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Year : 2011  |  Volume : 48  |  Issue : 4  |  Page : 514--515

Which non-small-cell lung cancer patients achieve long-term survival?

N Ahbeddou, M Fetohi, S Boutayeb, H Errihani 
 Department of Medical Oncology, National Institute of Oncology, Morocco

Correspondence Address:
N Ahbeddou
Department of Medical Oncology, National Institute of Oncology
Morocco




How to cite this article:
Ahbeddou N, Fetohi M, Boutayeb S, Errihani H. Which non-small-cell lung cancer patients achieve long-term survival?.Indian J Cancer 2011;48:514-515


How to cite this URL:
Ahbeddou N, Fetohi M, Boutayeb S, Errihani H. Which non-small-cell lung cancer patients achieve long-term survival?. Indian J Cancer [serial online] 2011 [cited 2020 Jul 10 ];48:514-515
Available from: http://www.indianjcancer.com/text.asp?2011/48/4/514/92248


Full Text

Sir,

Lung cancer is the first cause of cancer death worldwide. The prognosis of patients with advanced non-small-cell lung cancer (NSCLC) remains poor. Recent phase III trials demonstrated median survivals from 8 to 10 months and only 4-8% of patients have been reported to survive more than 5 years. [1],[2] We write to you to share an unexpected and hopeful experience: A NSCLC patient with an advanced disease, now in 12-year remission.

Mr. E, a 58-year-old man, consulted us in June 1998 because of chest pain and weight loss. The patient was a heavy smoker (20 pack year). He had a good performance status and no significant medical history. Thoracic computed tomography (CT) revealed an upper lobe mass of 9 × 7.6 cm in the right lung associated with mediastinal lymphadenopathy. Fibroscopic bronchoscopy did not show any neoplastic lesion. A CT-guided biopsy was performed and the histopathological report showed features consistent with squamous carcinoma. Immunohistochemical staining was positive for cytokeratin 7/5/6 while cytokeratin 20 was negative. This profile assessed the diagnosis of stage III NSCLC (T3, N1, M0). He was not a suitable candidate for surgery. Chemoradiotherapy was performed (64 Gy in 32 fractions in 4 weeks) with three cycles of cisplatin and vinorelbin. A CT after the end of treatment showed a partial response with a continued benefice at 1-year control. Twelve years later, the patient is asymptomatic with a good performance status, good quality of life, and no evidence of recurrence.

Such unexpected clinical remission and long-term survival is extremely rare. Several reports in the literature tried to establish prognostic models. Some suggested that good performance status, weight loss, adenocarcinoma histotype, resectable N2, T3N0, single-site distant metastasis, and EGFR-TKI therapy play an important role in the long-term survival.[1] ,[2]

A systematic overview of the literature suggested additional factors to refine the accuracy of prognosis: age, number of sites involved, hemoglobin, LDH, and albumin.[3]

We should keep in mind such cases when discussing with patients about fears, hopes, and realistic expectations. More researches are required to fully assess more accurate predictors of the outcome. Further prognostic markers as EGFR mutation should be investigated. New promising factors include proliferation markers, Ki-67, NSE, TPA, and coagulation factors. [3]

References

1Wang T, Nelson RA, Bogardus A, Grannis FW Jr. Five-year lung cancer survival: Which advanced stage non small cell lung cancer patients attain long-term survival? Cancer 2010;116:1518-25.
2Kaira K, Takahashi T, Murakami H, Tsuya A, Nakamura Ynone , Naito Tnone ,et al. Long-term survivors of more than 5 years in advanced non-small cell lung cancer. Lung Cancer 2010;67:120-3.
3Brundage MD, Davies D, Mackillop WJ. Prognostic Factors in Non-small Cell Lung Cancer: A Decade of Progress. Chest 2002;122:107-57.