The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  66 (2024)
Volume  65 (2023)
Volume  64 (2022)
Volume  63 (2021)
Volume  62 (2020)
Volume  61 (2019)
Volume  60 (2018)
Volume  59 (2017)
Volume  58 (2016)
Volume  57 (2015)
Volume  56 (2014)
Volume  55 (2013)
Volume  54 (2012)
Volume  53 (2011)
Volume  52 (2010)
Related articles

VOLUME 65 , ISSUE 4 ( October-December, 2023 ) > List of Articles

Original Article

Consolidation Radiotherapy in M1a Non-small Cell Lung Cancer Yields Equivalent Outcomes as Locally Advanced Disease

Adarsh Hegde, Sushma Agrawal, Joe Jose, Senthil SK Kumar, KJ Maria Das, Zia Hashim

Keywords : Advanced non-small cell lung cancer, Pleural hydrops, Radical radiotherapy

Citation Information : Hegde A, Agrawal S, Jose J, Kumar SS, Das KM, Hashim Z. Consolidation Radiotherapy in M1a Non-small Cell Lung Cancer Yields Equivalent Outcomes as Locally Advanced Disease. Indian J Chest Dis Allied Sci 2023; 65 (4):176-181.

DOI: 10.5005/jp-journals-11007-0101

License: CC BY-NC 4.0

Published Online: 26-03-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: The role of locoregional radiotherapy (RT) in M1a [malignant pleural effusion (MPE)] non-small cell lung cancer (NSCLC) remains limited. Ninety percent of the patients who come to our clinic are at an advanced stage. The standard of care for advanced cases is chemotherapy. Chemotherapy may cause resolution of pleural fluid in some patients. Do patients with a good performance status benefit from radical radiation therapy? We present our RT experience in M1a NSCLC patients who responded to chemotherapy. Materials and methods: We studied patients with advanced NSCLC (locally advanced with/without pleural effusion) who received postchemotherapy radiation therapy between January 2005 and December 2019. These patients were given four cycles of cisplatin-pemetrexed/gefitinib [epidermal growth factor receptor (EGFR)-positive] in adenocarcinoma and carboplatin-paclitaxel/cisplatin-etoposide in squamous cell carcinoma (SCC) followed by radical RT in three-dimensional (3D) [50–66 Gy conventional radiotherapy (CRT) technology]. Chemotherapy response, overall survival (OS), and factors affecting OS were evaluated by univariate and multivariate analysis. Results: A total of 36 of 154 patients had M1a disease. At a median follow-up of 14 months [interquartile range (IQR, 10–22 months)], the median OS was 14 months in the M1a subgroup vs 16 months in the non-M1a subgroup (p = 0.6). Median target volume was larger in M1a patients compared to M0 patients; 614 cc (IQR, 333–855 cc) and 564 cc (IQR, 391–763 cc). Factors affecting OS are gender (male vs female) (14 months vs 17 months in M0; 13 months vs 22 months in M1, p = 0.012), Karnofsky's performance is healthy (>70 vs <70) (14 months vs 11 months in M0; 18 months vs 13 months in M1, p = 0.04), diabetes (present vs not present) (12 months vs 14 months in M0; 10 months vs 16 months in M1, p = 0.03), chemical activity [biologically effective dose (BED) <72 vs >72)] (12 months vs 15 months in M0; 15 months vs 18 months in M1, p = 0.04), and radiation esophagitis (grade II vs grade I) (11 months vs 14 months in M0; 2 months vs 18 months in M0, p = 0.001). Conclusion: Primary RT is feasible and effective in chemotherapy-responsive NSCLC M1a patients; Despite a higher planned target volume (PTV) in M1a patients, it gives equivalent results compared to localized disease (M0). The potential of RT in this regard needs to be further validated.

