title: Timing of local and distant failure in resected lung cancer: implications for reported rates of local failure.
abstract: BACKGROUND
  Most adjuvant lung cancer trials only report first sites of failure. The relative timing of local (i.e., local/regional) versus distant recurrence after surgery could potentially affect reported rates of local failure. We assessed this phenomenon in a large group of patients undergoing surgery for early-stage lung cancer.
  
  
  METHODS
  This institutional review board-approved retrospective study identified all patients who underwent surgery at Duke University Medical Center for pathologic stages I to II non-small cell lung cancer between 1995 and 2005. Medical records and pertinent radiographs were reviewed to assess for local and distant sites of recurrence. Both first and subsequent failures were examined. The time interval between surgery and date of local and/or distant failure was compared using the Mann-Whitney U test.
  
  
  RESULTS
  Of 975 patients undergoing surgery, 250 patients developed recurrent disease (43 local only, 110 distant only, and 97 both). The median time from surgery to local failure was 13.9 months (range, 1-79). The median time to distant failure was 12.5 months (range, 1-79 months). These were not significantly different (p = 0.34). Among 97 patients who experienced both local and distant failure, 72 (74%) failed at both sites simultaneously, 19 (20%) failed at local sites first, and 6 (6%) failed at distant sites first.
  
  
  CONCLUSIONS
  The time interval from surgery to either local or distant failure is not significantly different. Patterns of failure analyses in which only first sites of failure are scored will underestimate the frequency of local recurrence. Nevertheless, the magnitude of this error is expected to be small.
authors.affiliation: Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Jessamy A
authors.initials: JA
authors.lastname: Boyd
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Hubbs
authors.forename: Dong W
authors.initials: DW
authors.lastname: Kim
authors.forename: Donna
authors.initials: D
authors.lastname: Hollis
authors.forename: Lawrence B
authors.initials: LB
authors.lastname: Marks
authors.forename: Chris R
authors.initials: CR
authors.lastname: Kelsey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome