Journal Information
Vol. 39. Issue 2.
Pages 81-86 (February 2003)
Share
Share
Download PDF
More article options
Vol. 39. Issue 2.
Pages 81-86 (February 2003)
Full text access
Carcinoma no microcítico de pulmón. Supervivencia y factores pronósticos del tratamiento radioterápico
Non-small cell lung cancer. Survival after radiotherapy and prognostic factors
Visits
16588
J. Jaén Olasoloa,
Corresponding author
jjaen@hpm.sas.junta-andalucia.es

Correspondencia: Servicio de Oncología Radioterápica. Hospital Universitario Puerta del Mar.Avda. Ana de Viya, 21. 11009 Cádiz. España
, E. Alonso Redondoa, A. León Jiménezb, A. Rueda Ramosc
a Servicio de Oncología Radioterápica. Hospital Universitario Puerta del Mar. Cádiz
b Sección de Neumología. Hospital Universitario Puerta del Mar. Cádiz
c Servicio de Oncología Médica. Hospital Universitario Puerta del Mar. Cádiz. España
This item has received
Article information
Abstract
Bibliography
Download PDF
Statistics
Objetivo

Analizar los resultados de la radioterapia en el carcinoma no microcítico de pulmón y las características clí-nicas y terapéuticas que pueden influir en ellos

Pacientes Y Método

Sobre una base poblacional de 109 pacientes, 87 cumplieron los criterios de inclusión para el es-tudio. Recibieron radioterapia torácica sobre el volumen tu-moral macroscópico y áreas de drenaje linfático, en fraccio-namiento convencional. El 61% recibió, además, tratamiento sistémico con citostáticos

Resultados

La distribución por estadios fue: 33% (28/87) I + II; 20% (18/87) IIIA, y 47% (41/87) IIIB. La do-sis media de radioterapia fue de 66,7 Gy (intervalo de con-fianza [IC] del 95%, 65–67). Consiguió la remisión clínica completa el 22% (18/87), de los cuales la mitad recidivó pos-teriormente; el 26% (21/87) obtuvo una remisión parcial y el 52% (42/87) no respondió. Se encontraron diferencias esta-dísticamente significativas en la supervivencia actuarial, se-gún la estadificación y respuesta tumoral. La mediana de supervivencia para estadios I + II fue de 29 meses (IC del 95%, 19–39); para los IIIA, de 22 meses (IC del 95%, 16–28), y para los IIIB, de 16 meses (IC del 95%, 12,20). Las com-plicaciones más frecuentes fueron las cutáneas, esofágicas y pulmonares, con una baja incidencia de toxicidad grado 3 (inferior al 3%) y ausencia de grado

Conclusiones

No se encontraron diferencias en la super-vivencia según la edad, localización tumoral y tipo histológi-co. El control local de la enfermedad influyó decisivamente en la supervivencia de estos pacientes

Palabras clave:
Cáncer de pulmón
Radioterapia
Quimioterapia
Objective

To analyze the results of radiotherapy for non-small cell lung cancer and identify the clinical and the-rapeutic variables that might influence prognosis

Patients And Methods

In a population base of 109 pa-tients, 87 met the enrollment criteria. The patients received thoracic radiotherapy over the macroscopic tumor volume and lymph drainage areas, using conventional fractions. Systemic cytostatic therapy was also given to 61% of the pa-tients

Results

Staging was as follows: 33% (28/87) I and II, 20% (18/87) IIIA and 47% (41/87) IIIB. The mean radiothe-rapy dose was 66.7 Gy (95% CI, 65–67). Full clinical remis-sion was achieved by 22% (18/87), half of whom later suffe-red recurrences. Partial remission was achieved by 26% (21/87). No response was observed in 52% (42/87). Statistically significant differences in actuarial survival ra-tes were found for staging and tumor response. Mean survi-val for stages I and II was 29 months (95% CI, 19–39), for IIIA it was 22 (95% CI, 16–28) months, and for IIIB 16 months (95% CI, 12–20). The most common complications were cutaneous, esophageal and pulmonary, with a low inci-dence of grade 3 toxicity (less than 3%) and absence of gra-de 4

Conclusions

No differences in survival were observed for age, tumor location or histological type. Local control of the disease decisively influenced patient survival

