Prognostic Factors Affecting the Overall Survival and Disease-Free Survival in Carcinoma Lung Patients Treated with Sequential Chemoradiation and Concurrent Chemoradiation: A Retrospective Study
DOI:
https://doi.org/10.30683/1927-7229.2025.14.02Keywords:
Lung cancer, Prognostic factors, Overall survival, Diseases free survival, Concurrent CTRT, Definitive CTRTAbstract
Introduction: Lung cancer is the most commonly occurring cancer worldwide accounting for 12.4% of total new cases and also the leading cause of cancer deaths (18.7%). In India, Lung cancer accounts for 5.8% of new cases and 8.2% of cancer deaths. Chemotherapy and Radiation therapy plays a major role in treatment especially in inoperable cases. In this study we evaluated the factors which could affect the Overall Survival (OS) and Disease -Free Survival (DFS) in patients with Lung carcinoma treated by Sequential Chemoradiation (CTRT) and Concurrent CTRT.
Materials and Method: A retrospective review was carried out on 38 patients with Lung carcinoma who were treated with either Concurrent or Sequential CTRT at our institute. Various factors like age, gender, habits, disease laterality, histology, group stage, treatment received and radiation dose were evaluated. Results were analysed using IBM SPSS Statistics version 25 and Kaplan-Meier curves.
Results: Median age of patients was 65 years. The majority were men (89.4 %) and smokers (57.8%). Adenocarcinoma (63.2%) was the most common histological type followed by Squamous cell (18.4%) and Small cell carcinoma (18.4%). Majority were left-sided tumors (52.6%). Most common stage was IIIA (44.7%) followed by IIIB (39.5%). Most of the patients were treated with Sequential CTRT (78.9%) and the rest with Concurrent CTRT (21.1%). The mean radiation dose used was 61.82Gy (Range: 45Gy-66Gy). The 2-year OS and DFS in all patients was 21% and 18.4% respectively and the 5-year OS and DFS was 13.1% and 10.5% respectively. OS and DFS was better in patients diagnosed at young age (36-45 years), females, non-smokers, Adenocarcinoma histology, left-sidedtumors, stage IIIA and treated with Sequential CTRT but was not statistically significant except for Stage IIIA (p=0.007) and left-sidedtumors (p=0.029) which had significantly better OS and DFS respectively.
Conclusion: Young age, females, non-smokers, left-sided tumors, Adenocarcinoma histology are favorable prognostic factors for OS and DFS in Lung cancer patients. Left-sided tumors also had a better statistically significant DFS.
References
Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: Epidemiology, etiology, and prevention. Clin Chest Med 2011; 32(4): 605-44.
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2024; 74(3): 229-263.
Who.int. Available from: https://gco.iarc.who.int/media/ globocan/factsheets/populations/356-india-fact-sheet.pdf.
Garg P, Singhal S, Kulkarni P, Horne D, Malhotra J, Salgia R, et al. Advances in non -small lung cancer: Current insights and future directions. J Clin Med 2024; 13(14): 4189.
Van Laar M, van Amsterdam WAC, van Lindert ASR, de Jong PA, Verhoeff JJC. Prognostic factors for overall survival of stage III non-Small cellLung cancer patients on computed tomography: A systematic review and meta-analysis. Radiother Oncol 2020; 151: 152-175.
National cancer institute (Gov). Cancer.gov.2011. Available from: https://www.cancer.gov/publications/dictionaries/ cancer-terms/def/overall-survival.
Andriani R, Rosewitasari J, Hanif MA, Mulawarman A, Kurniawati SA, Fachri A. Factors affecting 2-year survival in patients with non-small cell lung cancer brain metastases: Evidence from Indonesia’s national cancer center, Jakarta, Indonesia. Clin Med Insights Oncol 2023; 17.
Zahed H, Feng X, Sheikh M, Bray F, Ferlay J, Ginsburg O, et al. Age at diagnosis for Lung, colon, breast and prostate cancers: An international comparative study. Int J of Cancer 2024; 154(1): 28-40.
Akcay O, Kaya S, Ceylan K. Does age have an impact on lung cancer survival? Eurasian J Pulmonol 2018; 20(3): 162.
