ABSTRACT
PURPOSE: To detennine the extent and the clinical significance of site-dependent differences in response to chemotherapy in patients with metastatic lung cancer. MATERIALS AND METHODS: We reviewed the records of patients with metastatic lung cancer who had received chemotherapy and were evaluated for the response of primary lung and metastatic lesions simultaneously. Total 52 patients were eligible. RESULTS: The discordance rate of response between primary lung lesion and various metastatic lesions was 0% (0/51) at regional lymph nodes, 12% (1/8) at distant lymph nodes, 45% (5/11) at hematogenous metastatic lung lesion, 0% (0/7) at liver, 50% at adrenal glands, and 21% (3/14) at bone. As a result, the concordance rate of response amang lymph nodes, liver, and primary lung lesions was high. But some differences in response were observed at intrapulmonary metastatic lesion, adrenal glands, and bone lesions in comparison with primary lung lesion. CONCLUSION: We conclude that the effective therapeutic strategies against those discordant metastatic lesions should be developed to increase the overall treatment effect in patients with metastatic lung cancer.
Subject(s)
Humans , Adrenal Glands , Drug Therapy , Liver , Lung Neoplasms , Lung , Lymph Nodes , Neoplasm MetastasisABSTRACT
BACKGROUND: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. METHOD: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. RESULT: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. CONCLUSION: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.