Radiation therapy for stage III non-small cell lung cancer invading chest wall

Abstract

The treatment outcome and prognostic factors for Stage III non-small cell lung cancer (NSCLC) invading the chest wall and treated with definitive radiation therapy alone were investigated. From 1976 to 1990, 40 consecutive patients with Stage III NSCLC invading the chest wall underwent radiation therapy alone. There were 31 with Stage IIIA and nine with Stage IIIB. Squamous cell carcinoma was present in 30 patients (75%). All the patients underwent radiation therapy at a total dose of 60-80 Gy at 2 Gy per fraction. Local pain completely disappeared in 11/13 (85%) and decreased in the remainder after treatment. The 5-year survival rate was 8% for all patients, 10% for Stage IIIA and 0% for IIIB (P = 0.02), 11% for lesions invading the parietal pleura and 0% for those invading the ribs or spine (P = 0.2). Good performance status, Stage IIIA, metastases of lymph nodes less than N3 and small tumor size were better prognostic factors by univariate analysis. By multivariate analysis, performance status (P = 0.01) and Stage (P = 0.03) were the important prognostic factors. Five-year local progression-free survival rates were 51% for patients with lesions invading the parietal pleura and 0% for those invading the ribs or spine (P = 0.009). Good pain relief was achieved in patients with lesions invading the ribs or spine by radiation therapy. Tumors invading the parietal pleura were fairly well controlled by radiation therapy alone.