Clinical Outcomes of Stage III Non-small Cell Lung Cancer Patients Treated With Radical Radiotherapy in a Institution in Brazil

ABSTRACT

Introduction: Lung cancer is the leading cause of cancer death. Most cases are diagnosed at advanced stages. Stage III cancers are treated in a curative manner, despite the low success rate. Our objective was to define the clinical and epidemiological profile of stage III non-small cell lung cancer (NSCLC) patients (pts) treated with radiotherapy (RT) and their response to therapy. Method(s) It is a retrospective and observational study of all non-surgical stage III NSCLC pts treated with RT with curative intent at a public cancer center in the south of Brazil between January/2016 and June/2022. Data collected dates of biopsy, treatment initiation, image progression or relapse, death and last registration;ECOG-PS;sex;smoking status;histology;stage (TNM 7th Ed) and chemotherapy (CT) use. Survival analysis were performed using the Kaplan-Meier method and factors associated with the events were analyzed using Cox regression. Groups were compared with chi-square and Kruskal-Wallis tests. Result(s) Eighty-seven pts were identified;median age 63 years-old;46 (52%) male, 78 (90%) former or present smokers;51 (62%) ECOG-PS 0/1;49 (58%) squamous (sq) histology;48 (60%) stage IIIb;60 (68%) had abdomen, bone and brain scans;64 (73%) had concurrent CT, 11(13%) sequential and 12 (14%) exclusive RT;64 (74%) concluded RT;53 (60%) had disease progression or relapse and 47 (54%) died. It took a median of 77 days (d) from biopsy to treatment initiation, without difference between pre or during COVID-19 pandemic. The follow-up was of 305d, progression free survival 192d and overall survival 253d (median for all), using the treatment initiation as baseline date. Younger pts and ECOG-PS 0/1 pts were more commonly treated with concurrent CT (X28,87;p 0,0054 and X210,82;p 0,004 respectively). No factor influenced progression free survival on uni or multivariable analyses. Factors correlated with overall survival on univariable analysis were ECOG-PS (hazard ratio (HR) 2,02;p 0,010);bone scan (HR 0,5;p 0,028);treatment conclusion (HR 3,53;p<0,0001). Multivariable analysis: ECOG-PS (HR 2,95;p 0,017), non-sq histology (HR 2,26;p 0,044);RT conclusion (HR 4,69;p<0,0001). Conclusion(s) Our study shows shorter overall and progression free survival than literature, with a large portion of patients being treated with ECOG-PS of 2 or greater and without adequate systemic staging. About one-quarter of patients did not conclude the treatment, and this was the most negative factor impacting survival next to ECOG-PS.Copyright © 2023