The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma
Purpose Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall...
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| creator | Higginson, Daniel S., MD Chen, Ronald C., MD, MPH Tracton, Gregg, BSE Morris, David E., MD Halle, Jan, MD Rosenman, Julian G., MD Stefanescu, Mihaela Pham, Erica Socinski, Mark A., MD Marks, Lawrence B., MD |
| description | Purpose Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation ( P =.0046), total volume of intrathoracic disease ( P =.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography ( P |
| doi_str_mv | 10.1016/j.ijrobp.2012.04.045 |
| format | Article |
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A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation ( P =.0046), total volume of intrathoracic disease ( P =.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography ( P <.0001). When partitioned into central and peripheral volumes, central ( P <.0001) but not peripheral ( P =.74) disease was associated with worse survival. On multivariate analysis with known factors, pulmonary symptoms (hazard ratio, 1.46; P =.042), central disease volume (hazard ratio, 1.47; P =.042), and bronchial/vascular compression (hazard ratio, 1.54; P =.022) remained significant. Conclusions Patients with bulky central disease, bronchial/vascular compression, and/or pulmonary symptoms exhibited worse overall survival after first-line, platinum-based chemotherapy. A subset of these patients may be studied to determine whether early, planned palliative thoracic radiation could also be of benefit.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2012.04.045</identifier><identifier>PMID: 22857887</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Analysis of Variance ; Antibodies, Monoclonal, Humanized - therapeutic use ; Antineoplastic Agents - therapeutic use ; Bevacizumab ; BRONCHI ; Carboplatin - therapeutic use ; Carcinoma, Non-Small-Cell Lung - diagnostic imaging ; Carcinoma, Non-Small-Cell Lung - drug therapy ; Carcinoma, Non-Small-Cell Lung - mortality ; Carcinoma, Non-Small-Cell Lung - pathology ; CARCINOMAS ; CHEMOTHERAPY ; CHEST ; CLINICAL TRIALS ; Clinical Trials, Phase II as Topic ; Clinical Trials, Phase III as Topic ; COMPRESSION ; COMPUTERIZED TOMOGRAPHY ; DEATH ; DIAGNOSIS ; Erlotinib Hydrochloride ; Female ; HEALTH HAZARDS ; Hematology, Oncology and Palliative Medicine ; Humans ; Lung Neoplasms - diagnostic imaging ; Lung Neoplasms - drug therapy ; Lung Neoplasms - mortality ; Lung Neoplasms - pathology ; LUNGS ; Male ; Middle Aged ; MULTIVARIATE ANALYSIS ; PATIENTS ; PLATINUM COMPLEXES ; Prospective Studies ; Quinazolines - therapeutic use ; Radiography ; Radiology ; RADIOLOGY AND NUCLEAR MEDICINE ; RADIOTHERAPY ; SYMPTOMS ; Tumor Burden</subject><ispartof>International journal of radiation oncology, biology, physics, 2012-11, Vol.84 (3), p.e385-e392</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-b8bc2100ba1a61a773e30739be87ca97752ff57f921c6e968ac05078eb6f7a043</citedby><cites>FETCH-LOGICAL-c445t-b8bc2100ba1a61a773e30739be87ca97752ff57f921c6e968ac05078eb6f7a043</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0360301612006426$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,776,780,881,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22857887$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://www.osti.gov/biblio/22149599$$D View this record in Osti.gov$$Hfree_for_read</backlink></links><search><creatorcontrib>Higginson, Daniel S., MD</creatorcontrib><creatorcontrib>Chen, Ronald C., MD, MPH</creatorcontrib><creatorcontrib>Tracton, Gregg, BSE</creatorcontrib><creatorcontrib>Morris, David E., MD</creatorcontrib><creatorcontrib>Halle, Jan, MD</creatorcontrib><creatorcontrib>Rosenman, Julian G., MD</creatorcontrib><creatorcontrib>Stefanescu, Mihaela</creatorcontrib><creatorcontrib>Pham, Erica</creatorcontrib><creatorcontrib>Socinski, Mark A., MD</creatorcontrib><creatorcontrib>Marks, Lawrence B., MD</creatorcontrib><title>The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Purpose Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation ( P =.0046), total volume of intrathoracic disease ( P =.