Tas F, Ciftci R, Kilic L, Karabulut S. Age is a prognostic factor affecting survival in Lung cancer patients. Oncol Lett 2013; 6(5): 1507-13.
Chen T, Zhou F, Jiang W, Mao R, Zheng H, Qin L, et al. Age at diagnosis is a heterogeneous factor for non-Small cellLung cancer patients. J Thorac Dis 2019; 11(6): 2251-2266.
Yu XQ, Yap ML, Cheng ES, Ngo PJ, Vaneckova P, Karikios D, et al. Evaluating prognostic factors for sex differences in Lung cancer survival: Findings from a large Australian cohort. J Thorac Oncol 2022; 17(5): 688-699.
Islam MR, Siddiqua SM, Rabbani G, Ayub SBA, Islam R, Saha B, et al. Exploring sex difference in the risk factors and prognosis of inoperable lung cancer. Cancer Treat Res Commun 2024; 41: 100848.
Pinto JA, Vallejos CS, Raez LE, Mas LA, Ruiz R, Torres-Roman JS, et al. Gender and outcomes in non-Small cellLung cancer: an old prognostic variable comes back for targeted therapy and immunotherapy? ESMO Open 2018; 3(3): e000344.
Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. The Prognostic Impact of Cigarette Smoking on Patients with Non-Small cell Lung Cancer. J Thorac Oncol 2011; 6(4): 735-42.
Zou K, Sun P, Huang H, Zhuo H, Qie R, Xie Y, et al. Etiology of lung cancer: Evidence from epidemiologic studies. J Natl Cancer Cent 2022; 2(4): 216-225.
Ban WH, Yeo CD, Han S, Kang HS, Park CK, Kim JS, et al. Impact of smoking amount on clinicopathological features and survival in non-Small cellLung cancer. BMC Cancer 2020; 20(1): 848.
Gallaway MS, Huang B, Chen Q, Tucker T, McDowell J, Durbin E, et al. Identifying Smoking Status and Smoking Cessation Using a Data Linkage Between the Kentucky Cancer Registry and Health Claims Data. JCO Clin Cancer Inform 2019; 3: 1-8.
Zhang P, Chen P-L, Li Z-H, Zhang A, Zhang X-R, Zhang Y-J, Liu D, Mao C. Association of smoking and polygenic risk with the incidence of lung cancer: a prospective cohort study. Br J Cancer 2022; 126(11): 1637-1646.
Lai H, Liu Q, Ye Q, Liang Z, Long Z, Hu Y, Wu Q, Jiang M. Impact of smoking cessation duration on lung cancer mortality: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2024; 196(104323): 104323.
Shin SH, Kim T, Kim H, Cho J, Kang D, Park HY. Impact of smoking reduction on lung cancer risk in patients with COPD who smoked fewer than 30 pack-years: a nationwide population-based cohort study. Respir Res 2024: 25(1).
Jørgensen N, Meline EL, Jeppesen SS, Hansen O, Nielsen M and Schytte T. The effect of tumor laterality on survival for non-Small cellLung cancer patients treated with radiotherapy. Acta Oncol 2019; 58(10): 1393-8.
Landi L, Resuli B, D’Incecco A, Tufman A, Cannita K, Minuti G, et al. 2022P ALBA project: Prognostic impact of laterality in Small cellLung cancer. Ann Oncol 2023; 34: S1074.
McWilliam A, Vasquez Osorio E, Faivre-Finn C, van Herk M. Influence of tumour laterality on patient survival in non-small cell lung cancer after radiotherapy. Radiother Oncol 2019; 137: 71-76.
He S, Li, H, Cao M, Sun D, Yang F, Yan X, et al. Survival of 7,311 lung cancer patients by pathological stage and histological classification: a multicenter hospital-based study in China. TranslLung Cancer Res 2022: 11(8): 1591-1605.
Garinet S, Wang P, Mansuet-Lupo A, Fournel L, Wislez M, Blons H. Updated Prognostic Factors in Localized NSCLC. Cancers 2022; 14(6): 1400.
Gerard R, Velez-Cubian F, Moodie C, Garrett J, Fontaine J, Toloza E. P12 Lungtumor histology as a prognostic factor for short- and long-term postoperative outcomes. J Thorac Oncol 2018; 13(9): 165.
