Article

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

ABSTRACT

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.

Download full-text

Full-text

Available from: Yuhchyau Chen
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and purpose: For metastatic non-small cell lung cancer (NSCLC) patients with controlled extrathoracic disease after systemic treatment, stable or progressive primary lung lesions may cause respiratory symptoms and increase comorbidities. In the present study, we sought to investigate whether aggressive palliative thoracic radiotherapy (RT) can enhance local control and improve the survival for this subgroup of patients. Materials and methods: Between March 2006 and December 2014, 56 patients with metastatic NSCLC who had responsive or stable extrathoracic diseases after chemotherapy and/or molecular targets, and received thoracic RT for stable and progressive primary lung lesions were included. RT with a median dose of 55 Gy (range, 40-62 Gy) was administered in 1.8-2.5 Gy fractions to primary lung tumor and regional mediastinal lymph nodes using modern RT technique. Overall survival (OS) from diagnosis, and locoregional progression-free survival (LRPFS), and survival calculated from radiotherapy (OS-RT) were estimated using the Kaplan-Meier method. Results: There were 37 men and 19 women with a median age of 60 years at diagnosis. The median interval from the diagnosis of metastatic disease to thoracic RT was 8 months. Following thoracic RT, 26 patients (46%) achieved complete or partial response (overall response rate, ORR). Patients with squamous cell carcinoma or poorly-differentiated carcinoma had a higher ORR than those with adenocarcinoma (63% vs. 34%, P = 0.034). EGFR mutations was closely associated with a better ORR (45% vs. 29%, P = 0.284). At a median follow-up time of 44 months, the median OS, LRPFS after RT, and OS-RT were 50 months, 15 months, and 18 months. Conclusion: Radical palliative throractic RT is safe and might be beneficial for primary lung lesions of metastatic NSCLC patients with controlled extrathoracic diseases.
    Full-text · Article · Dec 2015 · PLoS ONE
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The application of high-dose irradiation to centrally-located lung tumors is generally considered to be of high risk in causing bronchial injury. The aim of the present retrospective study was to investigate the safety and efficacy of stereotactic body radiation therapy (SBRT) for patients with centrally-located lung tumors. In total, 28 patients who underwent SBRT for lung tumors within 2 cm of a major bronchus were retrospectively analyzed. The median total dose prescribed was 45 Gy (range, 36.3-52.5 Gy), the median fraction was 12 (range, 10-15) and the median dose per fraction was 3.6 Gy (range, 3-5 Gy). The median follow-up period for the surviving patients was 14 months (range, 10-41 months). The local control rate of SBRT was 100%, with a complete response (CR) rate of 32.1% (9/28); a partial response (PR) rate of 50% (14/28) and a stable disease (SD) rate of 17.9% (5/28). In total, 15 patients survived and 13 patients succumbed; 11 patients succumbed to tumor progression, one to congestive heart failure and one to a brain hemorrhage. The main side-effects included grade 2 esophagitis (17.9%; 5/28) atelectasis (10.7%; 3/28) and grade 2 late radiation pneumonitis (7.1%; 2/28). Severe late toxicity (≥ grade 3) was not observed in any patient. SBRT is an effective and safe therapy for centrally-located lung tumors.
    Full-text · Article · Apr 2014 · Oncology letters
  • Source
    • "Study N Metastatic sites Treatments 1-year PFS 5-year OS University of Maryland [23] 72 Brain (metachronous) SRS 13.2% University of Maryland [24] 42 Brain (synchronous) SRS, TS, RT, CRT, HIGRT 21% Hopital Louis Pradel Hospices Civils de Lyon, Lyonnce [25] 51 Brain (synchronous) BS, TS, RT, CRT 42% (BS + others) versus 5% (BS only) * University of Rochester [26] 38 Multisite, 1–8 metastases HIGRT 14% Rush University Medical Center [27] 23 Multi-site, 1-2 metastases TS, RT, HIGRT 22% "
    [Show abstract] [Hide abstract]
    ABSTRACT: Metastatic non-small cell lung cancer (NSCLC) carries a dismal prognosis. Clinical evidence suggests the existence of an intermediate, or oligometastatic, state when metastases are limited in number and/or location. In addition, following initial curative therapy, many patients present with limited metastatic disease, or oligo-recurrence. Metastasis-directed, anti-cancer therapies may benefit these patients. A growing evidence-base supports the use of hypofractionated, image-guided radiotherapy (HIGRT) for a variety of malignant conditions including inoperable stage I NSCLC and many metastatic sites. When surgical resection is not possible, HIGRT offers an effective alternative for local treatment of limited metastatic disease. Early studies have produced promising results when HIGRT was delivered to all known sites of disease in patients with oligometastatic/oligo-recurrent NSCLC. In a population of patients formerly considered rapidly terminal, these studies report five year overall survival rates of 13-22%. HIGRT for metastatic NSCLC warrants further study. We call for large, intergroup, and even international randomized trials incorporating HIGRT and other metastasis-directed therapies into the treatment of patients with oligometastatic/oligo-recurrent NSCLC.
    Full-text · Article · Oct 2012 · Pulmonary Medicine
Show more