• Vol. 36 No. 9, 778–783
  • 15 September 2007

Radical Radiotherapy in Stage I Non-small Cell Lung Cancer (NSCLC) – Singapore National Cancer Centre Experience



Introduction: The aim of this study was to assess the outcome of radical treatment for stage I non-small cell lung cancer (NSCLC) with external beam radiation therapy. Materials and Methods: A retrospective series of 23 patients with stage I NSCLC treated radically with radiotherapy from September 1997 to December 2004 at the National Cancer Centre, Singapore. Eighteen patients had 3D conformal radiotherapy and 5 patients had 2D planning. The median radiation dose delivered was 55 Gy (range, 50 to 67.5 in 20 to 33 fractions). The estimated median BED10 was 63.9 Gy (range, 57.6 to 70.1). Complete response (CR) rates, overall survival and cause-specific survival rates were analysed for evaluation of treatment results. Local regional failure was defined as disease in the ipsilateral lung and entire mediastinum. Recurrence at the contralateral lung and other distal organs was defined as distant metastases. Survival data were calculated using the Kaplan-Meier method and tested for significance with log-rank statistics. Results: A total of 23 patients (16 males, 7 females) with a median age of 73 years (range, 45 to 88) were analysed. Six (26%) had stage IA and 17 (74%) had stage IB disease. Eleven patients refused surgery and 12 patients were medically inoperable. The median follow-up was 18.9 months (range, 6.2 to 117.4). The overall survival at 2 years and 3 years was 54.7% and 24.3% respectively. The overall cause-specific survival was 57.4% at 2 years and 25.6% at 3 years. Radiological CR was obtained in 6/23 patients (26%) and the median survival was 24.8 months as compared to 20 months in patients who attained partial response (PR) or unknown response (P = 0.24). The median survival for 12 patients who received a BED10 of ≥63.9Gy was not reached as compared to 20 months in 11 patients with BED10 of <63.9 Gy (P = 0.03). Sixteen patients died, 14 due to disease recurrence or progression and 2 of unrelated causes. Seven patients (29.2%) remained alive. The longest surviving patient had a follow-up time of 117.4 months. Four of these 7 patients were disease-free and 3 were alive with disease (2 with bone metastases and 1 with recurrence in the primary site). Conclusion: Our data are consistent with the reported literature for stage I NSCLC treated with radical radiotherapy. Patients who received a higher dose of radiation have a better outcome. The 3-year cause-specific survival of 25.6% is less than ideal and further investigations into dose escalation with modern radiotherapy techniques and perhaps the addition of chemotherapy or new targeted agents to radiation are warranted to improve the outcome.

Surgical resection is well established as the main curative treatment in early stage I to II non-small cell lung cancer (NSCLC). The overall 5-year survival for pathological stage I disease is as high as 57% to 67%.1 However, a huge proportion of lung cancer patients have poor performance status with multiple medical problems, which preclude surgery as the choice of therapy. In this instance, radiotherapy is often the only curative option. The 5-year survival rates in patients with unresectable stage I to II disease treated with radiotherapy range from 15% to 30%.2-18 The majority of the radiotherapy reports are retrospective studies with relatively small numbers of patients. This is not surprising as existing comorbidities which exclude these patients from curative lung resection is often also a contra-indication to radical radiotherapy.

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