Stage III NSCLC Survival Rate Doubles With Standard Radiation Therapy

PURPOSE Patients with laparotomy-staged (PS) III 1A Hodgkin's disease confined to the upper abdomen are believed to have a favorable prognosis and require less aggressive treatment than patients with more-extensive stage III disease. We evaluated prognostic factors and outcome in 93 patients with PS III 1A Hodgkin's disease treated either with radiation therapy (RT) alone or combined RT and chemotherapy (combined modality treatment [CMT]) to determine the extent of treatment needed in this subgroup of stage IIIA patients. MATERIALS AND METHODS We retrospectively reviewed the freedom from relapse (FFR) rate, sites of recurrence, and survival rate of PS III 1A patients selected to receive extended-field irradiation (MPA, n = 27), total-nodal irradiation (TNI, n = 34), and CMT (n = 32) between 1969 and 1987. CMT consisted of six cycles of mechlorethamine, vincristine, procarbazine, and prednisone (MOPP) chemotherapy and MPA. Patients treated with MPA were part of a prospective trial designed to reduce treatment to patients with minimal stage III disease with very favorable characteristics. RESULTS Histologic subclass and treatment were the only prognostic factors for FFR and survival rates. Patients with nodular sclerosis or lymphocyte predominance histology had significantly higher FFR and survival rates compared to patients with mixed-cellularity (MC) histology. The 10-year actuarial FFR of PSIII 1A patients treated with MPA was only 39%, versus 55% for TNI (P = .02) and 94% for CMT (v MPA, P < .0001; v TNI, P = .006). The patterns of recurrence in patients who received MPA and TNI were significantly different, with MPA patients relapsing more often in untreated pelvic or inguinal nodes, and TNI patients relapsing more often in extranodal sites with or without nodal sites. The 10-year actuarial overall survival rate for patients treated with CMT was 89% versus 78% for MPA (v CMT, P = .09) and 70% for TNI (v CMT, P = .05). CONCLUSION Patients with PSIII 1A Hodgkin's disease treated with RT have a significantly higher risk of relapse and potentially a poorer survival compared with patients treated with CMT. These findings suggest that CMT should play a greater role in the treatment of this favorable substage of patients. Management with modified chemotherapy and RT in an attempt to reduce long-term treatment-induced complications may be a preferred approach for future trials.

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In hindsight if treatment had begun early: A study to determine the OS and PFS in patients with stage III lung carcinoma based on the time elapsed from the diagnosis to start of treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.8_suppl.230 ◽

2017 ◽

Vol 35 (8_suppl) ◽

pp. 230-230

Author(s):

Jyothirmai Seepana ◽

Abdo S. Haddad ◽

Suryanarayan Mohapatra ◽

Sidra Khalid ◽

Subanandhini Subramaniam ◽

...

Keyword(s):

