Impact of Tumor Extent and Location on Treatment Outcome in Patients with Stage III Non-small Cell Lung Cancer Treated with Radiation Therapy

Abstract

The results of treatment of 141 patients with stage III non-small cell lung cancer (NSCLC) who received definitive radiation therapy at Gunma University Hospital between 1976 and 1989 were retrospectively analyzed. Radiation was given with standard fractionation for a planned prophylactic dose of 40 Gy over 4 weeks and a definitive dose of 60 Gy over 6 weeks or more. The two- and five-year survival rates were 27% and 12% for stage IIIA, and 18% and 8% for stage IIIB, respectively (P = 0.052). By univariate analysis, a primary tumor less than 5 cm in diameter was also an important predictor of survival (P = 0.008). As for tumor location, the patients with primary tumors in the upper lobes or the superior segment of the lower lobes of the lung lived longer than those with primary tumors at any other site (P = 0.032). Patients with epidermoid carcinoma had a higher survival rate at 5 years than those with other histologic types (14% vs 3%, P = 0.074). Multivariate analysis showed that among tumor characteristics, the site of the primary tumor, the pattern of tumor spread and N stage were significantly associated with overall survival. Among the patients with stage III NSCLC, those with stage IIIA epidermoid carcinoma in the upper lobe or the superior segment of the lower lobe of the lung were considered to be the most favorable candidates for definitive radiation therapy.

Location of stage I–III non‐small cell lung cancer and survival rate: Systematic review and meta‐analysis

“…Twenty‐five studies were selected for the full‐text review. Finally, 10 retrospectively designed studies were included as relevant to assess our hypothesis . Studies excluded from full‐text review and reasons for exclusion are described in the Supplement data 3 in Appendix S1.…”

Does tumor localization of operated NSCLC have an effect on relapse and survival?

“…However, to the contrary of Inoue, Ichinose et al (13) found that the survival was better in left lower lobe tumors in the patients with N2-positive stage 3A tumors. In the study by Hayakawa et al (14) conducted on the patients who received definitive radiotherapy without being operated, the survival of the upper lobe tumors was observed to be better than the lower lobe tumors. In our study, no statistically significant difference was found in both of relapse-free survival and overall survival in stage 3A patients in terms of tumor localization.…”

Clinical Management of Lung Cancer

“…25,27 Involvement of supraclavicular lymph nodes also increases the risk of eventual failure. 24 Outcomes with radiotherapy are somewhat better for squamous cell carcinoma than for other tumor types.…”

“…24 Outcomes with radiotherapy are somewhat better for squamous cell carcinoma than for other tumor types. 27 The location of the primary tumor also may be relevant. 28 If a patient has a peripheral lower lobe primary tumor and nodal involvement, then the size of the radiotherapy field and the amount of lung destroyed by the radiotherapy will be relatively large, whereas the size of the radiotherapy field is much smaller and the amount of radiation damage to lung is much less if the patient has a centrally placed upper lobe tumor, and the probability of survival is higher with inoperable upper lobe tumors than with inoperable tumors in other locations.…”

“…28 If a patient has a peripheral lower lobe primary tumor and nodal involvement, then the size of the radiotherapy field and the amount of lung destroyed by the radiotherapy will be relatively large, whereas the size of the radiotherapy field is much smaller and the amount of radiation damage to lung is much less if the patient has a centrally placed upper lobe tumor, and the probability of survival is higher with inoperable upper lobe tumors than with inoperable tumors in other locations. 27 Radiation has to travel through the lung to reach the tumor and subsequently passes out of the far side of the lung; in the process, this energy destroys lung tissue in its path. Scatter to more distant lung also may occur, and the resultant exposure may be sufficient to cause extensive radiation pneumonia, which may respond to steroids but also can prove fatal in some instances.…”