Important prognostic factors for the long-term survival in non-small cell lung cancer patients treated with combination of chemotherapy and conformal radiotherapy

Abstract

Purpose: Combined modality therapy is standard of care for patients with unresectable locally advanced non-small cell lung cancer (NSCLC), however, insufficient data exist regarding prognostic factors in this disease setting.

Methods: To evaluate the treatment results and prognostic variables, 85 NSCLC patients treated from October 2005 to April 2008 were randomly assigned to one of the two treatment arms. In the first arm (sequential arm), 45 patients received sequential chemotherapy with 4 cycles of carboplatin and etoposide followed by conformal 3-dimensional (3D) radiotherapy (RT). In the second arm (concurrent arm), 40 patients received concomitant chemotherapy with cisplatin and etoposide and conformal RT, followed by two cycles of consolidation chemotherapy with carboplatin and etoposide.

Results: The median survival was 13 months for the patients in the sequential arm and 19 months for those in the concurrent treatment arm (p=0.0039). The disease-free survival (DFS) was 9 months in the sequential arm and 16 months in the concurrent treatment arm (p=0.0023). The following prognostic factors significantly influenced the survival of the patients treated with combination of RT and chemotherapy: age (p<0.05), performance status (PS) (p<0.001), weight loss (p<0.001), tumor size (p<0.05), nodal involvement (p<0.05).

Conclusions: Given the higher toxicity in the second arm, this should be reserved for younger patients (<70 years), having good PS and minimal weight loss. We highly recommend precise stage and prognostic factors definitions in such patients so that they receive the most beneficial treatment.