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Effect of Histologic Type on Recurrence Pattern in Radiation Therapy for Medically Inoperable Patients with Stage I Non-Small-Cell Lung Cancer

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Abstract

Japanese randomized trials showed that there was a significant impact on survival from stage I adenocarcinoma (AD) of the lung by adjuvant chemotherapy with uracil-tegaful after complete resection but there was no effect for patients with squamous cell carcinoma (SQ). The purpose of this study was to examine the correlation of tumor histology and clinical outcome of radiation therapy (RT) for stage I non-small-cell lung cancer (NSCLC) and to consider the necessity of adjuvant chemotherapy after RT for these patients. The subjects were 83 patients, 54 with SQ and 29 with AD; they had received definitive RT with the total dose ranging from 60 to 80 Gy with conventional fractionation at a daily dose of 2 Gy. The differences between SQ and AD with respect to survival and recurrence pattern were investigated. The 5-year overall survival and cause-specific survival rates were 26.5% and 49.1%, respectively. No difference in survival was observed between SQ and AD patients, and the recurrence rates were almost identical (44% for SQ and 45% for AD). However, the 5-year primary control rate of SQ was significantly poorer than that of AD (SQ: 61.5%; AD: 87.6%; p = 0.03). Conversely, the 5-year metastasis-free survival rate of SQ was significantly better than that of AD (SQ: 88.2%; AD: 53.0%; p = 0.005). The different failure pattern, according to tumor histology, indicates that taking into consideration the difference in their clinical behaviors would also be important for planning RT and surgery for early lung cancer.

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References

  1. Asamura H, Nakayama H, Kondo H, et al. (1996) Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy? J Thorac Cardiovasc Surg 111:1125–1134

    Article  PubMed  CAS  Google Scholar 

  2. Dillman RO, Seagren SL, Propert KJ, et al. (1990) A randomized trial of induction chemotherapy plus high-dose radiation versus radiation alone in stage III non-small-cell lung cancer. N Engl J Med 323:940–945

    Article  PubMed  CAS  Google Scholar 

  3. Endo C, Sagawa M, Sakurada A, et al. (2003) Surgical treatment of stage I non-small cell lung carcinoma. Ann Thorac Cardiovasc Surg 9:283–289

    PubMed  Google Scholar 

  4. Feld R, Rubinstein LV, Weisenberger TH (1984) Sites of recurrence in resected stage I non-small-cell lung cancer: a guide for future studies. J Clin Oncol 2:1352–1358

    PubMed  CAS  Google Scholar 

  5. Filderman AE, Shaw C, Matthay RA (1986) Lung cancer. Part I: Etiology, pathology, natural history, manifestations, and diagnostic techniques. Invest Radiol 21:80–90

    Article  PubMed  CAS  Google Scholar 

  6. Gauden S, Ramsay J, Tripcony L (2005) The curative treatment by radiotherapy alone of stage I non-small cell carcinoma of the lung. Chest 108:1278–1282

    Google Scholar 

  7. Geddes DM (1979) The natural history of lung cancer: a review based on rates of tumour growth. Br J Dis Chest 73:1–17

    Article  PubMed  Google Scholar 

  8. Gressen EL, Curran WJ (2002) Inoperable localized stage I and stage II non-small cell lung cancer. Curr Treat Options Oncol 3:75–83

    PubMed  Google Scholar 

  9. Hayakawa K, Mitsuhashi N, Nakajima N, et al. (1992) Radiation therapy for stage I–III epidermoid carcinoma of the lung. Lung Cancer 8:213–224

    Article  Google Scholar 

  10. Hayakawa K, Mitsuhashi N, Saito Y, et al. (1999) Limited field irradiation for medically inoperable patients with peripheral stage I non-small cell lung cancer. Lung Cancer 26:137–142

    Article  PubMed  CAS  Google Scholar 

  11. Izbicki JR, Passlick B, Hosch SB, et al. (1996) Mode of spread in the early phase of lymphatic metastasis in non-small-cell lung cancer: significance of nodal micrometastasis. J Thorac Cardiovasc Surg 112:623–630

    Article  PubMed  CAS  Google Scholar 

  12. Kaplan E, Meier P (1958) Non-parametric estimation from incomplete observation. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  13. Kato H, Ichinose Y, Ohta M, et al. (2004) Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med 350:1713–1721

    Article  PubMed  CAS  Google Scholar 

  14. Komaki R, Scott CB, Sause WT, et al. (1997) Induction cisplatin/vinblastine and irradiation vs. irradiation in unresectable squamous cell lung cancer: failure patterns by cell type in RTOG 88-08/ECOG 4588. Radiation Therapy Oncology Group and Eastern Cooperative Oncology Group. Int J Radiat Oncol Biol Phys 39:537–544

    Article  PubMed  CAS  Google Scholar 

  15. McGarry RC, Song G, des Rosiers P, Timmerman R (2002) Observation-only management of early stage, medically inoperable lung cancer: poor outcome. Chest 121:1155–1158

    Article  PubMed  Google Scholar 

  16. Miyamoto T, Yamamoto N, Nishimura H, et al. (2003) Carbon ion radiotherapy for stage I non-small cell lung cancer. Radiother Oncol 66:127–140

    Article  PubMed  Google Scholar 

  17. Nagata Y, Negoro Y, Aoki T, et al. (2002) Clinical outcomes of 3D conformal hypofractionated single high-dose radiotherapy for one or two lung tumors using a stereotactic body frame. Int J Radiat Oncol Biol Phys 52:1041–1046

