The following is a summary of “Patterns of Failure and Optimal Treatment Paradigm for Large, Inoperable, Node-Negative Non–small Cell Lung Cancer” published in the November 2022 issue of Clinical Lung Cancer by Schneider et al.

Large, node-negative, non-small cell lung cancer (NSCLC) patients have an unclear non-operative therapeutic option. To inform this population’s most effective treatment paradigms, researchers analyzed failure patterns and the effects of radiation therapy (RT) and chemotherapy use.

Patients with nodal-negative non-small cell lung cancer and primary tumors measuring 5+cm or more were identified for definitive RT. The starting points of development were studied. The cumulative incidence function and Kaplan-Meier methods were used to examine local progression, regional/distant progression, progression-free survival, and overall survival. Univariate and multivariate competing risk regression was used to analyze the relationship between clinicopathologic factors and the likelihood of local versus regional/distant progression after treatment.

There were 88 patients selected for this study. An initial study of failure patterns among patients with recurrent illness (N=36) showed that isolated distant (27.8%) and isolated regional progression (22.2%) were the most common. It was shown that 88.9% of advanced patients had distant or regional failure as part of their initial failure, while solitary local failure was unusual (11.1%). SBRT was linked to a lower risk of local progression (HR 0.23, P=.012), and chemotherapy was related to a lower risk of regional/distant progression (HR 0.12, P=.040), as determined by univariate and multivariate competing hazards regression analyses. There is a substantial risk of regional and distant progression in individuals with large, node-negative NSCLC who undergo final RT. Patients in this subset of the cancer population benefit from both SBRT and chemotherapy in terms of slowing regional and distant disease progression. When combined with the right systemic therapy, SBRT may be the ideal treatment.