Łazar-Poniatowska M, Bandura A, Dziadziuszko R and Jassem J. Concurrent chemoradiotherapy for stage III non-small-cell Lung cancer: recent progress and future perspectives (a narrative review). Transl Lung Cancer Res 2021; 10(4): 2018-31.
Walraven I, Damhuis RA, ten Berge MG, Rosskamp M, van Eycken L, de Ruysscher D, et al. Treatment Variation of Sequential versus Concurrent Chemoradiotherapy in Stage III Non-Small cellLung Cancer Patients in the Netherlands and Belgium. Clin Oncol 2017; 29(11): e177-85.
Ohara S, Kanda S, Okuma H, Goto Y, Hidehito Horinouchi, Fujiwara Y, et al. Effect of sequential chemoradiotherapy in patients with limited-disease small-cell Lung cancer who were ineligible for concurrent therapy: a retrospective study at two institutions. Jpn J Clin Oncol 2018; 48(1): 82-88.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Similar Articles
- Chinedu Henry Okoroafor, Tobias Innocent Ndubuisi Ezejiofor, Ikechukwu Ugbaga Nkole, Emenike Fidelis Awagu, Anti-Tumorigenic Activities of Diodia Sarmentosa Leaf Extract on Diethyl Lnitrosamine-Induced Hepatocellular Carcinoma in Wistar Rats , Journal of Analytical Oncology: Vol. 13 (2024)
- Sally McLaren, Frank Arfuso, Nik Zeps, Arun Dharmarajan, The Role of Secreted Frizzled Related Protein 4 (sFRP-4) in Regulating Oestradiol-Induced Growth of the MCF-7 Breast Cancer Cell Line , Journal of Analytical Oncology: Vol. 3 No. 1 (2014)
- T.G. Shrihari, Myeloid Derived Suppressor Cells in Oral Cancer: An Emerging Concept , Journal of Analytical Oncology: Vol. 7 No. 2 (2018)
- Megha Jain, Vipin Jain, Anish Gupta, Swati Saawarn, Samar Khan, Role of Hormones in Oral Squamous Cell Carcinoma - An Update , Journal of Analytical Oncology: Vol. 6 No. 4 (2017)
- Jing Jiang, Shunjiang Yu, Li Chen, Feng Gao , Xiaoguang Qiu , Primary Intracranial Thalamic Leiomyosarcoma: Clinical Report of a Case and Review of the Literature , Journal of Analytical Oncology: Vol. 3 No. 4 (2014)
- Mariana Varna, Philippe Bertheau , Luc G. Legrès , Tumor Microenvironment in Human Tumor Xenografted Mouse Models , Journal of Analytical Oncology: Vol. 3 No. 3 (2014)
- Arunima Ghosh, Karlena Lara-Otero, Marston W. Linehan , Maria J. Merino , Can Mutations in the BAP1 Gene be Detected by Immunohisto-chemistry in Hereditary Kidney Cancers? , Journal of Analytical Oncology: Vol. 3 No. 3 (2014)
- Karen Reyes, Guido F. Verbeck, True One Cell Chemical Analysis in Cancer Research: A Review , Journal of Analytical Oncology: Vol. 12 (2023)
- Tatiana Levkovich, Theofilos Poutahidis, Kelsey Cappelle, Mark B. Smith, Allison Perrotta, Eric J. Alm , Susan E. Erdman , ‘Hygienic’ Lymphocytes Convey Increased Cancer Risk , Journal of Analytical Oncology: Vol. 3 No. 3 (2014)
- D.A. Tzerkovsky, A.N. Mazurenko, F.F. Borychevsky, D.V. Shashkouski, Radiodynamic Therapy with Photosensitizers: Mini-Review of Experimental and Clinical Studies , Journal of Analytical Oncology: Vol. 11 (2022)
You may also start an advanced similarity search for this article.
Most read articles by the same author(s)
- K. Namratha, Geeta S. Narayanan, S. Arpitha, K.R. Sindhu, B.R. Kiran Kumar, Dosimetric Analysis of Organs at Risk and its Correlation with Radiation Techniques in Left-Sided Breast Radiotherapy , Journal of Analytical Oncology: Vol. 14 (2025)