Clinicopathological factors and multimodality treatment for nonsmall cell lung carcinoma in a government tertiary care center – A benchmarking approach
Authors: Parameswaran Shradha , Jeeva S. , Indhumathi J , Vijayasree T. N. , Ramaswamy Giridharan , Nithiya Antoinette Mary , Arjuhn R 
Published: October 2023

Abstract:

BACKGROUND:
Lung carcinoma is the leading cause of death due to cancer worldwide. The most common histology among lung cancer is nonsmall cell carcinoma lung (84%). Majority of nonsmall cell lung cancer (NSCLC) in India comes under stage III and stage IV at the time of presentation. Concurrent chemoradiation is the standard of care in stage III NSCLC.

AIM:
The aim of this study was to elaborate the clinicopathological factors in NSCLC patients who presented in our department without metastasis and received radiotherapy (RT) and discuss the multimodality management received by those patients.

MATERIALS AND METHODS:
A total of 125 histopathologically proven NSCLC patients who received RT from 2016 to 2019 in our department were retrospectively analyzed. All data regarding demographic characteristics, tumor characteristics, treatment details, and follow-up period were collected from our medical records and with the help of telephonic conversations with patients’ relatives. Patients received concurrent chemoradiation or RT, followed by chemotherapy or radical RT or palliative RT, according to the performance status (PS). Majority of the patients received cisplatin–etoposide doublet chemotherapy. Radiation dose ranged from 30 Gy in palliative intent to 60 Gy in curative intent with two-dimensional technique using anterior-posterior/posterior-anterior portals, followed by oblique with telecobalt machine.

RESULTS:
The average age of the entire study population was 58.6 years. Gender preponderance was seen in males with 87% (n = 109) and association with smoking in 91% (n = 100). Most patients had a PS of 2 (58%, n = 73) during presentation. In the wide spectrum of presenting symptoms, cough with expectoration (50%) and breathlessness (40%) were highly accounted. In the population studied, side laterality was seen for the right-sided carcinoma lung. 80% (n = 64) of the diagnosed had squamous cell carcinoma histologically with other histologies being adenocarcinoma, neuroendocrine tumor, and sarcomatoid carcinoma. Stage III (72%, n = 90) was the biggest stage group with stage IIIB the most common among it. Most patients with PS 1 or 2 received CCRT, whereas most patients with PS >2 received palliative RT or best supportive care. 20% (n = 25) of patients defaulted during the treatment. 50.4% (n = 63) of patients received CCRT. CDDP and etoposide were the used regimens for concurrent use with RT. The median follow-up in the study population was 7.5 months. In patients who underwent CCRT, the median overall survival was 12 months and in patients who underwent palliative treatment was 5 months.

CONCLUSION:
Patients with PS of 1 and 2 has a better overall survival in comparison with PS > 2. Concurrent chemoradiation is the standard of care for all stage III inoperable NSCLC patients. In spite of multimodality management, the overall survival is poor with stage III NSCLC.