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Unexpected long-term survival after low-dose palliative radiotherapy for nonsmall cell lung cancer
Article first published online: 23 JAN 2006
Copyright © 2006 American Cancer Society
Volume 106, Issue 5, pages 1110–1116, 1 March 2006
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
- Issue published online: 17 FEB 2006
- Article first published online: 23 JAN 2006
- Manuscript Accepted: 29 SEP 2005
- Manuscript Revised: 31 AUG 2005
- Manuscript Received: 31 MAY 2005
- nonsmall cell lung cancer;
- survival analysis;
- radiation therapy;
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.
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.
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.
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.