Outcomes of patients with unresected stage III and stage IV non-small cell lung cancer: A single institution experience

INTRODUCTION: To report on the demographic profile and survival outcomes of North Indian population affected with stage III and stage IV non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: From November 2008 to January 2012, 138 consecutively diagnosed NSCLC patients were included in this study. The patient, tumor and treatment related factors were analyzed. Median overall survival (OS), Kaplan-Meier survival plots, t-test, Cox proportional hazards models were generated by multivariate analysis [MVA]) and analyzed on SPSS software (version 19.0; SPSS, Inc., Chicago, IL). RESULTS: Median OS of stage III patients was 9.26 ± 1.85 months and 2-year survival rate of 13% while stage IV patients had median OS of 5 ± 1.5 months with a 2-year survival rate of 8%. Cox regression modeling for MVA demonstrated higher biologically equivalent dose (BED) (P = 0.01) in stage III while in stage IV non-squamous histology (P = 0.01), administration of chemotherapy (P = 0.02), partial responders to chemotherapy (P = 0.001), higher BED (P = 0.02), and those with skeletal metastasis alone (P = 0.17) showed a better OS. CONCLUSION: Our data showed that a higher BED is associated with favorable outcomes, indicating a role of dose escalated radiation therapy to the primary lesion in both stage III and essentially in stage IV NSCLC. Additionally, optimal use of chemotherapy relates to better survival. The developing, resource restrained nations need to follow an economically feasible multimodality approach.