The standard treatment for stage IIIA non-small cell lung cancer (NSCLC) is definitive chemoradiotherapy (dCRT). However, approximately 80% of patients experience relapse, resulting in a poor prognosis. The aim of this study was to evaluate the relapse patterns of patients with stage IIIA NSCLC after dCRT and their clinical courses.
A retrospective review of patients treated for stage IIIA NSCLC at the National Cancer Center between 2002 and 2011 was performed. Data on patients characteristics, the first relapse site after dCRT (inside or outside of the radiotherapy field, presence or absence of brain metastasis), salvage treatment, and the disease progression site after salvage treatment were collected. The post-progression overall survival (PPOS) was evaluated using the Kaplan-Meier method.
Among the 152 patients who were treated with dCRT, 115 (76%) relapsed and were included in this analysis. Of these, infield recurrence (IR) and brain metastasis (BM) as a first relapse were observed in 30 (26%) and 14 (12%) patients, respectively. The other 71 patients (62%) experienced mixed recurrences (MR) including infield and distant metastases. Salvage treatments including radiotherapy, chemotherapy, and surgery were performed in 83 (72%) patients. In patients with IR, 2 patients (7%) underwent surgery, and the others were treated using chemotherapy. The median PPOS (mPPOS) and the 3-year PPOS (3yPPOS) rate in patients with IR were 16.8 months and 0%, respectively. All the patients with BM underwent local radiotherapy. The mPPOS and the 3yPPOS rate in patients with BM were 25.3 months and 39.3%, respectively. After salvage treatment, 17 (56%) of the 30 patients with IR experienced infield disease progression, and 10 (71%) of the 14 patients with BM developed CNS progression. In patients with MR, the mPPOS and 3yPPOS rate were 10.9 months and 17.2%, respectively.
Patients with IR tended to have a poorer prognosis than those with other patterns of relapse because of persistent local disease progression, while patients with BM experienced a better survival outcome. The development of an effective salvage therapy taking the recurrence pattern into account is mandatory.
Clinical trial identification
The study protocol was approved by the institutional review boards of the
National Cancer Center Hospital (number: 2015-355)
Legal entity responsible for the study
National Cancer Center
H. Horinouchi: Corporate-sponsored research: Taiho, Merck Serono, MSD, Astellas, Novartis. H. Nokihara: Honoraria: Boehringer Ingelheim, Taiho, AstraZeneca, Ono, Sanofi, Lilly Research Funding: Merck, Pfizer, Taiho, Eisai, Chugai, Lilly, Novartis, Daiichi Sankyo, GlaxoSmithKline, Yakult, Quintiles, Astellas, AstraZeneca, Boehringer Ingelheim, Ono. N. Yamamoto: Research funds (as institutions): Quintiles, Astellas, Chugai, Esai, Taiho, BMS, Pfizer, Novartis, Daiichi-Sankyo, Boehringer Ingelheim, Kyowa-Hakko Kirin. Honoraria: AstraZeneca, Pfizer, Lilly, Chugai. Y. Ohe: Reserch: AstraZeneca, Chugai, Lilly, Ono, BMS, Kyorin, Dainippon-Sumitomo, Pfizer, Taiho, Novaltis, Merc honoraria: AstraZeneca, Chugai, Lilly, Daiichi-Snkyo, Nippopnkayaku, Boehringer Ingelheim, Beyer, MSD, Taiho, Clovis, Sanofi. All other authors have declared no conflicts of interest.