Is prolonged survival possible for patients with supraclavicular node metastases in non-small cell lung cancer treated with chemoradiotherapy?: Analysis of the Radiation Therapy Oncology Group experience

Purpose: To determine if patients with non-small cell lung carcinoma (NSCLC ) and positive supraclavicular nodes (SN+) have a similar outcome to other patients with Stage IIIB NSCLC (SN-) when treated with modern chemoradiothe rapy. Methods and Materials: Using the Radiation Therapy Oncology Group (RTOG) da tabase, data were retrospectively analyzed from five RTOG trials studying c hemoradiotherapy for NSCLC: 88-04, 88-08 (chemo-RT arm), 90-15, 91-06, 92-0 4. Comparisons were made between the SNC and SN- subgroups,vith respect to overall survival, progression-free survival (PFS), and metastases-free surv ival (MFS) using the log rank test. Cox multivariate proportional hazards r egression analysis was used to determine the effect of several potential co nfounding variables, including histology (squamous vs. nonsquamous), age (> 60 vs. less than or equal to 60), Karnofsky Performance Status (KPS) (<90 v s. greater than or equal to 90), weight loss (greater than or equal to 5% v s. <5%), and gender. Results: A total of 256 Stage III patients were identified, of whom 47 had supraclavicular nodes (SN+) and 209 did not (SN-). Statistically significan tly more SN+ patients had nonsquamous histology (p = 0.05); otherwise, know n prognostic factors were well balanced. The median survival for SN+ patien ts was 16.2 months, vs. 15.6 months for SN- patients. The 4-year actuarial survival rates were 21% and 16% for SN+ and SN- patients respectively (p = 0.44). There was no statistically significant difference in the 4-year PFS rates (19% vs. 14%,p 0.48). The Cox analysis did not show the presence or a bsence of supraclavicular nodal disease to be a prognostic factor for survi val, MFS, or PFS. The only statistically significant factor on multivariate analysis was gender, with males having a 40% greater risk of mortality tha n females (p = 0.03). There mere no clinically significant differences in t oxicity when comparing SN+ vs. SN- patients. Among the 47 SNC patients, the re were no reported cases of brachial plexopathy or other greater than or e qual to Grade 2 late neurologic toxicity. Conclusions: When treated with modern chemoradiotherapy, the outcome for pa tients with supraclavicular metastases appears to be similar to that of oth er Stage III patients. SN+ patients should continue to be enrolled in trial s studying aggressive chemoradiotherapy regimens for locally advanced NSCLC . (C) 1999 Elsevier Science Inc.