Risk factors of treatment-related death in chemotherapy and thoracic radiotherapy for lung cancer

We retrospectively analysed the incidence and risk factors of treatment-related death in the treatment of chemotherapy- and thoracic radiotherapy-naive patients with lung cancer. Between July 1992 and December 1997, 1799 patients were diagnosed as having lung cancer in our hospital and 926 patients received chemotherapy and/or thoracic radiotherapy. 25 patients (2.7%) died from toxicity of the treatment, 10 from pneumonia, 7 from radiation pneumonitis, 6 from sepsis, 1 from perforation of the small intestine and 1 for an unknown reason. 18 patients (2.3%) died from chemotherapy-related toxicity. The incidence of treatment-related death (TRD) from chemotherapy was highly correlated with the performance status (PS), PS 0: 0.7%, PS 1. 2.2%, PS 2. 4.0%. PS 3. 7.7% and PS 4. 25% (P = 0.004). 7 patients (1.6%) died from pneumonitis after thoracic radiotherapy. Multivariate analyses demonstrated that poor PS (relative risk (RR): 1.95, 95% confidence interval (CI): 1.05-3.65, P = 0.034) and chemotherapy using the cisplatin + vindesine + mitomycin C regimen (RR: 9.36, 95% CI: 1.29-68.0, P = 0.027) are associated with treatment-related death from chemotherapy. Pulmonary fibrosis identified on a plain chest X-ray film (RR: 165.7, 95% Ct: 8.79-3122, P < 0.001), the combination of cisplatin + irinotecan (RR: 120.5, 95% CI: 2.90 4993. P = 0.012). advanced age (RR: 1.17, 95% CI: 1.002-1.37, P = 0.047), and elevated lactate dehydrogenase (LDH) (RR: 10.4. 95% CI: 1.20-90.2, P = 0.033) were also associated with treatment-related death from thoracic radiotherapy. The administration of mitomycin C in addition to cisplatin-based regimens for patients with lung cancer should be carefully considered. (C) 2001 Elsevier Science Ltd. All rights reserved.