Survival Rate ◽

Median Survival ◽

Mediastinal Lymph Node ◽

Clinical Stage ◽

Lymph Node Involvement ◽

Stage Iii ◽

Kaplan Meier ◽

Mediastinal Lymph Node Involvement ◽

Node Involvement ◽

Stage Iii Nsclc

230 Background: Stage III non-small cell lung cancer (NSCLC) is defined as loco-regionally advanced disease due to primary tumor extension into the extra-pulmonary structures (T3 or T4) or mediastinal lymph node involvement (N2 or N3) without evidence of distant metastasis. Patients are concerned about beginning treatment early after diagnosis. The role of the study is to determine the outcome if treatment is started within 8 weeks or after 8 weeks. In a retrospective study, the Cleveland Clinic’s database was used to identify patients treated through 2003 – 2014. Methods: Stage III NSCLC was ascertained as per the pathological or clinical stage. Kaplan-Meier estimate was used to determine the survival of patients. Results: Of the 561 patients patients with stage III NSCLC, 408 had treatment within 8 weeks and 153 after 8 weeks. See table. Treatment within 8 weeks of diagnosis: In total, 105 patients were recorded as having died, the median survival was 55.1 months (95% CI: 48.2, 62.5). The 2-year survival rate was 98% ± 0.9%, and the 5-year survival rate was 44.5% ± 4.7%. The median PFS was 15.3 months (95%Ci 12.0, 23.1). The 2-year PFS was 43% ± 0.28%, and the 5-year PFS was 14.5% ± 2.1%. Treatment after 8 weeks of diagnosis: In total, 34 patients were recorded as having died, the median survival was 60.6 months (95% CI: 50.3, 73.8). The 2-year survival rate was 97.5% ± 1.4%, and the 5-year survival rate was 53.2% ± 8.3%. The median PFS was 12.1 months (95%Ci 9.5, 15.3). The 2-year PFS was 32.8% ± 4.4%, and the 5-year PFS was 12.8% ± 3.2%. Among the following sub-groups: < 65 years, 65-75 years and > 75 years, there was no observable difference whether treatment was begun within eight weeks or after eight weeks. Conclusions: In the combined group and within subgroups, OS and PFS were not significantly different between patients who received treatment within 8 weeks and those who received treatment after 8 weeks. [Table: see text]

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Role of T0 status in overall survival for unresectable stage III non-small cell lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.9026 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 9026-9026

Author(s):

Takefumi Komiya ◽

Emily Powell ◽

Charles Vu ◽

Achuta Kumar Guddati

Keyword(s):

Lung Cancer ◽

Overall Survival ◽

Survival Rate ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Stage Iii ◽

Small Cell Lung ◽

Unresectable Stage ◽

Stage Iii Nsclc

9026 Background: Occult (T0) primary non-small cell lung cancer (NSCLC) with mediastinal involvement is a known but rare clinical condition. Its prognosis has not been evaluated well in the literature. Methods: Using National Cancer Database (NCDB), cases diagnosed between 2004 and 2016 with unresectable clinical stage III NSCLC with N2 or N3 involvement were selected and assigned to T0 or T1-4 group according to AJCC staging version 6th or 7th. Clinical demographics including use of chemotherapy/immunotherapy in first course of treatment were collected. As validation, independent data using Surveillance, Epidemiology, and End Results Program (SEER) was analyzed accordingly. Survival analyses were conducted using Kaplan-Meier and log-rank tests. Results: A total of 458 and 84,263 cases met criteria for unresectable, N2/N3 stage III NSCLC with T0 and T1-4 status, respectively. T0 status was associated with younger age, recent diagnosis, adenocarcinoma histology, N3, and use of chemotherapy. Overall survival (OS) was improved in T0 over T1-4 group (p < 0.0001) with a five-year survival rate of 30.5% and 12.7%, respectively, with a validation with multivariate proportional hazard models. Propensity score matching analyses using all 458 patients in each group demonstrated a significant difference in OS (p < 0.0001). The difference was also significant in a subset of those who have undergone chemoradiation (p < 0.0001). Independent analysis using SEER data confirmed its superior survival of T0 over T1-4 with a five-year survival rate of 35.3% and 13.5%, respectively. Conclusions: Both NCDB and SEER analyses demonstrated better survival of T0 than T1-4 counterpart in the setting of unresectable stage III NSCLC, irrespective of chemotherapy status. This group may require a distinct assignment to new staging group after further investigation.

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Combined modality therapy with carboplatin, irinotecan and radiation therapy followed by consolidation docetaxel for patients with stage III NSCLC

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.17088 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 17088-17088

Author(s):

L. E. Raez ◽

E. Roman ◽

L. Negret ◽

C. Takita ◽

C. Lobo ◽

...

