BACKGROUND AND OBJECTIVEThe efficacy of complete resection of the cancer for patients with stage IIIa non-small cell lung cancer (NSCLC) is limited. Synthetic therapy is taken the lead in advocating at present. However, the value of post-operative radiotherapy is not still clear. The aim of this study is to evaluate the survival time and side effects of postoperative chemotherapy or chemoradiotherapy in the treatment of stage IIIa NSCLC.

METHODSBetween December 2003 and June 2007, 52 cases that have completed followed-up data with stage IIIa of NSCLC received in the First Affiliated Hospital of Dahan Medical University. Twenty-three patients received postoperative chemoradiotherapy (group A) and 29 patients received postoperative chemotherapy combined with radiotherapy (group B). Group A adopted platinum-based combination chemotherapy for 4-6 cycles. The chemotherapeutics included gemcitabine, vinorelbine and docetaxel. Group B used chemotherapy for 2-4 cycles and then received 3-dimensional conformal radiotherapy (3D-CRT). The prescribe dose of target volume was 50 Gy. The chemotherapy was same as for group A and needed 4 cycles in all. The impact of postoperative adjuvant treatment on survival and toxicity was observed in patients with stage IIIa NSCLC and the reason of disease progression was analyzed.

RESULTSThe median survival was 32.5 months in group A and 31.9 months in group B (P = 0.371). Progression-free survival extended about 6 months (P = 0.044). The survival rate was 87% at 1 year, 0.1% at 2 year, 33% at 3 year for group A compared with 93%, 69%, 45% for group B. The major side effects were hematological and gastrointestinal toxicities, including nausea, vomiting and neutropenia. There was no significant difference in these toxicities between the two groups (P > 0.05). Radioactive esophageal infection occurred in 17.2% of the patients. Acute and late radioactive lung infection occurred in 13.8% and 27.6% of the patients. All these toxicities were below degree 2. Distant metastases were the main reason of disease progression. There was no significant difference in the rates of local recurrence and metastases between the two groups (P > 0.05).

CONCLUSIONCombined modality therapy should be the main therapy of stage IIIa NSCLC. The addition of radiotherapy can effectively prolong progression-free survival and don't highly increase the toxicities.

Carcinoma, Non-Small-Cell Lung ; drug therapy ; mortality ; radiotherapy ; surgery ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Lung Neoplasms ; drug therapy ; mortality ; radiotherapy ; surgery ; Male ; Middle Aged

PURPOSE: To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. MATERIALS AND METHODS: Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. RESULTS: The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. CONCLUSION: The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.
Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/mortality/*radiotherapy/surgery ; Female ; Humans ; Lung Neoplasms/mortality/*radiotherapy/surgery ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*radiotherapy/surgery ; Survival Rate ; Treatment Outcome

We aimed to compare the duration of survival among subjects receiving brachytherapy (BT) in combination with Nd:YAG laser therapy (LT), and those receiving LT or BT alone. The medical records of subjects who received endobronchial treatment for unresectable tracheobronchial malignancies between January 1997 and December 1999 in a single center were reviewed retrospectively. A total of 80 patients were evaluated. The overall symptomatic response rate after treatment was 86.5%. Median survival durations for the LT, BT, and combined therapy (CT) group were 111, 115, and 264 days, respectively. The survival duration was significantly longer in the CT group than in the BT group (p=0.0078), but the difference was not statistically significant between the CT and the LT group. The bronchoscopic finding of endobronchial polypoid lesion was associated with a longer survival time than extraluminal with compression type (p=0.0023) by univariate analysis. Other factors associated with the better prognosis included hemoglobin > or = 12.5 g/dL, serum albumin level > or =37 g/L, and BT dose > or = 15 Gy at 1 cm distance. Of these factors, specific bronchoscopic findings, serum albumin level, CT modality, and dose of BT retained statistical significance in multivariate analysis. In conclusion, combined LT and BT is associated with increased patient survival compared with BT alone. Combined therapy may improve survival time in selected patients with endobronchial malignancies.
Aged ; *Brachytherapy ; Carcinoma, Non-Small-Cell Lung/*mortality/*radiotherapy/surgery ; Combined Modality Therapy ; Female ; Humans ; Iridium Radioisotopes/therapeutic use ; Laser Therapy ; Lung Neoplasms/*mortality/*radiotherapy/surgery ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Survival Analysis