title: Poor prognosis patients with inoperable locally advanced NSCLC and large tumors benefit from palliative chemoradiotherapy: a subset analysis from a randomized clinical phase III trial.
abstract: BACKGROUND
  Poor prognosis patients with bulky stage III locally advanced non-small-cell lung cancer may not be offered concurrent chemoradiotherapy (CRT). Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients, this analysis was performed to explore how tumor size influenced survival and health-related quality of life (HRQOL).
  
  
  METHODS
  A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8, at 3-week intervals. The experimental arm (N = 94) received radiotherapy with fractionation 42 Gy/15, starting at the second chemotherapy course. This subset study compares outcomes in patients with tumors larger than 7 cm (N = 108) versus tumors 7 cm or smaller (N = 76).
  
  
  RESULTS
  Among those with tumors larger than 7 cm, the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months, respectively (p = 0.001). The 1-year survival was 33% and 56%, respectively (p = 0.01). Except for a temporary decline during treatment, HRQOL was maintained in the CRT arm, regardless of tumor size. Among those who did not receive CRT, patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL. The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size.
  
  
  CONCLUSIONS
  In patients with poor prognosis and inoperable locally advanced non-small-cell lung cancer, large tumor size should not be considered a negative predictive factor. Except for performance status 2, patients with tumors larger than 7 cm apparently benefit from CRT.
authors.affiliation: *Department of Medicine, Helgeland Hospital, Sandnessjøen, Norway; †Department of Clinical Medicine, University of Tromsø, Tromsø, Norway; ‡Department of Oncology, University Hospital of North Norway, Tromsø, Norway; §The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway; and ‖Department of Pulmonary Medicine, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Hans H
authors.initials: HH
authors.lastname: Strøm
authors.forename: Roy M
authors.initials: RM
authors.lastname: Bremnes
authors.forename: Stein H
authors.initials: SH
authors.lastname: Sundstrøm
authors.forename: Nina
authors.initials: N
authors.lastname: Helbekkmo
authors.forename: Ulf
authors.initials: U
authors.lastname: Aasebø
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D019583:Dose Fractionation, Radiation; D004941:Esophagitis / Q000209:etiology; D005260:Female; D006760:Hospitalization; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D010166:Palliative Care; D011379:Prognosis; D011788:Quality of Life; D015996:Survival Rate; D047368:Tumor Burden; D014747:Vinblastine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077235:Vinorelbine
chemical_list: D014747:Vinblastine; D016190:Carboplatin; D000077235:Vinorelbine