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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).


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.

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