Keyword(s):

Radiation Therapy ◽

Planning Target Volume ◽

Primary Tumor ◽

Radiation Pneumonitis ◽

Combined Modality Therapy ◽

Active Role ◽

Target Volume ◽

Nodal Metastasis ◽

Stage Iii ◽

Stage Iii Nsclc

17088 Background: Irinotecan (I) has an active role and potential as a radiosensitizing agent in patients with NSCLC. SWOG 9504 established the concept of “consolidation” chemotherapy with 3 cycles of docetaxel (D) after chemo/radiation (CRXT). We evaluated the efficacy and safety of administering weekly doses of carboplatin/irinotecan (CI) concomitantly with radiation therapy followed by D chemotherapy for patients (pts) with stages IIIA/B NSCLC. Methods: We have enrolled 23 pts, treatment included: C: (AUC = 2) and I: 30 mg/m2, weekly concomitant with radiation therapy, and D: 75 mg/m2 every 3 weeks for 3 times after CRXT was finished. The daily administered dose of radiation was 1.8 Gy, 5 days a week for 5 weeks, 25 fractions, (45 Gy) to the primary tumor and mediastinum (primary planning target volume: PPTV. After 45 Gy, the primary tumor and involved nodal metastasis (secondary planning target volume: SPTV) was boosted at 2 Gy per day to 18 Gy in 9 fractions. The total dose given was 63 Gy in 35 fractions over seven weeks. Evaluation of response has been done with RECIST criteria. Results: Median age is 55 years (range: 42–78), 18 (78%) of the pts are female, 17 (74%) are white, 13 (57%) are Hispanic, and 14 (65%) had an ECOG 1. Most common histologies are poorly differentiated and squamous cell carcinomas: 14 pts (61%), and half of the pts are stage IIIB. 111 weeks of CI and 39 cycles of D have been administered and we have documented 22 grade 3/4 adverse events (AE) among them: 4 pts pneumonia (17%), 3 pts radiation pneumonitis (13%), 2 pts: dehydration o neutropenia o dyspnea (9%) and 1 pt with diarrhea, nausea and vomiting (4.5%). No grade 4 neutropenia, esophagitis or diarrhea was reported. 12 severe AE were reported including: 2 pts with pneumonia (9%), 2 pts with dehydration (9%), and 2 pts with radiation pneumonitis (9%) requiring hospitalization. The rest of SAE were unrelated to therapy. Data for response is available in 18 pts. A partial response was seen in 10 pts (56%), and stable disease in 6 pts (33%). 2 pts are ineligible for response. Median survival (and PFS) has not been reached and it will be presented in the meeting. Conclusions: CI administered with radiation therapy and followed by D is safe and efficacious in the treatment of stage III NSCLC. [Table: see text]

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OC-0634 Lymphocyte Sparing Radiation Therapy for stage III NSCLC: a dosimetric study

Radiotherapy and Oncology ◽

10.1016/s0167-8140(21)06990-5 ◽

2021 ◽

Vol 161 ◽

pp. S498-S500

Author(s):

P. Fernandes ◽

Y. Jourani ◽

W. Birkfellner ◽

F. Charlier ◽

A. Ferreira ◽

...

Keyword(s):

Radiation Therapy ◽

Stage Iii ◽

Dosimetric Study ◽

Stage Iii Nsclc

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A phase III trial of carboplatin, paclitaxel, and thoracic radiation therapy with or without thalidomide in patients with stage III non-small cell carcinoma of the lung (NSCLC): E3598

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.7503 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 7503-7503 ◽

Cited By ~ 2

Author(s):

