BACKGROUND & OBJECTIVE: The patients with stage IV non-small cell lung cancer (NSCLC) usually need radiotherapy and have good responses, particularly in those with brain or bone metastases. This study was to evaluate the influence of radiotherapy on the survival of stage IV NSCLC patients.

METHODS

Clinical data of 287 patients with stage IV NSCLC were retrospectively analyzed. Whole brain was treated with two parallel fields irradiation; bone metastases were treated with one local field irradiation. Primary tumors, regional lymph nodes and other distant metastases were treated by conventional fractionation radiotherapy or 3-dimensional conformal radiotherapy. Whole brain and bone radiotherapy was delivered with a total dose of 40 Gy in 20 fractions in 4 weeks or with a total dose of 30 Gy in 10 fractions in 2 weeks. The median dose for primary tumors and regional lymph nodes was 50 Gy (20-70 Gy), and the median dose for other distant metastases was 46 Gy (40-60 Gy).

RESULTS

The median survival time of the 287 patients was 9 months (8-10 months). The 1- and 2-year overall survival rates were 30.2% and 8.9%. The median survival time was significantly longer in the patients received chemotherapy than in the patients didn't (10 months vs. 8 months, P = 0.049). In the patients with brain, bone, or other distant metastases, the median survival time was 8, 9, and 10 months, respectively; the 1-year survival rates were 24.8%, 28.7%, and 37.5%, respectively; the 2-year survival rates were 6.7%, 7%, and 15.3%, respectively. By unitivariate analysis, histological type and patients' age were prognostic factors of NSCLC. The median survival time was significantly longer in adenocarcinoma patients than in squamous cell carcinoma patients and other carcinoma patients (10 months vs. 7 and 9 months, P = 0.046), longer in the patients of < or =60 years old than in those of >60 years old (11 months vs. 8 months, P = 0.012), and longer in the patients with only bone metastases than in the patients with concomitant other distant metastases (10 months vs. 6 months, P = 0.033), but there was no significant difference between the patients with only brain metastases and those with concomitant other distant metastases (9 months vs. 8 months, P = 0.374). Radiotherapy for primary tumors and lymph nodes, complications of other chronic diseases, and irradiation dose and pattern had no effect on the survival.

CONCLUSIONS

Histological type and patients' age may affect the efficacy of radiotherapy on stage IV NSCLC. The irradiation patterns of 40 Gy in 20 fractions in 4 weeks or 30 Gy in 10 fractions in 2 weeks have no effect on the survival of patients with brain or bone metastases.