24807158
BACKGROUND	Poor prognosis patients with bulky stage III locally advanced non-small-cell lung cancer may not be offered concurrent chemoradiotherapy ( CRT ) .
BACKGROUND	Following a phase III trial concerning the effect of palliative CRT in inoperable poor prognosis patients , this analysis was performed to explore how tumor size influenced survival and health-related quality of life ( HRQOL ) .
METHODS	A total of 188 poor prognosis patients recruited in a randomized clinical trial received four courses intravenous carboplatin day 1 and oral vinorelbine day 1 and 8 , at 3-week intervals .
METHODS	The experimental arm ( N = 94 ) received radiotherapy with fractionation 42 Gy/15 , starting at the second chemotherapy course .
METHODS	This subset study compares outcomes in patients with tumors larger than 7 cm ( N = 108 ) versus tumors 7 cm or smaller ( N = 76 ) .
RESULTS	Among those with tumors larger than 7 cm , the median overall survival in the chemotherapy versus CRT arm was 9.7 and 13.4 months , respectively ( p = 0.001 ) .
RESULTS	The 1-year survival was 33 % and 56 % , respectively ( p = 0.01 ) .
RESULTS	Except for a temporary decline during treatment , HRQOL was maintained in the CRT arm , regardless of tumor size .
RESULTS	Among those who did not receive CRT , patients with tumors larger than 7 cm experienced a gradual decline in the HRQOL .
RESULTS	The CRT group had significantly more esophagitis and hospitalizations because of side effects regardless of tumor size .
CONCLUSIONS	In patients with poor prognosis and inoperable locally advanced non-small-cell lung cancer , large tumor size should not be considered a negative predictive factor .
CONCLUSIONS	Except for performance status 2 , patients with tumors larger than 7 cm apparently benefit from CRT .