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography ( P <.0001). When partitioned into central and peripheral volumes, central ( P <.0001) but not peripheral ( P =.74) disease was associated with worse survival. On multivariate analysis with known factors, pulmonary symptoms (hazard ratio, 1.46; P =.042), central disease volume (hazard ratio, 1.47; P =.042), and bronchial/vascular compression (hazard ratio, 1.54; P =.022) remained significant. Conclusions Patients with bulky central disease, bronchial/vascular compression, and/or pulmonary symptoms exhibited worse overall survival after first-line, platinum-based chemotherapy. A subset of these patients may be studied to determine whether early, planned palliative thoracic radiation could also be of benefit.</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Analysis of Variance</subject><subject>Antibodies, Monoclonal, Humanized - therapeutic use</subject><subject>Antineoplastic Agents - therapeutic use</subject><subject>Bevacizumab</subject><subject>BRONCHI</subject><subject>Carboplatin - therapeutic use</subject><subject>Carcinoma, Non-Small-Cell Lung - diagnostic imaging</subject><subject>Carcinoma, Non-Small-Cell Lung - drug therapy</subject><subject>Carcinoma, Non-Small-Cell Lung - mortality</subject><subject>Carcinoma, Non-Small-Cell Lung - pathology</subject><subject>CARCINOMAS</subject><subject>CHEMOTHERAPY</subject><subject>CHEST</subject><subject>CLINICAL TRIALS</subject><subject>Clinical Trials, Phase II as Topic</subject><subject>Clinical Trials, Phase III as Topic</subject><subject>COMPRESSION</subject><subject>COMPUTERIZED TOMOGRAPHY</subject><subject>DEATH</subject><subject>DIAGNOSIS</subject><subject>Erlotinib Hydrochloride</subject><subject>Female</subject><subject>HEALTH HAZARDS</subject><subject>Hematology, Oncology and Palliative Medicine</subject><subject>Humans</subject><subject>Lung Neoplasms - diagnostic imaging</subject><subject>Lung Neoplasms - drug therapy</subject><subject>Lung Neoplasms - mortality</subject><subject>Lung Neoplasms - pathology</subject><subject>LUNGS</subject><subject>Male</subject><subject>Middle Aged</subject><subject>MULTIVARIATE ANALYSIS</subject><subject>PATIENTS</subject><subject>PLATINUM COMPLEXES</subject><subject>Prospective Studies</subject><subject>Quinazolines - therapeutic use</subject><subject>Radiography</subject><subject>Radiology</subject><subject>RADIOLOGY AND NUCLEAR MEDICINE</subject><subject>RADIOTHERAPY</subject><subject>SYMPTOMS</subject><subject>Tumor Burden</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFks9u1DAQxi0EokvhDRCyxIVLtraT2MkFqV0KRFpRxJY_N8txJrsOG3uxk4g-Am-NoxQOXJAsW5Z_38x4vkHoOSVrSii_6Nam864-rRmhbE2yuPIHaEULUSZpnn97iFYk5SRJI3yGnoTQEUIoFdljdMZYkYuiECv06_YAuOpPSg_YtXjrtDpiZRv8CfbG2Xh5YwKoAPj65wA2QhbfTODV8Yh3o5_MFBFj8Uc1mPgc8FczHPBlMymrocG7Qe1j_Kq6uqi-4A_OJrt-lm4gbtvR7vFGeW2s69VT9KhVxwDP7s9z9Pnt9e3mfbK9eVdtLreJzrJ8SOqi1owSUiuqOFVCpJASkZY1FEKrUoictW0u2pJRzaHkhdIkJ6KAmrdCkSw9Ry-XuC4MRgZtBtAH7awFPUjGaFbmZRmpVwt18u7HCGGQvQk6Vq0suDFISkQmOONFHtFsQbV3IXho5cmbXvm7CMnZKtnJxSo5WyVJFtcse3GfYax7aP6K_ngTgdcLALEbkwE_FwtzW42fa22c-V-GfwPoo7EmOvwd7iB0bvTR4PgXGaJG7uZxmaeFMkJ4xnj6GzmfuiM</recordid><startdate>20121101</startdate><enddate>20121101</enddate><creator>Higginson, Daniel S., MD</creator><creator>Chen, Ronald