Quality of survivorship among patients with locally advanced NSCLC treated with chemoradiation on RTOG 0617.
Hitchcock K, Bradley JD, Morris CG, Hu C, Paulus R, Movsas B, and Hoppe BS. Quality of survivorship among patients with locally advanced NSCLC treated with chemoradiation on RTOG 0617. Int J Radiat Oncol Biol Phys 2017; 99(2):E461.
Int J Radiat Oncol Biol Phys
Purpose/Objective(s): Studies on the use of chemoradiation among patients with locally advanced non-small cell lung cancer (LA-NSCLC) have generally focused on disease-specific outcomes and toxicities with few details regarding survivorship. The present study investigates the quality of survivorship among patients treated on RTOG 0617 with chemoradiation. Purpose/Objective(s): Through a data-sharing project with NRG, we retrospectively reviewed the medical records of patients treated with chemoradiation for stage III NSCLC on RTOG 0617. Patients were required to have an initial ECOG score of 0-1. For this study, quality of survivorship was evaluated by using the ECOG performance status (PS) reported at each follow-up; a score of 3 or higher (PS3+) was considered poor quality of survivorship. We considered the time between completion of treatment and the onset of poor PS as well as the influence of cancer recurrence and approaching death on PS. Patients who lived > 2 years after treatment were analyzed as a unique subset. Results: The distribution of PS during follow-up among patients without recurrent cancer appears in Table 1. Of 455 evaluable patients, 398 (87%) reported ECOG PS of 0-2 throughout the follow-up period. Among the 57 who experienced PS3+, 13 had a single period of poor PS status but recovered normal self-care by their last followup, and 32 were initially well but had a single poor PS recorded just before death (29/32 of these deaths were from recurrence of NSCLC). Normal self-care was never achieved after treatment by 12 patients, of whom 3 died of treatment-related complications and 7 died of disease progression by the first follow-up. Among the 215 patients (43%) who survived for more than 2 years, 16 (7%) experienced PS3+ during their follow-up. These included 3 with a PS3+ in the first 4 months after treatment and then quickly improved, 12 who developed a fatal recurrence of the NSCLC, and 1 who had pneumonitis at 6 months that was cured with a return of good PS by month 9. Conclusion: Patients treated for LA-NSCLC with chemoradiation on RTOG 0617 reported a good quality of survivorship as measured by a PS indicating independence of self-care (0-2). In most cases, poor PS (3-4) was experienced only in the 3 months after treatment or was a result of progressive NSCLC. Two-year survivors who remained free from cancer recurrence maintained good quality of survivorship over the subsequent 3 years.