PDF Share
  1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71(3):209–249. DOI: 10.3322/caac.21660.
  2. Agrawal S. Challenges in optimizing chemoradiation in locally advanced non-small-cell lung cancers in India. South Asian J Cancer 2013;2(4):265–271. DOI: 10.4103/2278-330X.119893.
  3. Thomas JM, Musani AI. Malignant pleural effusions: A review. Clin Chest Med 2013;34(3):459–471. DOI: 10.1016/j.ccm.2013.05.004.
  4. Morgensztern D, Waqar S, Subramanian J, et al. Prognostic impact of malignant pleural effusion at presentation in patients with metastatic non-small-cell lung cancer. J Thorac Oncol 2012;7(10):1485–1489. DOI: 10.1097/JTO.0b013e318267223a.
  5. Kasapoglu US, Arınç S, Gungor S, et al. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions. Clin Respir J 2016;10(6):791–799. DOI: 10.1111/crj.12292.
  6. Ren Y, Dai C, Shen J, et al. The prognosis after contraindicated surgery of NSCLC patients with malignant pleural effusion (M1a) may be better than expected. Oncotarget 2016;7(18):26856–26865. DOI: 10.18632/oncotarget.8566.
  7. Bonomi M, De Filippis C, Lopci E, et al. Clinical staging of malignant pleural mesothelioma: Current perspectives. Lung Cancer (Auckl) 2017;8:127–139. DOI: 10.2147/LCTT.S102113.
  8. Johnson KK, Rosen JE, Salazar MC, et al. Outcomes of a highly selective surgical approach to oligometastatic lung cancer. Ann Thorac Surg 2016;102:1166–1171. DOI: 10.1016/j.athoracsur.2016.04.086.
  9. Fukui T, Yokoi K. The role of surgical intervention in lung cancer with carcinomatous pleuritis. J Thorac Dis 2016;8(Suppl. 11):S901–S907. DOI: 10.21037/jtd.2016.06.36.
  10. Noronha V, Dikshit R, Raut N, et al. Epidemiology of lung cancer in India: Focus on the differences between non-smokers and smokers: A single-centre experience. Indian J Cancer 2012;49(1):74–81. DOI: 10.4103/0019-509X.98925.
  11. Arrieta O, Escamilla–López I, Lyra–González I, et al. Radical aggressive treatment among non-small cell lung cancer patients with malignant pleural effusion without extra-thoracic disease. J Thorac Dis 2019;11(2):595–601. DOI: 10.21037/jtd.2019.01.36.
  12. Bhattacharjee A, Bahar I, Saikia A. Nutritional assessment of patients with head and neck cancer in North-East India and dietary intervention. Indian J Palliat Care 2015;21(3):289–295. DOI: 10.4103/0973-1075.164889.
  13. Kumar G, Panda N, Roy R, et al. An observational study to assess socioeconomic status and demographic profile of advanced cancer patients receiving palliative care in a tertiary-level cancer hospital of Eastern India. Indian J Palliat Care 2018;24(4):496–499. DOI: 10.4103/IJPC.IJPC_72_18.
  14. Önal Ö, Koçer M, Eroğlu HN, et al. Survival analysis and factors affecting survival in patients who presented to the medical oncology unit with non-small cell lung cancer. Turk J Med Sci 2020;50(8): 1838–1850. DOI: 10.3906/sag-1912-205.
  15. Agarwal JP, Hotwani C, Prabhash K, et al. Optimizing treatment and analysis of prognostic factors for locally advanced non-small cell lung cancer in resource-limited population. Indian J Cancer 2016;53(1):96–101. DOI: 10.4103/0019-509X.180810.
  16. Xiao W, Hong M. Concurrent vs sequential chemoradiotherapy for patients with advanced non-small-cell lung cancer: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021;100(11):e21455. DOI: 10.1097/MD.0000000000021455.
  17. Agrawal S, Kumar S, Lawrence A, et al. Ipsilateral lung dose volume parameters predict radiation pneumonitis in addition to classical dose volume parameters in locally advanced NSCLC treated with combined modality therapy. South Asian J Cancer 2014;3(1):13–15. DOI: 10.4103/2278-330X.126503.
  18. Palma DA, Senan S, Tsujino K, et al. Predicting radiation pneumonitis after chemoradiation therapy for lung cancer: An international individual patient data meta-analysis. Int J Radiat Oncol Biol Phys 2013;85(2):444–450. DOI: 10.1016/j.ijrobp.2012.04.043.
  19. Noronha V, Prabhash K, Thavamani A, et al. EGFR mutations in Indian lung cancer patients: Clinical correlation and outcome to EGFR targeted therapy. PLoS One 2013;8(4):e61561. DOI: 10.1371/journal.pone.0061561.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.