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Vol. 39. Issue 2.
Pages 81-86 (February 2003)
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Vol. 39. Issue 2.
Pages 81-86 (February 2003)
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Carcinoma no microcítico de pulmón. Supervivencia y factores pronósticos del tratamiento radioterápico
Non-small cell lung cancer. Survival after radiotherapy and prognostic factors
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J. Jaén Olasoloa,
Corresponding author
jjaen@hpm.sas.junta-andalucia.es

Correspondencia: Servicio de Oncología Radioterápica. Hospital Universitario Puerta del Mar.Avda. Ana de Viya, 21. 11009 Cádiz. España
, E. Alonso Redondoa, A. León Jiménezb, A. Rueda Ramosc
a Servicio de Oncología Radioterápica. Hospital Universitario Puerta del Mar. Cádiz
b Sección de Neumología. Hospital Universitario Puerta del Mar. Cádiz
c Servicio de Oncología Médica. Hospital Universitario Puerta del Mar. Cádiz. España
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Objetivo

Analizar los resultados de la radioterapia en el carcinoma no microcítico de pulmón y las características clí-nicas y terapéuticas que pueden influir en ellos

Pacientes Y Método

Sobre una base poblacional de 109 pacientes, 87 cumplieron los criterios de inclusión para el es-tudio. Recibieron radioterapia torácica sobre el volumen tu-moral macroscópico y áreas de drenaje linfático, en fraccio-namiento convencional. El 61% recibió, además, tratamiento sistémico con citostáticos

Resultados

La distribución por estadios fue: 33% (28/87) I + II; 20% (18/87) IIIA, y 47% (41/87) IIIB. La do-sis media de radioterapia fue de 66,7 Gy (intervalo de con-fianza [IC] del 95%, 65–67). Consiguió la remisión clínica completa el 22% (18/87), de los cuales la mitad recidivó pos-teriormente; el 26% (21/87) obtuvo una remisión parcial y el 52% (42/87) no respondió. Se encontraron diferencias esta-dísticamente significativas en la supervivencia actuarial, se-gún la estadificación y respuesta tumoral. La mediana de supervivencia para estadios I + II fue de 29 meses (IC del 95%, 19–39); para los IIIA, de 22 meses (IC del 95%, 16–28), y para los IIIB, de 16 meses (IC del 95%, 12,20). Las com-plicaciones más frecuentes fueron las cutáneas, esofágicas y pulmonares, con una baja incidencia de toxicidad grado 3 (inferior al 3%) y ausencia de grado

Conclusiones

No se encontraron diferencias en la super-vivencia según la edad, localización tumoral y tipo histológi-co. El control local de la enfermedad influyó decisivamente en la supervivencia de estos pacientes

Palabras clave:
Cáncer de pulmón
Radioterapia
Quimioterapia
Objective

To analyze the results of radiotherapy for non-small cell lung cancer and identify the clinical and the-rapeutic variables that might influence prognosis

Patients And Methods

In a population base of 109 pa-tients, 87 met the enrollment criteria. The patients received thoracic radiotherapy over the macroscopic tumor volume and lymph drainage areas, using conventional fractions. Systemic cytostatic therapy was also given to 61% of the pa-tients

Results

Staging was as follows: 33% (28/87) I and II, 20% (18/87) IIIA and 47% (41/87) IIIB. The mean radiothe-rapy dose was 66.7 Gy (95% CI, 65–67). Full clinical remis-sion was achieved by 22% (18/87), half of whom later suffe-red recurrences. Partial remission was achieved by 26% (21/87). No response was observed in 52% (42/87). Statistically significant differences in actuarial survival ra-tes were found for staging and tumor response. Mean survi-val for stages I and II was 29 months (95% CI, 19–39), for IIIA it was 22 (95% CI, 16–28) months, and for IIIB 16 months (95% CI, 12–20). The most common complications were cutaneous, esophageal and pulmonary, with a low inci-dence of grade 3 toxicity (less than 3%) and absence of gra-de 4

Conclusions

No differences in survival were observed for age, tumor location or histological type. Local control of the disease decisively influenced patient survival

