Clinical significance of the delay in starting special treatmentfor patients with satge III inoperable non-small cell lung cancer: results of study and literature review

Introduction. Up to 30 % of patients with non-small cell lung cancer have locally advanced tumor. Increased waiting time for radiation therapy and/or chemotherapy can result in tumor progression and impaired survival. The purpose of the study was to evaluate the influence of the length of time before starting therapy on the overall survival in patients with inoperable locally advanced non-small cell lung cancer. Materials and methods. In the retrospective study, 139 patients with non-small cell lung cancer, receiving chemoradiotherapy were divided into subgroups by the length of time before starting therapy. The overall survival was assessed using the Kaplan-Meier method with determination of differences between groups by long-rank test, and the cumulative overall survival was compared using the χ 2 test. The Cox regression model was applied to evaluate the effect of covariates on overall survival. Results. Chemoradiotherapy was started within 1 month after diagnosis in 87 (63 %) patients and in 31 days and later in 52 (37 %) patients. Distribution by initial prognostic factors was uniform, except for exploratory thoracotomy, which was performed more often in patients who received chemotherapy within 1 month after diagnosis (р=0.001). The median overall survival rate was 14.2 months (95 % CI: 11.8-16.7) for patients who received chemoradiotherapy within 1 month after diagnosis and 19.1 months (95 % CI: 14.7-23.5) for patients, who received therapy at least 1 months after diagnosis (χ 2=0.562, р=0.453). Risk ratio (RR) of death was 0.87 (95 % CI: 0.59-1.26) in patients with late onset of special treatment. Conclusion. The retrospective analysis showed that time before onset of chemoradiotherapy in patients with stage III non-small cell lung cancer had no influence on prognosis of survival, with the initial chemotherapy as well as radiotherapy. These results require confirmation in randomized trials.