Medicina (Kaunas) 2009; 45 (6): 452-459
Treatment outcome of locally advanced stage IIIA/B lung cancer
Saulius Cicėnas1, 2, Aurelija Žalienė1, Vydmantas Atkočius1
1Institute of Oncology, Vilnius University, 2Institute of Rehabilitation, Sports Medicine and Nursing Lithuania
Key words: nonsmall cell lung cancer; survival; stages; morphology; treatment methods; statistical analysis.
Summary. Objective. To determine survival of patients with stage IIIA/B nonsmall cell lung cancer considering disease stage and treatment methods.
Material and methods. A total of 304 patients with nonsmall cell lung cancer were treated at the Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University, in 20002004. Stage IIIA (T3N1-2M0) cancer was diagnosed for 193 (63.5%) patients and stage IIIB (T4N0-1M0) cancer was diagnosed for 111 (36.5%) patients. There were 277 (91.1%) males and 27 (8.9%) females. According to morphology, there were 219 (72%) patients with squamous cell lung cancer, 80 (26.3%) with adenocarcinoma, and 5 (1.7%) patients with large cell carcinoma. Surgery was performed in 145 patients: 84 (57.9%) patients underwent lung resection (T3-4N0-1M0), 51 (35.2%) patients thoracotomy, and 10 (6.7%) patients other palliative thoracic procedures (mediastinotomy, pleurectomy, mediastinoscopy). Forty-eight (30.2%) patients were treated with radiation therapy with total doses of >40 Gy and 58 (36.5%) patients were treated with radiation therapy with total doses of <40 Gy. Fifty-four (33.9%) patients were treated with Gemzar and cisplatin and 19 (11.9%) patients were treated with etoposide and cisplatin.
Results. Overall median and mean survival was 7.8 months (95% CI, 6.8 to 8.8) and 9.9 months (95% CI, 9.0 to 10.9), respectively. The median and mean survival of patients with stage IIIA cancer was 8.3 months and 10.4 months, respectively, and that of patients with stage IIIB cancer 6.4 months and 9.0 months, respectively (P≤0.05). The median survival of the patients with stage IIIA cancer who received a combination of operation, chemotherapy, and radiation therapy with a total dose of >40 Gy was 14.4 months (mean, 14.7 months), and the median survival of those who received operation, chemotherapy, and radiation therapy with a total dose of ≤40 Gy was 9.7 months (mean, 14.1 months); the median survival of the patients who underwent surgery alone was 4.9 months (mean, 6.7 months) (P=0.004 and P=0.007), respectively. There was a significant difference in the median survival comparing the patients with stage IIIB cancer who underwent surgery alone and those who received a combination of radiation therapy and chemotherapy (median survival of 5.0 months [mean, 8.1 months] versus 16.8 months [mean, 17.6 months], respectively; P≤0.05).
Conclusions. Disease stage had an influence on the survival of patients with nonsmall cell lung cancer: patients with stage IIIA (T3N0-1M0) cancer without metastases to mediastinal lymph nodes (N factor) survived longer than patients with stage IIIB (T4N1-2M0) cancer, where not only N factor had an impact but T factor as well. Better treatment outcomes, i.e. longer survival, can be achieved when a combination of three treatment types surgery, chemotherapy, and radiation therapy is applied to patients with stage IIIA or IIIB nonsmall cell lung cancer. The patients with stage IIIA disease who received surgery and radiation therapy (total dose, >40 Gy), and combinations of surgery, chemotherapy, and radiation therapy and second-line chemotherapy showed a significantly longer survival than those who received surgery alone.
Correspondence to S. Cicėnas, Department of Thoracic Surgery and Oncology, Institute of Oncology, Vilnius University, Santariškių 1, 08660 Vilnius, Lithuania. E-mail: saulius.cicenas@vuoi.lt
Received 10 November 2008, accepted 3 June 2009