Radical thoracic radiotherapy may provide favorable outcomes for stage IV non-small cell lung cancer

Jingbo Wang, Zhe Ji, Xiaozhen Wang, Jun Liang, Zhouguang Hui, Jima Lv, Zongmei Zhou, Weibo Yin, Luhua Wang, Jingbo Wang, Zhe Ji, Xiaozhen Wang, Jun Liang, Zhouguang Hui, Jima Lv, Zongmei Zhou, Weibo Yin, Luhua Wang

Abstract

Background: This study investigates the outcome of synchronous stage IV non-small cell lung cancer (NSCLC) patients who received radical thoracic radiotherapy (TRT).

Methods: We retrospectively reviewed the charts of stage IV NSCLC patients treated with TRT between January 2007 and December 2011. Radiotherapy was considered radical if it was the primary therapy with non-symptom driven intent, or consolidation therapy after initial chemotherapy and the biologically equivalent dose ≥53 Gy halted disease progression. The patients' demographics, disease characteristics, and treatment parameters were uniformly collected.

Results: Eighty-one patients were irradiated with radical intent, including 52% with more than five metastatic lesions. The minimum follow-up was 31.5 months for survivors. The median overall survival (OS) was 20.8 months, with three and four-year OS rates of 23% and 18%, respectively. The median progression-free survival (PFS) was 8.2 months, with one and two-year PFS rates of 23% and 9%, respectively. Partial response (PR) after TRT and administration of targeted therapy were predictive of longer OS. The factors associated with favorable PFS included earlier local tunor node stage, absence of concurrent chemotherapy, and post-TRT PR. No correlation was found between the number of metastatic lesions and survival outcome. Incidences of grade ≥2 toxicities in the lung and esophagus were 9% and 26%, respectively.

Conclusions: Radical TRT may result in advantageous outcomes for selected stage IV NSCLC patients, regardless of the number of metastatic foci. Patients who achieved post-TRT PR attained the best outcomes.

Keywords: Non‐small cell lung cancer; stage IV; survival; thoracic radiotherapy; toxicity.

Figures

Figure 1
Figure 1
Survival for all patients receiving radical thoracic radiotherapy. (a) Overall survival; (b) progression free survival (solid lines represent estimated survival curves and dashed lines indicate 95% confidence intervals of survival).
Figure 2
Figure 2
Overall survival stratified by variable factors. (a) Post‐thoracic radiotherapy response. , partial response (PR); , stable disease (SD) + progressive disease (PD). (b) Use of targeted therapy. , Yes; , No. (c) Gender. , Male; , Female. (d) Number of metastatic lesions. , 1–5 metastases; , >5 metastases.
Figure 3
Figure 3
Progression‐free survival stratified by variable factors. (a) Post‐thoracic radiotherapy response. , PR; , SD + PD. (b) Local TN stage. , I‐II; , III. (c) Concurrent chemotherapy. , Yes; , No. (d) Number of metastatic lesions. , 1–5 metastases; , >5 metastases.
Figure 4
Figure 4
Patterns of failure of the study population who experienced disease progression (n = 73). Circle sizes are proportional to the number of patients with corresponding progression.

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