C., MD, MPH</creator><creator>Tracton, Gregg, BSE</creator><creator>Morris, David E., MD</creator><creator>Halle, Jan, MD</creator><creator>Rosenman, Julian G., MD</creator><creator>Stefanescu, Mihaela</creator><creator>Pham, Erica</creator><creator>Socinski, Mark A., MD</creator><creator>Marks, Lawrence B., MD</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>OTOTI</scope></search><sort><creationdate>20121101</creationdate><title>The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma</title><author>Higginson, Daniel S., MD ; Chen, Ronald C., MD, MPH ; Tracton, Gregg, BSE ; Morris, David E., MD ; Halle, Jan, MD ; Rosenman, Julian G., MD ; Stefanescu, Mihaela ; Pham, Erica ; Socinski, Mark A., MD ; Marks, Lawrence B., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-b8bc2100ba1a61a773e30739be87ca97752ff57f921c6e968ac05078eb6f7a043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Analysis of Variance</topic><topic>Antibodies, Monoclonal, Humanized - therapeutic use</topic><topic>Antineoplastic Agents - therapeutic use</topic><topic>Bevacizumab</topic><topic>BRONCHI</topic><topic>Carboplatin - therapeutic use</topic><topic>Carcinoma, Non-Small-Cell Lung - diagnostic imaging</topic><topic>Carcinoma, Non-Small-Cell Lung - drug therapy</topic><topic>Carcinoma, Non-Small-Cell Lung - mortality</topic><topic>Carcinoma, Non-Small-Cell Lung - pathology</topic><topic>CARCINOMAS</topic><topic>CHEMOTHERAPY</topic><topic>CHEST</topic><topic>CLINICAL TRIALS</topic><topic>Clinical Trials, Phase II as Topic</topic><topic>Clinical Trials, Phase III as Topic</topic><topic>COMPRESSION</topic><topic>COMPUTERIZED TOMOGRAPHY</topic><topic>DEATH</topic><topic>DIAGNOSIS</topic><topic>Erlotinib Hydrochloride</topic><topic>Female</topic><topic>HEALTH HAZARDS</topic><topic>Hematology, Oncology and Palliative Medicine</topic><topic>Humans</topic><topic>Lung Neoplasms - diagnostic imaging</topic><topic>Lung Neoplasms - drug therapy</topic><topic>Lung Neoplasms - mortality</topic><topic>Lung Neoplasms - pathology</topic><topic>LUNGS</topic><topic>Male</topic><topic>Middle Aged</topic><topic>MULTIVARIATE ANALYSIS</topic><topic>PATIENTS</topic><topic>PLATINUM COMPLEXES</topic><topic>Prospective Studies</topic><topic>Quinazolines - therapeutic use</topic><topic>Radiography</topic><topic>Radiology</topic><topic>RADIOLOGY AND NUCLEAR MEDICINE</topic><topic>RADIOTHERAPY</topic><topic>SYMPTOMS</topic><topic>Tumor Burden</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Higginson, Daniel S., MD</creatorcontrib><creatorcontrib>Chen, Ronald C., MD, MPH</creatorcontrib><creatorcontrib>Tracton, Gregg, BSE</creatorcontrib><creatorcontrib>Morris, David E., MD</creatorcontrib><creatorcontrib>Halle, Jan, MD</creatorcontrib><creatorcontrib>Rosenman, Julian G., MD</creatorcontrib><creatorcontrib>Stefanescu, Mihaela</creatorcontrib><creatorcontrib>Pham, Erica</creatorcontrib><creatorcontrib>Socinski, Mark A., MD</creatorcontrib><creatorcontrib>Marks, Lawrence B., MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>OSTI.GOV</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Higginson, Daniel S., MD</au><au>Chen, Ronald C., MD, MPH</au><au>Tracton, Gregg, BSE</au><au>Morris, David E., MD</au><au>Halle, Jan, MD</au><au>Rosenman, Julian G., MD</au><au>Stefanescu, Mihaela</au><au>Pham, Erica</au><au>Socinski, Mark A., MD</au><au>Marks, Lawrence B., MD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2012-11-01</date><risdate>2012</risdate><volume>84</volume><issue>3</issue><spage>e385</spage><epage>e392</epage><pages>e385-e392</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Purpose Patients with advanced stage IIIB or stage IV non-small cell lung carcinoma are typically treated with initial platinum-based chemotherapy. A variety of