Characteristics of 49 patients who survived for 5 years following radical radiation therapy for non-small cell lung cancer: The potential for cure

Purpose: To investigate the long-term curative potential of radical radiati on therapy (RT) for non-small cell lung cancer (NSCLC) by studying characte ristics of patients from a large prospective database who survived > 5 year s after RT, and by analyzing survival beyond 5 years. Methods and Materials: Five-year survivors were identified from a database containing information on 488 patients given radical RT following presentat ion to the Peter MacCallum Cancer Institute with NSCLC between 1984 and 199 0, Additional data were obtained from case notes of survivors. RT was compu ted tomography (CT)-planned, conventionally-fractionated, and given without chemotherapy. Results: Actuarial survival for 49 5-year survivors was 65% at 10 years. Fi ve 5-year survivors had documented disease progression within the first 5 y ears and subsequently died. Of 44 patients free-from-progression (FFP) at 5 years, an estimated 81% remained FFP in the second 5 years. Age and histol ogy were not significant prognostic factors, and only 22 patients (4.5%) ha d weight loss > 10%, For 277 patients who had not undergone thoracotomy, me dian RT dose was 60 Gy and survival at 5 and 10 years was 7% and 3%, respec tively. For 207 patients who received radical RT post-thoracotomy, median d ose was 60 Gy and survival at 5 and 10 years was 24% and 18%, respectively. Five-year survivors of post-thoracotomy RT had been treated for gross resi dual disease (n = 10), positive-margin (n = 6), or probable microscopic res idual disease (n = 17), Failure to regain ECOG performance status = 0 post- thoracotomy was associated with reduced survival (p < 0.0012). FFP in the s econd 5 years was superior for patients who had postoperative radiotherapy (90%) compared to patients without thoracotomy (62%,p = 0.008), Conclusion: Most patients FFP > 5 years after radical RT for NSCLC remained FFP in the following 5 years and were apparently cured. RT alone can cure small but significant numbers of patients. Long-term results of combined ch emotherapy/RT protocols, which are associated with increased median surviva l, are awaited for comparison. (C) 2000 Elsevier Science Inc.