Diagnosis, Treatment, and Outcomes Achieved in Patients with Non-Small-Cell Lung Cancer in Central Europe

Analyzed Data

This was a multicenter prospective non-interventional study. The authors used data from a web-based registry of NSCLC patients and conducted a centralized analysis. A total of 583 patients treated between March 2014 and March 2017 were included. They were followed up until February 2018, with a median follow-up time of 30 months.

Study Population

Out of the 583 patients with an average age of 65 years, 32% were women. 7% of the included patients had never smoked. The patients' performance status according to the ECOG was 0 in 25% of cases, 1 in 58%, 2 in 12%, and 3 in 5%. Most patients (53%) were diagnosed with squamous cell carcinoma, 38% with adenocarcinoma, and 10% had an EGFR mutation. Weight loss within 3 months prior to study entry occurred in 21% of cases.

Staging

For the diagnosis and staging of the disease, chest X-ray was used in 96%, chest CT in 97%, PET-CT or PET in 28%, brain imaging in 20%, bronchoscopy in 89%, endobronchial or endoscopic ultrasound in 14%, and CT-guided biopsy in 9% of cases.

55% of patients were in stage IIIA, the remaining 45% were in stage IIIB. Ipsilateral lymph node involvement (N2) was found in 60% of patients, contralateral lymph node involvement (N3) in 23%. Mediastinal lymph node involvement was histopathologically confirmed in 29.5% of patients.

Indicated Treatment

The median time from diagnosis to the start of treatment was 23 days (range 0–369 days). Combination therapy involving multiple therapeutic modalities was used in 56% of patients: chemoradiotherapy in 34%, and a combination of surgical treatment and chemotherapy in 13%. As for the use of a single therapeutic modality, 26% of patients received chemotherapy alone, 12% chest radiotherapy alone, and 1.5% surgical intervention alone. Best supportive care was provided to 5% of patients. Prophylactic cranial radiotherapy was not used in any patient.

Treatment Outcomes

Of the 334 patients whose best overall response to treatment was evaluable, complete remission was observed in 27.5%, partial remission in 35.9%, disease stabilization in 24.9%, and disease progression in 11.7% of cases. The median overall survival was 16.8 months, and the median progression-free survival was 11.2 months. Longer survival was associated with stage IIIA, female gender, absence of weight loss, pathological confirmation of mediastinal lymph node involvement, and combination therapy involving multiple modalities.

Conclusion

The authors conclude their work by noting, among other things, that the study highlighted significant heterogeneity in the diagnosis and treatment of stage III NSCLC in Central European countries and suggested that the use of PET-CT, brain imaging, and invasive mediastinal staging should be increased before the start of combination therapy.

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Source: Zemanová M., Pirker R., Petruželka L. et al. Care of patients with non-small-cell lung cancer stage III – the Central European real-world experience. Radiol Oncol 2020 May 28; 54 (2): 209−220, doi: 10.2478/raon-2020-0026.