Vol. 5, Issue 1, Part A (2023)

Introduction: Lung cancer in India is the second most commonly diagnosed cancer in men. For NSCLC, even with discovery of modern techniques to deliver high dose radiotherapy and various targeted agents for advanced disease, the overall prognosis is dismal. Various prognostic factors have been reported in literature, however, due to their heterogeneity, these may not be directly applied in clinical practice. We undertook this study to understand the impact of various prognostic factors on survival in our study population.
Materials and Methods: 60 patients with locally advanced non-small cell lung carcinoma underwent concurrent chemo radiation to a total dose of 60 Gy. Prognostic factors like age, tumor volume, KPS, Pulmonary function, TNM stage, pre-treatment haemoglobin were assessed for their impact on PFS using univariate analysis, Kaplan meier and log rank test. The toxicity data was collected weekly during treatment, 6 weeks after treatment and then 3 monthly during follow up.
Results: At the end of treatment, 10 patients had complete response, 25 had partial response and 25 had stable disease. KPS>70, T₁-T₂ primary, N0-N1 nodal status and tumor volume of <=120 cc were good prognostic factors with median PFS benefit of 8, 4, 2 and 3 months respectively. Patients with decrease in FEV1/FVC ratio of >4% had significantly higher grade 3-4 radiation pneumonitis compared to patients who had <=4% change in FEV1/FVC ratio (42.86% vs. 8.82%, p 0.006). Overall, 20% patients had grade 3-4 radiation pneumonitis.
Conclusion: In the locally advanced non-small cell lung cancer the prognostic criteria affecting progression free survival were gross tumor volume, Karnofsky performance status, tumor size and stage of the disease. These results underline once again that importance of careful staging and necessity of concurrent chemotherapy in eligible patients.