Keywords:
Lung cancer
Radiotherapy
Chemotherapy
Full text is only aviable in PDF
Bibliografía
[1.]
G. López-Albente, M. Pollan, P. De la Iglesia, M. Ruiz.
Characterization of the lung cancer epidemic in the European Union (1970–1990).
Cancer Epidermiol Biomarkers Prev, 4 (1995), pp. 813-820
[2.]
X. Bonfill, C. Moreno, G. Prada, E. Rivero, M. Rue.
Lung cancer mortality among males of Catalonia and Spain compared with other European countries between 1975–77 and 1987–89.
[3.]
American Cancer Society.
Cancer facts & figures –1997,
[4.]
E.W. Humphrey, C.R. Smart, D.P. Winchester, et al.
National survey of the pattern of care for carcinoma of the lung.
J Thorac Cardiovasc Surg, 100 (1990), pp. 837-843
[5.]
M. Saunders, S. Dische, A. Barrett, A. Harvey, G. Griffiths, M. Palmar.
Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee.
Radiother Oncol, 52 (1999), pp. 137-148
[6.]
M. Stuschke, H.D. Thames.
Hyperfractionated radiotherapy of human tumors: overview of the randomised clinical trials.
Int J Radiat Oncol Biol Phys, 37 (1997), pp. 259-267
[7.]
Z. Liao, R. Komaki, C. Stevens, J. Kelly, F. Fossella, J.S. Lee, et al.
Twice daily irradiation increases locoregional control in patients with medically inoperable or surgically unresectable stage II-IIIB non-small-cell lung cancer.
Int J Radiat Oncol Biol Phys, 53 (2002), pp. 558-565
[8.]
Non-small cell Lung Cancer Collaborative Group.
Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials.
Bmj, 311 (1995), pp. 899-909
[9.]
P. Marino, A. Preatoni, A. Cantoni.
Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb nonsmall cell lung cancer. A meta-analysis.
Cancer, 76 (1995), pp. 593-601
[10.]
R.S. Pritchard, S.P. Anthony.
Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer. A meta-analysis.
Ann Intern Med, 125 (1996), pp. 723-729
[11.]
C.F. Mountain.
Revisions in the International System for Staging Lung Cancer.
Chest, 111 (1997), pp. 1710-1717
[12.]
Lung.
American Joint Committee on Cancer, editor. AJCC cancer staging manual, 5th ed, pp. 127-137
[13.]
Grupo de Trabajo de la SEPAR.
Normativa actualizada (1998) sobre diagnóstico y estadificación del carcinoma broncogénico.
Arch Bronconeumol, 34 (1998), pp. 437-452
[14.]
D.A. Karnofsky, J.H. Buchenal.
Clinical evaluation of chemotherapeutic agents in cancer.
Evaluation of chemotherapeutic agents, pp. 191-205
[15.]
C.G. Zubrod, M. Schneiderman, E. Frei.
Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide.
J Chron Dis, 11 (1960), pp. 7-33
[16.]
A. Cordiner, F. De Carlo, R. De Gennaro, et al.
Prediction of postoperative pulmonary function following thoracic surgery for bronchial carcinoma.
Angiology, 42 (1991), pp. 985-989
[17.]
R.J. Pierce, J.M. Copland, K. Sharpe, C.E. Barter.
Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality.
Am J Respir Crit Care Med, 150 (1994), pp. 947-955
[18.]
Giordano, M.L. Calgagni, G. Meduri, et al.
Perfusion lung scintigraphy for the prediction of postlobectomy residual pulmonary function.
Chest, 111 (1997), pp. 1542-1547
[19.]
M.V. M Graham, J.A. Purdy, B. Emami, W. Harms, W. Bosch, M.A. Lockett, et al.
Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC).
Int J Radiat Oncol Biol Phys, 45 (1999), pp. 323-329
[20.]
M.L. Hernando, L.B. Marks, G.C. Bentel, et al.
Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer.
Int J Radiat Oncol Biol Phys, 51 (2001), pp. 650-659
[21.]
C.A. Pérez, L.W. Brady.
Overview.
Principles and practice of radiation oncology, pp. 1-63
[22.]
P. Therasse, S.G. Arbuck, E.A. Eisenhauer, et al.
New guidelines to evaluate the response to treatment in solid tumors.
J Natl Cancer Inst, 92 (2000), pp. 205-216
[23.]
E.L. Kaplan, P. Meier.
Nonparametric estimation from incomplete observations.
J Amer Statist Assoc, 55 (1958), pp. 457-481
[24.]
N. Breslow.
A generalized Kruskal-Wallis test for comparing k samples subject to unequal patterns of censorship.
