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Title: The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma

Abstract

Purpose: Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials: We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results: On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation (P=.0046), totalmore » volume of intrathoracic disease (P=.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography (P<.0001). When partitioned into central and peripheral volumes, central (P<.0001) but not peripheral (P=.74) disease was associated with worse survival. On multivariate analysis with known factors, pulmonary symptoms (hazard ratio, 1.46; P=.042), central disease volume (hazard ratio, 1.47; P=.042), and bronchial/vascular compression (hazard ratio, 1.54; P=.022) remained significant. Conclusions: Patients with bulky central disease, bronchial/vascular compression, and/or pulmonary symptoms exhibited worse overall survival after first-line, platinum-based chemotherapy. A subset of these patients may be studied to determine whether early, planned palliative thoracic radiation could also be of benefit.« less

Authors:
 [1]; ; ; ; ; ; ;  [1];  [2];  [1]
  1. Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)
  2. Department of Medicine, Division of Hematology and Oncology, University of North Carolina, Chapel Hill, North Carolina (United States)
Publication Date:
OSTI Identifier:
22149599
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 3; Other Information: Copyright (c) 2012 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BRONCHI; CARCINOMAS; CHEMOTHERAPY; CHEST; CLINICAL TRIALS; COMPRESSION; COMPUTERIZED TOMOGRAPHY; DEATH; DIAGNOSIS; HEALTH HAZARDS; LUNGS; MULTIVARIATE ANALYSIS; PATIENTS; PERFORMANCE; PLATINUM COMPLEXES; RADIOTHERAPY; SYMPTOMS

Citation Formats

Higginson, Daniel S., E-mail: daniel.higginson@gmail.com, Chen, Ronald C., Tracton, Gregg, Morris, David E., Halle, Jan, Rosenman, Julian G., Stefanescu, Mihaela, Pham, Erica, Socinski, Mark A., and Marks, Lawrence B. The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.04.045.
Higginson, Daniel S., E-mail: daniel.higginson@gmail.com, Chen, Ronald C., Tracton, Gregg, Morris, David E., Halle, Jan, Rosenman, Julian G., Stefanescu, Mihaela, Pham, Erica, Socinski, Mark A., & Marks, Lawrence B. The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma. United States. doi:10.1016/J.IJROBP.2012.04.045.
Higginson, Daniel S., E-mail: daniel.higginson@gmail.com, Chen, Ronald C., Tracton, Gregg, Morris, David E., Halle, Jan, Rosenman, Julian G., Stefanescu, Mihaela, Pham, Erica, Socinski, Mark A., and Marks, Lawrence B. Thu . "The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma". United States. doi:10.1016/J.IJROBP.2012.04.045.
@article{osti_22149599,
title = {The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma},
author = {Higginson, Daniel S., E-mail: daniel.higginson@gmail.com and Chen, Ronald C. and Tracton, Gregg and Morris, David E. and Halle, Jan and Rosenman, Julian G. and Stefanescu, Mihaela and Pham, Erica and Socinski, Mark A. and Marks, Lawrence B.},
abstractNote = {Purpose: Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials: We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results: On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation (P=.0046), total volume of intrathoracic disease (P=.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography (P<.0001). When partitioned into central and peripheral volumes, central (P<.0001) but not peripheral (P=.74) disease was associated with worse survival. On multivariate analysis with known factors, pulmonary symptoms (hazard ratio, 1.46; P=.042), central disease volume (hazard ratio, 1.47; P=.042), and bronchial/vascular compression (hazard ratio, 1.54; P=.022) remained significant. Conclusions: Patients with bulky central disease, bronchial/vascular compression, and/or pulmonary symptoms exhibited worse overall survival after first-line, platinum-based chemotherapy. A subset of these patients may be studied to determine whether early, planned palliative thoracic radiation could also be of benefit.},
doi = {10.1016/J.IJROBP.2012.04.045},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 3,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}