Cancer Res Treat.  2011 Mar;43(1):32-41.

Clinical Responses and Prognostic Indicators of Concurrent Chemoradiation for Non-small Cell Lung Cancer

• Lee DS
• Kim YS
• Kang JH
• Lee SN
• Kim YK
• Ahn MI
• Han DH
• Yoo IR
• Wang YP
• Park JG
• Yoon SC
• Jang HS
• Choi BO

Abstract

PURPOSE
To evaluate treatment outcomes and prognostic factors in non-small cell lung cancer (NSCLC) patients treated with concurrent chemoradiation.
MATERIALS AND METHODS
From January 2005 to June 2009, 51 patients were treated with concurrent chemoradiation for 3 different aims: locally advanced stage III, locally recurrent disease, and postoperative gross residual NSCLC. Median age was 63 years. Distribution of stages by the 6th edition of American Joint Committee on Cancer (AJCC) was as follows: IIIA (37.3%), IIIB (56.9%). Chemotherapy was administered every week concurrently with radiation using one of the following regimens: paclitaxel (60 mg/m2), docetaxel+cisplatin (20 mg/m2+20 mg/m2), cisplatin (30 mg/m2). Total radiation dose was 16-66.4 Gy (median, 59.4 Gy).
RESULTS
Median follow-up duration was 40.8 months. The overall response rate was 84.3% with 23 complete responses. The median survival duration for the overall patient group was 17.6 months. The 3-year survival rate was 17.8%. A total of 21 patients had recurrent disease at the following sites: loco-regional sites (23.6%), distant organs (27.5%). In the multivariate analysis of the overall patient group, a clinical tumor response (p=0.002) was the only significant prognostic factor for overall survival (OS). In the multivariate analysis of the definitive chemoradiation arm, the use of consolidation chemotherapy (p=0.022), biologically equivalent dose (BED)10 (p=0.007), and a clinical tumor response (p=0.030) were the significant prognostic factors for OS.The median survival duration of the locally recurrent group and the postoperative gross residual group were 26.4 and 23.9 months, respectively.
CONCLUSION
Our study demonstrated that clinical tumor response was significantly associated with OS in the overall patient group. Further investigations regarding the optimal radiation dose in the definitive chemoradiation and the optimal treatment scheme in locally recurrent NSCLC would be required.

Keyword

Non-small cell lung cancer; Concurrent chemoradiation; Prognostic factor; Recurrent non-small cell lung cancer

MeSH Terms

Arm
Carcinoma, Non-Small-Cell Lung
Cisplatin
Consolidation Chemotherapy
Follow-Up Studies
Humans
Joints
Multivariate Analysis
Paclitaxel
Survival Rate
Cisplatin
Paclitaxel

Figure

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  Fig. 1 First site of recurrence. The patterns of failure were locoregional relapse in 6 (11.8%) patients, distant metastasis in 8 (15.7%) patients, and combined loco-regional and distant failure in 6 (11.8%) patients.

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  Fig. 2 Overall survival (A) and progression free survival (B) curves for the overall patient group. The 2-yr and 3-yr overall survival rates were 42% and 17.8%, respectively. The 1-yr and 2-yr progression free survival rates were 51%and 23%, respectively.

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  Fig. 3 Overall survival (A) and progression free survival (B) curves according to the treatment arms. There was no statistical difference between the treatment groups with regard to overall survival (p=0.6389) and progression-free survival (p=0.5833).

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  Fig. 4 Overall survival curves stratified by clinical tumor response for the total patient group. Overall survival rate between responder (complete response+partial response [CR+PR]) and non-responder (stable disease+progressive disease [SD+PD]) groups was statistically different on log-rank test (p=0.002).

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  Fig. 5 Overall survival curves stratified by (A) clinical tumor response, (B) biologically equivalent dose (BED)10, (C) use of consolidation chemotherapy in the definitive arm. The difference in overall survival rate between responder (complete response+partial response [CR+PR]) and non-responder (stable disease+progressive disease [SD+PD]), BED10≥70 and BED10<70, was statistically different, as was the difference between use of consolidation chemotherapy and no use of consolidation chemotherapy (p=0.049, 0.011 and 0.042, respectively) on log-rank test for the definitive arm.

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