Care of patients with non-small-cell lung cancer stage III – the Central European real-world experience

• Published in: Radiology and oncology Vol. 54; no. 2; pp. 209 - 220
• Main Authors: Zemanova, Milada, Pirker, Robert, Petruzelka, Lubos, Zbozínkova, Zuzana, Jovanovic, Dragana, Rajer, Mirjana, Bogos, Krisztina, Purkalne, Gunta, Ceriman, Vesna, Chaudhary, Subhash, Richter, Igor, Kufa, Jirí, Jakubikova, Lenka, Zemaitis, Marius, Cernovska, Marketa, Koubkova, Leona, Vilasova, Zdenka, Dieckmann, Karin, Farkas, Attila, Spasic, Jelena, Fröhlich, Katerina, Tiefenbacher, Andreas, Hollosi, Virag, Kultan, Juraj, Kolarová, Iveta, Votruba, Jiri
• Format: Journal Article
• Language: English
• Published: Poland Sciendo 28.05.2020; De Gruyter Poland
• Subjects: Adenocarcinoma; Biopsy; Brain; Bronchoscopy; Chemoradiotherapy; Chemotherapy; Chest; Computed tomography; diagnostic procedures; Diagnostic systems; Epidermal growth factor receptors; Gender; Heterogeneity; Invasiveness; Lung cancer; Lymph nodes; Medical diagnosis; Medical imaging; multimodality treatment; Mutation; Neuroimaging; Non-small cell lung carcinoma; non-small-cell lung cancer; Positron emission; Positron emission tomography; Radiation therapy; Small cell lung carcinoma; Smoking; stage III; Surgery; Survival; Tomography; Ultrasound; Weight loss; multimodality treatment; stage III; diagnostic procedures; non-small-cell lung cancer
• ISSN: 1581-3207; 1318-2099; 1581-3207; 0485-893X
• DOI: 10.2478/raon-2020-0026

Background Management of non-small-cell lung cancer (NSCLC) is affected by regional specificities. The present study aimed at determining diagnostic and therapeutic procedures including outcome of patients with NSCLC stage III in the real-world setting in Central European countries to define areas for improvements. Patients and methods This multicentre, prospective and non-interventional study collected data of patients with NSCLC stage III in a web-based registry and analysed them centrally. Results Between March 2014 and March 2017, patients (n=583) with the following characteristics were entered: 32% females, 7% never-smokers; ECOG performance status (PS) 0, 1, 2 and 3 in 25%, 58%, 12% and 5%, respectively; 21% prior weight loss; 53% squamous carcinoma, 38% adenocarcinoma; 10% EGFR mutations. Staging procedures included chest X-ray (97% of patients), chest CT (96%), PET-CT (27%), brain imaging (20%), bronchoscopy (89%), endobronchial ultrasound (EBUS) (13%) and CT-guided biopsy (9%). Stages IIIA/IIIB were diagnosed in 55%/45% of patients, respectively. N2/N3 nodes were diagnosed in 60%/23% and pathologically confirmed in 29% of patients. Most patients (56%) were treated by combined modalities. Surgery plus chemotherapy was administered to 20%, definitive chemoradiotherapy to 34%, chemotherapy only to 26%, radiotherapy only to 12% and best supportive care (BSC) to 5% of patients. Median survival and progression-free survival times were 16.8 (15.3;18.5) and 11.2 (10.2;12.2) months, respectively. Stage IIIA, female gender, no weight loss, pathological mediastinal lymph node verification, surgery and combined modality therapy were associated with longer survival. Conclusions The real-world study demonstrated a broad heterogeneity in the management o f stage III NSCLC in Central European countries and suggested to increase the rates of PET-CT imaging, brain imaging and invasive mediastinal staging.