LONG-TERM SURVIVAL OUTCOMES OF RADIATION THERAPY FOR UNRESECTABLE, LOCALLY ADVANCED NON-SMALL CELL LUNG CANCER: A SINGLE-CENTER EXPERIENCE AT HOSPITAL 175

Nam Vu Hong; Cong Nguyen Thanh; Nhat Phan The; Huong Ngo Đang; Hong Ho Thi; Linh Nguyen Mai; Dung Truong Vu Manh; Cong Nguyen Đuc; Ngoc Nguyen The; Thao Nguyen Thi Thu

doi:10.59354/ydth175.2024.266

Từ khóa:

radiotherapy, non-small cell lung cancer (NSCLC), concurent chemoradiation, toxicity, immunotherapy

Tóm tắt

Objective: To evaluate the effectiveness of radiotherapy on overall survival (OS) and identify factors affecting survival outcomes in patients with stage III non-small cell lung cancer (NSCLC) where surgery is not feasible.

Methods: This retrospective study analyzed data from NSCLC patients treated with radiotherapy at Hospital 175 from January 2019 to June 2022. Collected data included patient demographics, pathology, TNM staging, concurrent chemotherapy, PET/CT characteristics, and radiotherapy parameters. Patients received concurrent or sequential chemotherapy with radiotherapy doses equivalent to or exceeding 60Gy, with regular follow-up and re-examination post-radiation to document final patient status.

Results: Among 240 patients (75% male), performance status (PS) scores of 0, 1, and 2 were 15%, 80%, and 5%, respectively. Histopathological subtypes included squamous cell carcinoma (9%), adenocarcinoma (83.5%), and others (7.5%). Stage IIIA, IIIB, and IIIC comprised 32%, 48%, and 20% of cases, respectively. The median follow-up was 16.3 months, with a median OS of 19.5 months. OS rates at 1, 2, and 3 years were 76.2%, 38.8%, and 27.4%, respectively. Patients receiving concurrent chemoradiotherapy had better OS compared to those with sequential chemoradiotherapy. Age, histopathological type, and lymph node metastasis significantly impacted overall survival.

Conclusion: The study highlights that OS rates at 1, 2, and 3 years were 76.2%, 38.8%, and 27.4%, respectively. Concurrent chemoradiotherapy provided a better prognosis than sequential therapy. Radiotherapy remains a crucial treatment modality for inoperable NSCLC, with concurrent chemoradiotherapy offering the best survival benefits. Prognostic factors for survival included age, lymph node metastasis, and histopathological type.

Tài liệu tham khảo

Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.

Herbst RS, Morgensztern D, Boshoff C. The biology and management of non-small cell lung cancer. Nature. 2018;553(7689):446-454.

Ettinger DS, Wood DE, Aisner DL, et al. NCCN Guidelines Insights: Non– Small Cell Lung Cancer, Version 2.2021. J Natl Compr Canc Netw. 2021;19(3):254-266.

Morgensztern D, Ng SH, Gao F, Govindan R. Trends in stage distribution for patients with non-small cell lung cancer: a National Cancer Database survey. J Thorac Oncol. 2010;5(1):29-33.

Vokes EE, Herndon JE 2nd, Kelley MJ, et al. Induction chemotherapy followed by concurrent chemoradiotherapy compared with concurrent chemoradiotherapy alone in patients with stage III non-small-cell lung cancer: Cancer and Leukemia Group B. J Clin Oncol. 2007;25(13):1698-1704.

Perez CA, Stanley K, Grundy G, et al. Impact of irradiation technique and tumor extent in tumor control and survival of patients with unresectable non-oat cell carcinoma of the lung: report of Radiation Therapy Oncology Group. Cancer. 1982;50(6):1091-1099.

Auperin A, Le Pechoux C, Rolland E, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol. 2010;28(13):2181-2190.

Fournel P, Robinet G, Thomas P, et al. Randomized phase III trial of sequential chemoradiotherapy compared with concurrent chemoradiotherapy in locally advanced non–small-cell lung cancer: Groupe Lyon-Saint-Etienne d’Oncologie Thoracique-Groupe Français de Pneumo-Cancérologie NPC 95-01 Study. J Clin Oncol. 2005;23(25):5910-5917.

Bradley JD, Paulus R, Komaki R, et al. Standard-dose versus high-dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non-small-cell lung cancer (RTOG 0617): a randomised, two-by-two factorial phase 3 study. Lancet Oncol. 2015 Feb;16(2):187-199.

Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatin–paclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361(10):947-957.

Borghaei H, Paz-Ares L, Horn L, et al. Nivolumab versus Docetaxel in Advanced Nonsquamous Non-Small-Cell Lung Cancer. N Engl J Med. 2015;373(17):1627-1639.

Movsas B, Scott C, Langer C, et al. Randomized trial of amifostine in locally advanced non-small-cell lung cancer patients receiving chemotherapy and hyperfractionated radiation: Radiation Therapy Oncology Group trial 98-01. J Clin Oncol. 2005;23(10):2145-2154.

Curran WJ Jr, Paulus R, Langer CJ, et al. Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410. J Natl Cancer Inst. 2011;103(19):1452-1460.

Mehta MP, Dakhil SR, Choy H, et al. A phase III trial of combined modality therapy with or without consolidation docetaxel in inoperable stage III non-small-cell lung cancer: the Hoosier Oncology Group and U.S. Oncology. J Clin Oncol. 2009;27(35):5756-5761.

Ettinger DS, Aisner DL, Wood DE, et al. NCCN Guidelines Insights: Non– Small Cell Lung Cancer, Version 5.2018. J Natl Compr Canc Netw. 2018;16(7):807-821.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68(1):7-30.

Wang T, Nelson RA, Bogardus A, Grannis FW Jr. Five-year lung cancer survival: which advanced stage nonsmall cell lung cancer patients attain long-term survival? Cancer. 2010;116(6):1518-1525.

Gomez DR, Liao KP, Swisher SG, et al. Time to treatment as a quality metric in lung cancer: Staging studies, time to treatment, and patient outcomes. J Thorac Oncol. 2015;10(4):591-600.