PURPOSE: Because most symptomatic lung cancer is discovered in advanced stage, the potential benefits and risks of lung cancer screening must be considered in relation to contemporary results of treatment of advanced stage lung cancer.
METHODS: A retrospective review of all patients diagnosed in stages IIIA, IIIB and IV NSCLC at an NCI NCCN Comprehensive Cancer Center between the years 1986-2001 analyzed patients who survived 5 years or longer. We attempted to identify parameters that might predict long-term survival.
RESULTS: Of 905 patients in Stages III and IV, 57 (6.7%) survived 5 years, of whom 21 died of progression of primary tumor beyond 5 years. Many others died of second tobacco-caused neoplasms and treatment-related complications including progressive respiratory failure following resection and dementia following whole brain radiation therapy.Eight (14.0%) patients with more than one primary neoplasm (Stages IIIB and IV) survived 5 years. Eight (41.9%) stage IV survivors had single site distant metastasis.85% of survivors in stages IIIA and IIIB received aggressive multimodality therapy. One (1.8%) patient survived 5 years following radiation therapy alone for treatment of stage III disease. Two (3.5%) Stage IV patients survived 5 years with chemotherapy alone; both later progressed and died. No patient with advanced stage disease survived 5 years without treatment.
CONCLUSION: In discussion of relative risks and benefits of lung cancer screening, patients should be presented with accurate information regarding treatment results for advanced stage symptomatic lung cancers. Current approaches to treatment of advanced stage NSCLC achieved low survival in this study. Only 6.7% survived 5 years, and only 4% ultimately survived the primary tumor. A substantial majority of survivors are from specific pathologic subsets including 1) resectable N2 disease (n=28), 2) multiple primary tumors (n=8), 3) T3N0 (n=6) and 4) single site distant metastasis (n=8) who were treated with aggressive multimodality therapy.
CLINICAL IMPLICATIONS: Screening for lung cancer has the potential to prevent advanced stage lung cancer by reducing the number of advanced stage lung cancers and the associated mortality, and increasing survival.
DISCLOSURE: Tina Wang, None.