Failure-specific prognostic factors after continuous hyperfractionated accelerated radiotherapy (CHART) or conventional radiotherapy in locally advanced nonsmall-cell lung cancer: A competing risks analysis

The aim of this study was to identify possible failure-specific prognostic factors in non-small-cell lung cancer. Clinical outcome was analysed in 549 patients participating in the randomized controlled trial of CHART vs conv entional radiotherapy. Local failure and distant failure with or without co ncurrent local relapse were subjected to a competing risk analysis using an accelerated failure-time model with a log-logistic hazard function. Random ization to CHART (2P = 0.005), increasing age (2P = 0.036) and female sex ( 2P = 0.09) was all associated with a prolonged interval to failure. Advance d clinical stage was associated with a decreased interval to failure (2P = 0.004) and a significantly increased risk (2P = 0.009) of failing in distan t rather than in local position. From this model, prognostic indices for lo cal and distant failure were estimated for each individual patient. Competi ng risk analysis allows identification of patients with different failure p atterns, and may provide a means of stratifying patients for intensified lo cal or systemic therapy. (C) 2001 Cancer Research Campaign.