Biometrika, 57 (1970), pp. 579-594
[25.]
N. Mantel.
Evaluation of survival data and two new rank order statistics arising in its consideration.
Cancer Chemotherapy Reports, 50 (1966), pp. 163-170
[26.]
D.R. Cox.
Regression models and life tables.
J Roy Statist Soc, 34 (1972), pp. 187-220
[27.]
N. Martini.
Surgical treatment of non-small cell lung cancer by stage.
Semin Surg Oncol, 6 (1990), pp. 248-254
[28.]
T. Naruke, T. Goya, R. Tsuchiya, K. Suemasu.
Prognosis and survival in resected lung carcinoma based on the new international staging system.
J Thorac Cardiovasc Surg, 96 (1988), pp. 440-447
[29.]
M. García-Yuste, J.M. Matilla, J.L. Duque, F. Heras, L.J. Cerezal, G. Ramos.
Tratamiento quirúrgico del cáncer de pulmón: evaluación comparativa de los sistemas de estadificación de 1986 y 1997. Resultados en 500 pacientes consecutivos.
Arch Bronconeumol, 36 (2000), pp. 245-250
[30.]
V. Calvo, J. Padilla, F. París, E. Blasco, J. Pastor, A. García.
Supervivencia posquirúrgica en el estadio II del carcinoma broncogénico no anaplásico de células pequeñas.
Arch Bronconeumol, 37 (2001), pp. 19-26
[31.]
F.A. Lederle, D.E. Niewoehner.
Lung cancer surgery. A critical review of the evidence.
Arch Intern Med, 154 (1994), pp. 2397-2400
[32.]
R. Morrison, T.J. Deeley, W.P. Cleland.
The treatment of carcinoma of the bronchus: a clinical trial to compare surgery and supervoltage radiotherapy.
Lancet, 1 (1963), pp. 683-684
[33.]
R.O. Dillman, J. Herndon, S.L. Seagren, W.L. Eaton, M.R. Green.
Improved survival in stage III non-small-cell lung cancer: sevenyear follow-up of cancer and leukemia group B (CALGB) 8433 trial.
J Natl Cancer Inst, 88 (1996), pp. 1210-1215
[34.]
W. Sause, P. Kolesar, S. Taylor, et al.
Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group.
Chest, 117 (2000), pp. 358-364
[35.]
B. Jeremic, J. Classen, M. Bamberg.
Radiotherapy alone in technically operable, medically inoperable, early-stage (I/II) non-smallcell lung cancer.
Int J Radiat Oncol Biol Phys, 54 (2002), pp. 119-130
[36.]
K.S. Albain, J.J. Crowley, I.I.I. Turrisi AT, D.R. Gandara, W.B. Farrar, J.I. Clark, et al.
Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group Phase II study, SWOG 9019.
J Clin Oncol, 20 (2002), pp. 3454-3460
[37.]
F. Robert, S.A. Spencer, H.A. Childs, R. Zhang, R.F. Meredith, R.H. Wheeler, et al.
Concurrent chemoradiation therapy with cisplatin and paclitaxel for locally advanced non-small cell lung cancer: long-term follow-up of a phase I trial.
Lung Cancer, 37 (2002), pp. 189-199
[38.]
R. Komaki, W. Seiferheld, D. Ettinger, J.S. Lee, B. Movsas, W. Sause.
Randomized phase II chemotherapy and radiotherapy trial for patients with locally advanced inoperable non-small-cell lung cancer: long-term follow-up of RTOG 92–04.
Int J Radiat Oncol Biol Phys, 53 (2002), pp. 548-557
[39.]
T.Y. Kim, S.H. Yang, S.H. Lee, Y.S. Park, Y.H. Im, W.K. Kang, et al.
A phase III randomized trial of combined chemoradiotherapy versus radiotherapy alone in locally advanced non-small-cell lung cancer.
Am J Clin Oncol, 25 (2002), pp. 238-243
[40.]
J. Aisner, H.H. Hansen.
Commentary: current status of chemotherapy for non-small cell lung cancer.
Cancer Treat Rep, 65 (1986), pp. 979-986
[41.]
M. Werner-Wasik, Y. Xiao, E. Pequignot, W.J. Curran, W. Hauck.
Assessment of lung cancer response after nonoperative therapy: tumor diameter, bidimensional product, and volume. A serial CT scan-based study.
Int J Radiat Oncol Biol Phys, 51 (2001), pp. 56-61
[42.]
Ball DL, Smith J, Wirth A, Mac Manus MP. Failure of stage to predict survival in patients with non-small cell lung cancer treated by radiotherapy with or without concomitant chemotherapy. Actas de 43rd Annual Meeting of the American Society for Therapeutic
Copyright © 2003. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?