    Article  PubMed  Google Scholar 

  18. Nakagawa M, Tanaka F, Tsubota N, et al. (2005) A randomized phase III trial of adjuvant chemotherapy with UFT for completely resected pathological stage I non-small-cell lung cancer: the West Japan Study Group for Lung Cancer Surgery (WJSG)—the 4th study. Ann Oncol 16:75–80

    Article  PubMed  CAS  Google Scholar 

  19. Nakayama Y, Hayakawa K, Mitsuhashi N, Saito Y, Niibe H (1997) Long-term survivors of non-small cell lung cancer after radiation therapy: the significance of histologic type. Anticancer Res 17:2769–2773

    PubMed  CAS  Google Scholar 

  20. Noordijk EM, vd Poest Clement E, Hermans J, Wever AM, Leer JW (1988) Radiotherapy as an alternative to surgery in elderly patients with resectable lung cancer. Radiother Oncol 13:83–89

    Article  PubMed  CAS  Google Scholar 

  21. Onishi H, Araki T, Shirato H, et al. (2004) Stereotactic hypofractionated high-dose irradiation for stage I nonsmall cell lung carcinoma: clinical outcomes in 245 subjects in a Japanese multiinstitutional study. Cancer 101:1623–1631

    Article  PubMed  Google Scholar 

  22. Perez CA, Pajak TF, Rubin P, et al. (1987) Long-term observations of the patterns of failure in patients with unresectable non-oat cell carcinoma of the lung treated with definitive radiotherapy. Report by the Radiation Therapy Oncology Group. Cancer 59:1874–1881

    Article  PubMed  CAS  Google Scholar 

  23. Petrovich Z, Stanley K, Cox JD, Paig C (1981) Radiotherapy in the management of locally advanced lung cancer of all cell types: final report of randomized trial. Cancer 48:1335–1340

    Article  PubMed  CAS  Google Scholar 

  24. Pisch J, Moskovitz T, Esik O, Homel P, Keller S (2002) Concurrent paclitaxel-cisplatin and twice-a-day irradiation in stage IIIA and IIIB NSCLC shows improvement in local control and survival with acceptable hematologic toxicity. Pathol Oncol Res 8:163–169

    Article  PubMed  CAS  Google Scholar 

  25. Rosenthal SA, Curran WJ Jr (1990) The significance of histology in non-small cell lung cancer. Cancer Treat Rev 17:409–425

    Article  PubMed  CAS  Google Scholar 

  26. Sause WT, Scott C, Taylor S, et al. (1995) Radiation Therapy Oncology Group (RTOG) 88-08 and Eastern Cooperative Oncology Group (ECOG) 4588: preliminary results of a phase III trial in regionally advanced, unresectable non-small-cell lung cancer. J Natl Cancer Inst 87:198–205

    PubMed  CAS  Google Scholar 

  27. Sause W, Kolesar P, Taylor S IV, et al. (2000) 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 117:358–364

    Article  PubMed  CAS  Google Scholar 

  28. Schaake-Koning C, van den Bogaert W, Dalesio O, et al. (1992) Effects of concomitant cisplatin and radiotherapy on inoperable non-small-cell lung cancer. N Engl J Med 326:524–530

    Article  PubMed  CAS  Google Scholar 

  29. Sibley GS, Jamieson TA, Marks LB, Anscher MS, Prosnitz LR (1998) Radiotherapy alone for medically inoperable stage I non-small-cell lung cancer: the Duke experience. Int J Radiat Oncol Biol Phys 40:149–154

    Article  PubMed  CAS  Google Scholar 

  30. Slotman BJ, Antonisse IE, Njo KH (1996) Limited field irradiation in early stage (T1-2N0) non-small cell lung cancer. Radiother Oncol 41:41–44

    PubMed  CAS  Google Scholar 

  31. Taylor NA, Liao ZX, Cox JD, et al. (2004) Equivalent outcome of patients with clinical stage IIIA non-small-cell lung cancer treated with concurrent chemoradiation compared with induction chemotherapy followed by surgical resection. Int J Radiat Oncol Biol Phys 58:204–212

    Article  PubMed  Google Scholar 

  32. Thomas P, Rubinstein L (1990) Cancer recurrence after resection: T1 N0 non-small cell lung cancer. Lung Cancer Study Group. Ann Thorac Surg 49:242–246

    CAS  Google Scholar 

  33. Uematsu M, Shioda A, Suda A, et al. (2001) Computed tomography-guided frameless stereotactic radiotherapy for stage I non-small cell lung cancer: a 5-year experience. Int J Radiat Oncol Biol Phys 51:666–670

    Article  PubMed  CAS  Google Scholar 

  34. Vrdoljak E, Mise K, Sapunar D, Rozga A, Marusic M (1994) Survival analysis of untreated patients with non-small-cell lung cancer. Chest 106:1797–1800

    PubMed  CAS  Google Scholar 

  35. Zimmermann FB, Bamberg M, Molls M, Jeremic B (2003) Radiation therapy alone in early stage non-small cell lung cancer. Semin Surg Oncol 21:91–97

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

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Correspondence to Hitoshi Ishikawa.

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Presented in part at the 10th World Conference on Lung Cancer, Vancouver, British Columbia, Canada, August 10–14, 2003.

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Ishikawa, H., Nakayama, Y., Kitamoto, Y. et al. Effect of Histologic Type on Recurrence Pattern in Radiation Therapy for Medically Inoperable Patients with Stage I Non-Small-Cell Lung Cancer. Lung 184, 347–353 (2006). https://doi.org/10.1007/s00408-006-0012-5

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  • DOI: https://doi.org/10.1007/s00408-006-0012-5

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