factors (eg, performance status, gender, age, histology, weight loss, and smoking history) are generally accepted as predictors of overall survival. Because uncontrolled pulmonary disease constitutes a major cause of death in these patients, we hypothesized that clinical and radiographic factors related to intrathoracic disease at diagnosis may be prognostically significant in addition to conventional factors. The results have implications regarding the selection of patients for whom palliative thoracic radiation therapy may be of most benefit. Methods and Materials We conducted a pooled analysis of 189 patients enrolled at a single institution into 9 prospective phase II and III clinical trials involving first-line, platinum-based chemotherapy. Baseline clinical and radiographic characteristics before trial enrollment were analyzed as possible predictors for subsequent overall survival. To assess the relationship between anatomic location and volume of disease within the thorax and its effect on survival, the pre-enrollment computed tomography images were also analyzed by contouring central and peripheral intrapulmonary disease. Results On univariate survival analysis, multiple pulmonary-related factors were significantly associated with worse overall survival, including pulmonary symptoms at presentation ( P =.0046), total volume of intrathoracic disease ( P =.0006), and evidence of obstruction of major bronchi or vessels on prechemotherapy computed tomography ( P <.0001). When partitioned into central and peripheral volumes, central ( P <.0001) but not peripheral ( P =.74) disease was associated with worse survival. On multivariate analysis with known factors, pulmonary symptoms (hazard ratio, 1.46; P =.042), central disease volume (hazard ratio, 1.47; P =.042), and bronchial/vascular compression (hazard ratio, 1.54; P =.022) remained significant. Conclusions Patients with bulky central disease, bronchial/vascular compression, and/or pulmonary symptoms exhibited worse overall survival after first-line, platinum-based chemotherapy. A subset of these patients may be studied to determine whether early, planned palliative thoracic radiation could also be of benefit.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>22857887</pmid><doi>10.1016/j.ijrobp.2012.04.045</doi></addata></record> |
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| ispartof | International journal of radiation oncology, biology, physics, 2012-11, Vol.84 (3), p.e385-e392 |
| issn | 0360-3016 1879-355X |
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| subjects | Adult Aged Aged, 80 and over Analysis of Variance Antibodies, Monoclonal, Humanized - therapeutic use Antineoplastic Agents - therapeutic use Bevacizumab BRONCHI Carboplatin - therapeutic use Carcinoma, Non-Small-Cell Lung - diagnostic imaging Carcinoma, Non-Small-Cell Lung - drug therapy Carcinoma, Non-Small-Cell Lung - mortality Carcinoma, Non-Small-Cell Lung - pathology CARCINOMAS CHEMOTHERAPY CHEST CLINICAL TRIALS Clinical Trials, Phase II as Topic Clinical Trials, Phase III as Topic COMPRESSION COMPUTERIZED TOMOGRAPHY DEATH DIAGNOSIS Erlotinib Hydrochloride Female HEALTH HAZARDS Hematology, Oncology and Palliative Medicine Humans Lung Neoplasms - diagnostic imaging Lung Neoplasms - drug therapy Lung Neoplasms - mortality Lung Neoplasms - pathology LUNGS Male Middle Aged MULTIVARIATE ANALYSIS PATIENTS PLATINUM COMPLEXES Prospective Studies Quinazolines - therapeutic use Radiography Radiology RADIOLOGY AND NUCLEAR MEDICINE RADIOTHERAPY SYMPTOMS Tumor Burden |
| title | The Impact of Local and Regional Disease Extent on Overall Survival in Patients With Advanced Stage IIIB/IV Non-Small Cell Lung Carcinoma |
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