Poor prognosis patients with inoperable locally advanced NSCLC and large tumors benefit from palliative chemoradiotherapy: a subset analysis from a randomized clinical phase III trial

Hans H Strøm, Roy M Bremnes, Stein H Sundstrøm, Nina Helbekkmo, Ulf Aasebø, Hans H Strøm, Roy M Bremnes, Stein H Sundstrøm, Nina Helbekkmo, Ulf Aasebø

Abstract

Introduction: Poor prognosis patients with bulky stage III locally advanced non-small-cell lung cancer may not be offered concurrent chemoradiotherapy (CRT). Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients, this analysis was performed to explore how tumor size influenced survival and health-related quality of life (HRQOL).

Methods: A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8, at 3-week intervals. The experimental arm (N = 94) received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. This subset study compares outcomes in patients with tumors larger than 7 cm (N = 108) versus tumors 7 cm or smaller (N = 76).

Results: Among those with tumors larger than 7 cm, the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months, respectively (p = 0.001). The 1-year survival was 33% and 56%, respectively (p = 0.01). Except for a temporary decline during treatment, HRQOL was maintained in the CRT arm, regardless of tumor size. Among those who did not receive CRT, patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL. The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size.

Conclusion: In patients with poor prognosis and inoperable locally advanced non-small-cell lung cancer, large tumor size should not be considered a negative predictive factor. Except for performance status 2, patients with tumors larger than 7 cm apparently benefit from CRT.

Conflict of interest statement

Disclosure: Dr. Strøm has received payment for lectures from Glaxo Wellcome and support for travel to meetings from Perre Fabre and Glaxo Wellcome. The remaining authors declare no conflict of interest.

Figures

FIGURE 1.
FIGURE 1.
Kaplan–Meier plots for (A) TTP for patients with tumors 7 cm or smaller; (B) TTP for patients with tumors larger than 7 cm; (C) overall survival for patients with tumors 7 cm or smaller; (D) overall survival for tumors larger than 7 cm; (E) 1- and 2-year survival in both groups. CI, confidence interval; TTP, time to progression.
FIGURE 2.
FIGURE 2.
Mean changes in the selected domains of HRQOL measurements. A high score for dysphagia indicates more pronounced symptoms, whereas higher score for the change in Global Quality of Life indicates better function. HRQOL, health-related quality of life.

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