Analysis of long-term survival in patients treated with three-dimensional conformal radiotherapy for locally advanced non-small cell lung cancer

Objective: To evaluate the prognostic factors of locally advanced non-small cell lung cancer (LA-NSCLC) treated with three dimensional conformal radiation therapy (3D CRT). Methods: In 106 patients with stage IIIa/IIIb NSCLC treated with 3DCRT from Nov 2000 to Mar 2004, 46 of them were treated with radiotherapy alone, 41 by concurrent chemoradiation, and 19 by sequential chemoradiation. The influence of related prognostic factors on survival was evaluated by univariate and multivariate analysis. The treatment outcome was analyzed by prognostic index model. Results: The 1-, 3- and 5- year overall survival rate was 50.0%, 22.2% and 15.5%, respectively, and the median survival time was 12 months. The univariate analysis showed that the following factors were significantly associated with the longer survival: female, good kamofsky performance status (KPS), squamous cell carcinoma, absence of supraclavicular lymph nodes, no smoking history, hemoglobin ≥130 g/L before treatment, N stage, the maximum diameter of tumor ≤5 cm, the volume of tumor ≤90 cm3, GTV ≤150 cm3 and the radiotherapy efficacy. However, multivariate analysis revealed that no smoking history, hemoglobin ≥130 g/L and GTV ≤150 cm3 were the independent risk factors for predicting the survival. Conclusions: Three dimensional conformal radiation therapy could be effective in the treatment of locally advanced NSCLC. No smoking history, hemoglobin ≥130 g/L and GTV ≤150 cm3 might be the independent risk factors for predicting the survival. Prognostic index model could improve the potential of multivariate analysis in predicting the survival of patients treated with radiotherapy for NSCLC. (authors)