Keywords:
Lung cancer
Radiotherapy
Chemotherapy
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Bibliografía
[1.]
G. López-Albente, M. Pollan, P. De la Iglesia, M. Ruiz.
Characterization of the lung cancer epidemic in the European Union (1970–1990).
Cancer Epidermiol Biomarkers Prev, 4 (1995), pp. 813-820
[2.]
X. Bonfill, C. Moreno, G. Prada, E. Rivero, M. Rue.
Lung cancer mortality among males of Catalonia and Spain compared with other European countries between 1975–77 and 1987–89.
[3.]
American Cancer Society.
Cancer facts & figures –1997,
[4.]
E.W. Humphrey, C.R. Smart, D.P. Winchester, et al.
National survey of the pattern of care for carcinoma of the lung.
J Thorac Cardiovasc Surg, 100 (1990), pp. 837-843
[5.]
M. Saunders, S. Dische, A. Barrett, A. Harvey, G. Griffiths, M. Palmar.
Continuous, hyperfractionated, accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small cell lung cancer: mature data from the randomised multicentre trial. CHART Steering committee.
Radiother Oncol, 52 (1999), pp. 137-148
[6.]
M. Stuschke, H.D. Thames.
Hyperfractionated radiotherapy of human tumors: overview of the randomised clinical trials.
Int J Radiat Oncol Biol Phys, 37 (1997), pp. 259-267
[7.]
Z. Liao, R. Komaki, C. Stevens, J. Kelly, F. Fossella, J.S. Lee, et al.
Twice daily irradiation increases locoregional control in patients with medically inoperable or surgically unresectable stage II-IIIB non-small-cell lung cancer.
Int J Radiat Oncol Biol Phys, 53 (2002), pp. 558-565
[8.]
Non-small cell Lung Cancer Collaborative Group.
Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials.
Bmj, 311 (1995), pp. 899-909
[9.]
P. Marino, A. Preatoni, A. Cantoni.
Randomized trials of radiotherapy alone versus combined chemotherapy and radiotherapy in stages IIIa and IIIb nonsmall cell lung cancer. A meta-analysis.
Cancer, 76 (1995), pp. 593-601
[10.]
R.S. Pritchard, S.P. Anthony.
Chemotherapy plus radiotherapy compared with radiotherapy alone in the treatment of locally advanced, unresectable, non-small-cell lung cancer. A meta-analysis.
Ann Intern Med, 125 (1996), pp. 723-729
[11.]
C.F. Mountain.
Revisions in the International System for Staging Lung Cancer.
Chest, 111 (1997), pp. 1710-1717
[12.]
Lung.
American Joint Committee on Cancer, editor. AJCC cancer staging manual, 5th ed, pp. 127-137
[13.]
Grupo de Trabajo de la SEPAR.
Normativa actualizada (1998) sobre diagnóstico y estadificación del carcinoma broncogénico.
Arch Bronconeumol, 34 (1998), pp. 437-452
[14.]
D.A. Karnofsky, J.H. Buchenal.
Clinical evaluation of chemotherapeutic agents in cancer.
Evaluation of chemotherapeutic agents, pp. 191-205
[15.]
C.G. Zubrod, M. Schneiderman, E. Frei.
Appraisal of methods for the study of chemotherapy of cancer in man: comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide.
J Chron Dis, 11 (1960), pp. 7-33
[16.]
A. Cordiner, F. De Carlo, R. De Gennaro, et al.
Prediction of postoperative pulmonary function following thoracic surgery for bronchial carcinoma.
Angiology, 42 (1991), pp. 985-989
[17.]
R.J. Pierce, J.M. Copland, K. Sharpe, C.E. Barter.
Preoperative risk evaluation for lung cancer resection: predicted postoperative product as a predictor of surgical mortality.
Am J Respir Crit Care Med, 150 (1994), pp. 947-955
[18.]
Giordano, M.L. Calgagni, G. Meduri, et al.
Perfusion lung scintigraphy for the prediction of postlobectomy residual pulmonary function.
Chest, 111 (1997), pp. 1542-1547
[19.]
M.V. M Graham, J.A. Purdy, B. Emami, W. Harms, W. Bosch, M.A. Lockett, et al.
Clinical dose-volume histogram analysis for pneumonitis after 3D treatment for non-small cell lung cancer (NSCLC).
Int J Radiat Oncol Biol Phys, 45 (1999), pp. 323-329
[20.]
M.L. Hernando, L.B. Marks, G.C. Bentel, et al.
Radiation-induced pulmonary toxicity: a dose-volume histogram analysis in 201 patients with lung cancer.
Int J Radiat Oncol Biol Phys, 51 (2001), pp. 650-659
[21.]
C.A. Pérez, L.W. Brady.
Overview.
Principles and practice of radiation oncology, pp. 1-63
[22.]
P. Therasse, S.G. Arbuck, E.A. Eisenhauer, et al.
New guidelines to evaluate the response to treatment in solid tumors.
J Natl Cancer Inst, 92 (2000), pp. 205-216
[23.]
E.L. Kaplan, P. Meier.
Nonparametric estimation from incomplete observations.
