional radical thoracic RT can improve survival rate by enhancing local tumor control. "
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    • "The difference between the survival time of patients with stage III and stage IV NSCLC was not significant in the present study. Cheruvu et al (22) reported 146 cases of NSCLC. The 5-year survival rate of patients with stage III, stage IV and recurrent stage IV, starting from diagnosis, was 7, 14 and 27%, respectively. "
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