Histology and smoking status predict survival of patients with advanced non-small-cell lung cancer. Results of West Japan Oncology Group (WJOG) Study 3906L.

INTRODUCTION: Smoking status is one of the prognostic factors in advanced non-small-cell lung cancer (NSCLC). Currently, adenocarcinoma (Ad) histology is considered a predictive factor in advanced NSCLC. We investigated the correlation between histology or smoking status and survival of NSCLC patients receiving chemotherapy. METHODS: We retrospectively reviewed clinical data from stage IIIB or IV NSCLC patients who started first-line chemotherapy at affiliated institutions of West Japan Oncology Group from 2004 to 2005. We also collected information on pack-years of cigarette smoking and years since cessation. Overall survival was compared using log-rank test, and Cox regression analysis was used to identify independent prognostic factors. RESULTS: In total, 2542 consecutive patients were enrolled at 40 institutions. Of those, 71 were excluded because of unknown smoking history. The median overall survival of nonsmoking Ad patients (593 days) was longer than that of smoking Ad, nonsmoking non-Ad, and smoking non-Ad patients (384, 374, and 319 days, respectively; p < 0.001). In Cox regression with sex, age, stage, performance, and treatment as covariates, we found significant interaction (p = 0.039) between histology (Ad/non-Ad) and smoking status (smoker/nonsmoker); smoking conferred a hazard ratio of 1.34 (95% confidence interval, 1.15-1.55) in Ad, but only 0.99 (0.75-1.31) in non-Ad. Higher pack-years and shorter period since cessation were significantly associated with poorer survival in Ad (p < 0.001), but not in non-Ad (p ≥ 0.434). CONCLUSION: Ad histology is associated with better prognosis, and only smoking status had a prognostic impact in Ad.

Limited-stage small cell lung cancer: local failure after concurrent chemoradiotherapy with use of accelerated hyperfractionation.

PURPOSE: The aim of this study was to update data of radiation therapy regimens for improvement in local control in patients with limited-stage small cell lung cancer, a retrospective study was conducted. MATERIALS AND METHODS: Results of early concurrent chemoradiotherapy with accelerated hyperfractionation in 30 patients between 1998 and 2005 were retrospectively reviewed. The prescribed dose was 45 Gy in 30 fractions in all patients. RESULTS: All patients received a full dose of radiation therapy; however, interruptions for >or=5 days, mainly due to hematologic toxicity, were required in 18 patients (60%). The 5-year Kaplan-Meier survival rate and the median survival time were 26% and 26 months, respectively. The 4-year in-field control rate was 56%. Sites of relapse were local relapse in 9 patients (6 for in-field relapse, 3 for marginal relapse) and distant metastases in 16 patients (11 for distant metastases only, 5 for distant metastases with local relapse). The sites of marginal relapse were the upper margin in two patients and the peripheral margin in one patient. Grade 3 radiation esophagitis was observed in only three patients. CONCLUSION: Because in-field control was insufficient, a more effective approach should be sought to provide better local control.

Phase II study of weekly paclitaxel for relapsed and refractory small cell lung cancer.

The purpose of this study was to evaluate the efficacy and toxicity of single-agent paclitaxel given weekly to patients with relapsed and refractory small cell lung cancer (SCLC). Patients were treated with 80 mg/m2 paclitaxel administered weekly for 1 h for 6 weeks in an 8-week cycle. Twenty-two patients were enrolled, 21 of whom were eligible. The patient characteristics included: 20 males, 1 female; median age 66 years (range 48-75); performance status 0/1 in 19 and 2 in 5 patients. Grade 3/4 leukopenia and neutropenia occurred in 47.5% and 64%, respectively. Other grade 3/4 toxicities included infection, skin rash, neuropathy and pulmonary toxicity. There were 5 partial responses in 3 out of the 11 sensitive cases and 2 out of the 10 refractory cases, respectively. Paclitaxel, administered as a weekly infusion at a dose of 80 mg/m2, was effective in treating relapsed and refractory SCLC.