J. H. Schiller ◽

S. E. Dahlberg ◽

M. Mehta ◽

D. H. Johnson

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Angiogenesis Inhibitor ◽

Data Monitoring Committee ◽

Phase Iii ◽

Stage Iii ◽

Thoracic Radiation ◽

Stage Iii Nsclc ◽

Clinically Significant ◽

Grade 3

7503 Background: Thalidomide (T) is an oral angiogenesis inhibitor with anti-tumor activity in hematological malignancies. Given that antiangiogenic drugs such as bevacizumab have proven activity in advanced NSCLC, ECOG conducted a phase III study to compare the effects of the addition of thalidomide to paclitaxel/carboplatin/radiation therapy (PC/RT) on overall survival (OS) in pts with newly diagnosed stage III NSCLC. Secondary endpoints included time to progression (PFS) and toxicity. Methods: Pts were required to have inoperable stage IIIA or IIIB (no pleural effusion) NSCLC and a PS of 0 or 1. Pts were randomized to receive 2 cycles of P (225 mg/m2)+ C (AUC=6) every 3 wks or PC + thalidomide starting at 200 mg daily with the possibility of dose escalation. This was followed by weekly C (AUC=2), P (45 mg/m2) and concurrent RT (60 Gy) ± T. Pts on PC/RT + T continued thalidomide for 24 mo. or until disease progression. Results: 277 eligible pts were randomized to PC/RT and 272 pts to PC/RT + T. Median age was 63; 61% of pts had stage IIIB disease, 35% had squamous histology, and 46% were PS 0. The third planned interim analysis was conducted with 403 of 506 planned deaths (73.9%) for full analysis and the trial was stopped early by the ECOG Data Monitoring Committee for futility. The median overall survival for the no T arm was 15.3 mo. (12.4–20.2 mo.) compared to 16.0 mo for the T arm (14.4–18.3 mo.); hazard ratio = 0.985 (0.81–1.19); p = 0.88. Median PFS for the no T arm was 7.6 mo. (6.6–8.7 mo.) compared to 8.0 mo. for the T arm (7.1–9.1 mo.), p>0.05. The most common toxicity on both arms was myelosuppression. 11% of pts on the T arm had a grade 3–5 thrombosis/embolism, compared to <3% on the no T arm. Conclusions: The addition of thalidomide to PC/RT in pts with stage III NSCLC does not provide a clinically significant benefit. [Table: see text]

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Phase II study of concurrent radiotherapy and chemotherapy for unresectable stage III non-small-cell lung cancer. Southern Osaka Lung Cancer Study Group.

Journal of Clinical Oncology ◽

10.1200/jco.1995.13.4.869 ◽

1995 ◽

Vol 13 (4) ◽

pp. 869-875 ◽

Cited By ~ 42

Author(s):

K Furuse ◽

K Kubota ◽

M Kawahara ◽

N Kodama ◽

M Ogawara ◽

...

Keyword(s):

Lung Cancer ◽

Survival Rate ◽

Small Cell Lung Cancer ◽

Small Cell ◽

Stage Iii ◽

Small Cell Lung ◽

Concurrent Radiotherapy ◽

Unresectable Stage ◽

Stage Iii Nsclc ◽

Grade 3

PURPOSE To evaluate the response rate, toxicity, and 2-year survival rate of concurrent radiotherapy and chemotherapy for unresectable stage III non-small-cell lung cancer (NSCLC). PATIENTS AND METHODS Between July 1989 and October 1990, 65 patients with histologically or cytologically proven unresectable stage III NSCLC without T3N0-1M0 disease were entered onto this study. Sixty-one patients were eligible for response, survival, and toxicity analysis. Chemotherapy consisted of vindesine (3 mg/m2 on days 1, 8, 29, and 36), cisplatin (100 mg/m2 on days 1 and 29), and mitomycin (8 mg/m2 on days 1 and 29). Radiotherapy was administered for 3 weeks (2 Gy given 13 times, five fractions per week), followed by 10-day rest periods and then the previous schedule of radiotherapy repeated for 3 weeks. RESULTS Of 61 eligible patients, 53 (86.9%) had a partial response (PR). The median response duration was 39.1 weeks (range, 8.4 to 163+). The median survival time was 16 months and the 2-year survival rate was 36.7%. Of 53 responding patients, 10 (16.4%) are alive and disease-free after 2 years. The major toxicity was leukopenia (> or = grade 3, 95%). Other toxicities of > or = grade 3 included thrombocytopenia (45%), anemia (28%), nausea/vomiting (16%), fever (11%), and esophagitis (6%). Treatment-related death occurred in two patients. One patient died of pulmonary toxicity (interstitial pneumonitis) and the other of esophagobronchial fistula with pulmonary infection. CONCLUSION Concurrent radiotherapy plus chemotherapy with mitomycin, vindesine, and cisplatin (MVP) can be safely administered to patients with stage III NSCLC, with excellent response rates and 2-year survival rates.

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