International Journal of Hematology and Oncology 2022, Vol 32, Num 2 Page(s): 023-034
National Multi-Center Observational Retrospective Study to Understand Treatment Patterns and Outcomes for Stage III Non-Small Cell Lung Cancer Patients in Turkey: Turkish Society for Radiation Oncology Study, STONE Trial

Cem ONAL1, Ayse NUR DEMIRAL2, Banu ATALAR3, Deniz YALMAN4, Nergiz DAGOGLU5, Pervin HURMUZ6, Petek ERPOLAT7, Serap AKYUREK8, Sule KARABULUT GUL9, Tanju BERBER10, Ozan CEM GULER1, Cenk UMAY2, Fatma SERT4, Eray KARAHACIOGLU7, Sumerya DURU BIRGI8, Gokhan YAPRAK9, Esra KAYTAN SAGLAM5

1Baskent University Faculty of Medicine, Department of Radiation Oncology, Adana Dr Turgut Noyan Research and Treatment Center, Adana, TURKEY
2 Dokuz Eylul University Faculty of Medicine, Department of Radiation Oncology, Izmir, TURKEY
3Acibadem MAA University Maslak Hospital, Department of Radiation Oncology, Istanbul, TURKEY
4Ege University Faculty of Medicine, Department of Radiation Oncology, Izmir, TURKEY
5Istanbul University Istanbul Faculty of Medicine, Department of Radiation Oncology, Istanbul, TURKEY
6Hacettepe University Faculty of Medicine, Department of Radiation Oncology, Ankara, TURKEY
7Gazi University Faculty of Medicine, Department of Radiation Oncology, Ankara, TURKEY
8Ankara University Faculty of Medicine, Department of Radiation Oncology, Ankara, TURKEY
9Kartal Training and Research Hospital, Radiation Oncology Clinic, Istanbul, TURKEY
10Okmeydani Training and Research Hospital, Radiation Oncology Clinic, Istanbul, TURKEY

Keywords: Lung cancer, Stage III, Treatment patterns, Chemotherapy, Radiotherapy
This study investigated treatment patterns and outcomes in patients with inoperable stage III non-small cell lung cancer (NSCLC) treated with radiotherapy (RT) in Turkey. We included 492 patients with stage III NSCLC in this multi-center retrospective study. Patient demographics, clinical characteristics, and clinical treatment patterns from the time of the initial diagnosis to disease progression were recorded. Additionally, the prognostic factors predicting overall survival (OS) and progression-free survival (PFS) were analyzed. For the initial treatment, 429 patients (89.2%) received chemotherapy and RT, whereas 53 patients (10.8%) were treated only with RT. The first disease progression occurred in 288 patients (58.4%) at 9.3 months (median) after the initial treatment, and 64.6% received treatment after first progression. The second disease progression occurred in 30 patients, and 20 patients (66.7%) received treatment. Median OS and PFS were 27.0 months and 13.4 months, respectively. Age (p< 0.001), stage (p= 0.04), poor performance score (PS) (p= 0.03) and RT doses (p= 0.002) were independent predictors for OS and PFS in our multivariate analysis. Additional significant predictors for OS in the multivariate analysis were gender (p= 0.004), treatment period (0.02), and irradiation technique (p= 0.02). Disease progression occurred in nearly 58% of the patients, and one-third of these patients remained untreated during the disease progression. These findings indicate a need for additional treatment options in patients with unresectable stage III NSCLC with high-risk features, namely older age, stage IIIB disease, poor PS, and lower RT doses.