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Unexpected long-term survival after low-dose palliative radiotherapy for nonsmall cell lung cancer

  1. Michael P. Mac Manus M.D.1,†,*,
  2. Jane P. Matthews Ph.D.2,
  3. Morikatsu Wada4,
  4. Andrew Wirth1,
  5. Valentina Worotniuk3,
  6. David L. Ball M.D.1

Article first published online: 23 JAN 2006

DOI: 10.1002/cncr.21704

Issue

Cancer

Cancer

Volume 106, Issue 5, pages 1110–1116, 1 March 2006

Additional Information

How to Cite

Mac Manus, M. P., Matthews, J. P., Wada, M., Wirth, A., Worotniuk, V. and Ball, D. L. (2006), Unexpected long-term survival after low-dose palliative radiotherapy for nonsmall cell lung cancer. Cancer, 106: 1110–1116. doi: 10.1002/cncr.21704

Author Information

  1. 1

    Department of Radiation Oncology, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia

  2. 2

    Center for Biostatistics and Clinical Trials, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia

  3. 3

    Patient Record Information Department, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia

  4. 4

    Department of Radiation Oncology, Austin and Repatriation Medical Center, Melbourne, Victoria, Australia

  1. †

    Fax: (011) 613-9656-1424

*Consultant Radiation Oncologist, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria 3000, Australia

  1. †

    Fax: (011) 613-9656-1424

Publication History

  1. Issue published online: 17 FEB 2006
  2. Article first published online: 23 JAN 2006
  3. Manuscript Accepted: 29 SEP 2005
  4. Manuscript Revised: 31 AUG 2005
  5. Manuscript Received: 31 MAY 2005

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Keywords:

  • nonsmall cell lung cancer;
  • survival analysis;
  • radiation therapy;
  • cure

Abstract

BACKGROUND

Many experienced oncologists have encountered patients with proven nonsmall cell lung cancer (NCLC) who received modest doses of palliative radiotherapy (RT) and who unexpectedly survived for > 5 years; some were apparently cured. We used a very large prospective database to estimate the frequency of this phenomenon and to look for correlative prognostic factors.

METHODS

Patients with histologically or cytologically proven NSCLC, treated with palliative RT to a dose of ≤ 36 Gy, were identified from a prospective database containing details of 3035 new patients registered from 1984–1990.

RESULTS

An estimated 1.1% (95% confidence interval, 0.7–1.6%) of 2337 palliative RT patients survived for 5 or more years after commencement of RT, including 18 patients who survived progression-free for 5 years. Estimated median survival was 4.6 months. Five-year survivors had significantly better Eastern Cooperative Oncology Group performance status at presentation than non-5-year survivors (P = 0.024) and were less likely to have distant metastases (P = 0.020). RT dose did not appear to be a significant prognostic factor. Patients who survived 5 years without progression had an estimated 78% probability of remaining free from progression in the next 5years.

CONCLUSIONS

Approximately 1% of patients with proven NSCLC survived for > 5 years after palliative RT, and many of these patients appeared to have been cured by a treatment usually considered to be without curative potential. Because of the potential for long-term survival, doses to late-reacting normal tissues should be kept within tolerance when prescribing palliative RT in NSCLC. Cancer 2006. © 2006 American Cancer Society.

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