Long-term outcome of definitive radiotherapy for locally advanced non-small cell lung cancer: a real-world single-center study

Abstract Background Locally advanced non-small cell lung cancer (NSCLC) is a heterogeneous disease with poor long-term survival. This study examined overall survival (OS), progression-free survival (PFS), treatment effectiveness, and toxicity in patients with locally advanced NSCLC treated with definitive radiotherapy. Methods A retrospective analysis of demographic information, clinical characteristics, treatment patterns, and clinical outcomes of 789 patients with locally advanced NSCLC who underwent radical radiotherapy at our center between January 2005 and December 2015 was performed. The Kaplan–Meier method and log-rank test were used for survival comparisons, and Cox regression was used for multivariate analysis. Results There were 328 patients with stage IIIA disease and 461 with stage IIIB disease. By the last follow-up, there were 365 overall deaths and 576 cases of recurrence, metastasis, or death. The median survival time was 31 months. The OS rates at 1-, 2-, 5-, and 10 years were 83.7%, 59.5%, 28.8%, and 18.9%, respectively. PFS rates at 1, 2, 5, and 10 years were 48%, 24.5%, 11.9%, and 5.5%, respectively. Rates of ≥ grade 3 acute radiation pneumonitis or esophagitis were 7.6% and 1.9%, respectively. Rates of ≥ grade 3 chronic radiation pneumonitis and esophagitis were 11% and 0.4%, respectively. Multivariate analysis showed that the Karnofsky Performance Status (KPS) score, smoking status, and combined chemotherapy were independent prognostic factors for OS ( P < 0.05). Multivariate analysis revealed that combined chemotherapy and radiation dose were independent prognostic factors for PFS ( P < 0.05). Conclusion Patients with stage III NSCLC treated with definitive radiotherapy had a median survival time of 31 months and a two-year OS rate of 59.5%. Patients with a KPS score of 80 or higher, who had never smoked, or underwent combination treatment had a considerably longer OS.