J Amer Statist Assoc, 55 (1958), pp. 457-481
[24.]
N. Breslow.
A generalized Kruskal-Wallis test for comparing k samples subject to unequal patterns of censorship.
Biometrika, 57 (1970), pp. 579-594
[25.]
N. Mantel.
Evaluation of survival data and two new rank order statistics arising in its consideration.
Cancer Chemotherapy Reports, 50 (1966), pp. 163-170
[26.]
D.R. Cox.
Regression models and life tables.
J Roy Statist Soc, 34 (1972), pp. 187-220
[27.]
N. Martini.
Surgical treatment of non-small cell lung cancer by stage.
Semin Surg Oncol, 6 (1990), pp. 248-254
[28.]
T. Naruke, T. Goya, R. Tsuchiya, K. Suemasu.
Prognosis and survival in resected lung carcinoma based on the new international staging system.
J Thorac Cardiovasc Surg, 96 (1988), pp. 440-447
[29.]
M. García-Yuste, J.M. Matilla, J.L. Duque, F. Heras, L.J. Cerezal, G. Ramos.
Tratamiento quirúrgico del cáncer de pulmón: evaluación comparativa de los sistemas de estadificación de 1986 y 1997. Resultados en 500 pacientes consecutivos.
Arch Bronconeumol, 36 (2000), pp. 245-250
[30.]
V. Calvo, J. Padilla, F. París, E. Blasco, J. Pastor, A. García.
Supervivencia posquirúrgica en el estadio II del carcinoma broncogénico no anaplásico de células pequeñas.
Arch Bronconeumol, 37 (2001), pp. 19-26
[31.]
F.A. Lederle, D.E. Niewoehner.
Lung cancer surgery. A critical review of the evidence.
Arch Intern Med, 154 (1994), pp. 2397-2400
[32.]
R. Morrison, T.J. Deeley, W.P. Cleland.
The treatment of carcinoma of the bronchus: a clinical trial to compare surgery and supervoltage radiotherapy.
Lancet, 1 (1963), pp. 683-684
[33.]
R.O. Dillman, J. Herndon, S.L. Seagren, W.L. Eaton, M.R. Green.
Improved survival in stage III non-small-cell lung cancer: sevenyear follow-up of cancer and leukemia group B (CALGB) 8433 trial.
J Natl Cancer Inst, 88 (1996), pp. 1210-1215
[34.]
W. Sause, P. Kolesar, S. Taylor, et al.
Final results of phase III trial in regionally advanced unresectable non-small cell lung cancer: Radiation Therapy Oncology Group, Eastern Cooperative Oncology Group, and Southwest Oncology Group.
Chest, 117 (2000), pp. 358-364
[35.]
B. Jeremic, J. Classen, M. Bamberg.
Radiotherapy alone in technically operable, medically inoperable, early-stage (I/II) non-smallcell lung cancer.
Int J Radiat Oncol Biol Phys, 54 (2002), pp. 119-130
[36.]
K.S. Albain, J.J. Crowley, I.I.I. Turrisi AT, D.R. Gandara, W.B. Farrar, J.I. Clark, et al.
Concurrent cisplatin, etoposide, and chest radiotherapy in pathologic stage IIIB non-small-cell lung cancer: a Southwest Oncology Group Phase II study, SWOG 9019.
J Clin Oncol, 20 (2002), pp. 3454-3460
[37.]
F. Robert, S.A. Spencer, H.A. Childs, R. Zhang, R.F. Meredith, R.H. Wheeler, et al.
Concurrent chemoradiation therapy with cisplatin and paclitaxel for locally advanced non-small cell lung cancer: long-term follow-up of a phase I trial.
Lung Cancer, 37 (2002), pp. 189-199
[38.]
R. Komaki, W. Seiferheld, D. Ettinger, J.S. Lee, B. Movsas, W. Sause.
Randomized phase II chemotherapy and radiotherapy trial for patients with locally advanced inoperable non-small-cell lung cancer: long-term follow-up of RTOG 92–04.
Int J Radiat Oncol Biol Phys, 53 (2002), pp. 548-557
[39.]
T.Y. Kim, S.H. Yang, S.H. Lee, Y.S. Park, Y.H. Im, W.K. Kang, et al.
A phase III randomized trial of combined chemoradiotherapy versus radiotherapy alone in locally advanced non-small-cell lung cancer.
Am J Clin Oncol, 25 (2002), pp. 238-243
[40.]
J. Aisner, H.H. Hansen.
Commentary: current status of chemotherapy for non-small cell lung cancer.
Cancer Treat Rep, 65 (1986), pp. 979-986
[41.]
M. Werner-Wasik, Y. Xiao, E. Pequignot, W.J. Curran, W. Hauck.
Assessment of lung cancer response after nonoperative therapy: tumor diameter, bidimensional product, and volume. A serial CT scan-based study.
Int J Radiat Oncol Biol Phys, 51 (2001), pp. 56-61
[42.]
Ball DL, Smith J, Wirth A, Mac Manus MP. Failure of stage to predict survival in patients with non-small cell lung cancer treated by radiotherapy with or without concomitant chemotherapy. Actas de 43rd Annual Meeting of the American Society for Therapeutic
Copyright © 2003. Sociedad Española de Neumología y Cirugía Torácica
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