Lung Cancer: Optimal Treatment Strategies

ABSTRACT

Search of best treatment plan for non-small lung cancer (LC) patients (LCP) was realized.

In trial (1985-2008) the data of consecutive 535 LCP after complete resections (R0) (age = 57.3 ± 8.2 years; male-482, female-53; tumor diameter: D = 4.7 ± 2.2 cm; pneumonectomies-222, lobectomies-313, combined procedures with resection of pericardium, atrium, aorta, VCS, carina, diaphragm, ribs-155; only surgery-S-316, adjuvant chemoimmunoradiotherapy- AT-117: CAV/gemzar + cisplatin + thymalin/taktivin + radiotherapy 45-50Gy, postoperative radiotherapy 45-50Gy-RT-102; squamous-341, adenocarcinoma-153, large cell-41; stage IA-105, IB-130, IIA-21, IIB-122, IIIA-116, IIIB-41; T1-150, T2-230, T3-114, T4-41; N0-310, N1-118, N2-107; G1-126, G2-152, G3-257) were reviewed. Variables selected for 5-year survival (5YS) study were input levels of blood, biochemic and hemostatic factors, sex, age, TNMG, D. Survival curves were estimated by Kaplan-Meier method. Differences in curves between groups were evaluated using a log-rank test. Neural networks computing, Cox regression, clustering, structural equation modeling, Monte Carlo and bootstrap simulation were used to determine any significant regularity.

For total of 535 LCP overall life span (LS) was 1723.3 ± 1294.9 days and cumulative 5YS reached 63.6%, 10 years – 52.8%. 304 LCP (LS = 2597.3 ± 1037 days) lived more than 5 years without LC progressing. 186 LCP (LS = 559.8 ± 383.1 days) died because of LC during first 5 years after surgery. 5YS of LCP with N1-2 was superior significantly after AT (65.6%) compared with RT (39.5%) (P = 0.0003 by log-rank test) and S (28.3%) (P = 0.000). Cox modeling displayed that 5YS significantly depended on: phase transition (PT)“early-invasive LC”, PT N0-N12, AT, age, weight, histology, G, T, D, blood cell subpopulations, cell ratio factors, ESS, prothrombin index, heparin tolerance, recalcification time, bilirubin, (P = 0.000-0.046). Neural networks computing, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT N0-N12 (rank = 1), procedure type, G, T, histology, AT, PT “earlyinvasive LC”, RT, S, sex, ESS, prothrombin index, fibrinogen, Hb, protein, weight, lymphocytes. Correct prediction of 5YS was 99.6% by neural networks computing (error = 0.045; urea under ROC curve = 0.995).

Optimal treatment strategies for LCP are: 1) screening and early detection of LC; 2) availability of experienced surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymphadenectomy for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.