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Indian Journal of Cancer
Medknow Publications on behalf of Indian Cancer Society
ISSN: 0019-509X EISSN: 1998-4774
Vol. 48, Num. 4, 2011, pp. 514-515

Indian Journal of Cancer, Vol. 48, No. 4, October-December, 2011, pp. 514-515

Letter to Editor

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

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

Code Number: cn11136

PMID: 22293271
DOI: 10.4103/0019-509X.92248


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]


1.Wang 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.   Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Kaira 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.  Back to cited text no. 2    
3.Brundage MD, Davies D, Mackillop WJ. Prognostic Factors in Non-small Cell Lung Cancer: A Decade of Progress. Chest 2002;122:107-57.  Back to cited text no. 3    

Copyright 2011 - Indian Journal of Cancer

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