Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation

Abstract

BackgroundApproximately 15% of lung cancer patients are diagnosed in early stages. Microscopic proof of disease cannot always be obtained because of comorbidity or reluctance to undergo invasive diagnostic procedures. In the current study, survival data of patients with and without pathology are compared.MethodsOne hundred and sixty three patients with NSCLC I–IIb (T3 N0) treated between 2002 and 2016 were eligible: 123 (75%) had pathological confirmation of disease, whereas 40 (25%) did not. In accordance with international guidelines, both groups received radiotherapy. Comorbidity was assessed with the Charlson Comorbidity Index (CCI).ResultsThe median follow‐up was 28.6 months (range: 0.3–162): 66 (40%) patients are still alive, while 97 (59%) patients died: 48 (29%) cancer‐related deaths and 49 (30%) from causes other than cancer. Median overall survival (OS) in patients without pathological confirmation was 58.6 months (range: 0.5–162), which did not differ from those with microscopic proof of disease (39.4 months, range: 0.3–147.5; logrank P = 0.481). Median cancer‐specific survival (CSS) also did not differ at 113.4 months (range: 0.5–162) in the non‐confirmation group (logrank P = 0.763) versus 51.5 months (range: 3.7–129.5) in patients with pathology. In Cox regression, a CCI of ≥ 3 was associated with poor OS (hazard ratio 2.0; range 1.2–3.4; P = 0.010) and CSS (hazard ratio 2.0; 1.0–4.0; P = 0.043).ConclusionOS and CSS in early lung cancer patients depend on comorbidity rather than on pathological confirmation of disease.

Non-invasive approach to treat primary solid solitary pulmonary nodule: a narrative review by the radiation oncologist perspective

“…However, in the studies analyzed (when reported) median BED 10 was usually superior to 100 Gy, but many patients received inferior doses. In the cohort of Zehentmayr et al (26) the minimum BED 10 used was 15% lower, while only 15% of patients had a BED 10 <100 Gy in Inoue et al (13).…”

“…All studies included but two (9,18), are retrospective. In six studies (12)(13)(14)(15)(16)(17), only patients without pathological confirmation were included, while other 14 studies compared histologically proven and not populations in terms of clinical outcomes and safety (6,(9)(10)(11)18,(20)(21)(22)(23)(24)(25)(26)(27). The studies included in the analysis were published between January 2009 and December 2019.…”

“…Moreover, no pre-test threshold was usually described. Only few authors (10,12,14,26) described the predictive model of cancer probability.…”