Journal Article

Chest Tube Drainage, Bone Radiotherapy, and Brain Radiotherapy in Advanced Lung Cancer: A Retrospective Analysis of Associated Factors and Survival

Okamoto, Isamu, Yamamoto, Nobuyuki, Shintani, Yasushi, Takahashi, Kazuhisa, Miyaoka, Etsuo, Inoue, Akira, Shimamura, Shoko Sonobe, Yoshino, Ichiro, Shukuya, Takehito, Takayama, Koichi, Kawaguchi, Tomoya, Date, Hiroshi, Sekine, Ikuo

2025

Overview

Background Palliative interventions, such as chest tube drainage and radiotherapy for bone and brain metastases, are crucial for managing survival and quality of life in patients with advanced lung cancer. Methods This retrospective study analyzed 8171 patients with unresectable Stage IV lung cancer from the Japanese Joint Committee of Lung Cancer Registry (JJCLCR) database. At treatment initiation, 8.6% of patients underwent chest tube drainage, 9.9% underwent bone radiotherapy, and 11.5% underwent brain radiotherapy. In this study, associated factors for palliative interventions were evaluated, and their impact on patient survival was also assessed. Results High‐associated factors for upfront chest tube drainage included age ≥ 75 years, ECOG‐PS ≥ 2, pleural nodules, and adenocarcinoma, while EGFR mutation, serum albumin ≥ 3.2 mg/dL, adrenal gland, and brain metastases were low‐associated factors. For upfront brain radiotherapy, low‐associated factors included malignant pleural effusion (MPE) and bone metastases, whereas ECOG‐PS ≥ 2 was a high‐associated factor. High‐associated factors for upfront bone radiotherapy were serum albumin ≥ 3.2 mg/dL, ECOG‐PS ≥ 2, adenocarcinoma, and squamous cell carcinoma, while pleural nodules, MPE, liver, and brain metastasis were low‐associated factors. Patients receiving upfront bone radiotherapy had shorter survival, whereas survival did not significantly differ for those with or without upfront chest tube drainage or brain radiotherapy. Conclusion This study identified associated factors for palliative interventions in advanced lung cancer and their association with overall survival. Future prospective studies with more detailed data are necessary to confirm these findings and improve clinical decision‐making. Trial Registration: Approval No. 15,321 This retrospective study analyzed 8171 patients with unresectable Stage IV lung cancer from the JJCLCR database to assess associated factors for palliative interventions (chest tube drainage, bone radiotherapy, and brain radiotherapy) and their impact on survival. It identified high‐ and low‐associated factors for each intervention. Patients undergoing upfront bone radiotherapy had shorter survival, while no significant survival differences were observed for chest tube drainage or brain radiotherapy. The study highlights the need for future prospective research to validate these findings and improve palliative care decision‐making in advanced lung cancer.

• Publisher: John Wiley & Sons Australia, Ltd,John Wiley & Sons, Inc,Wiley
• Subject: Aged / Aged, 80 and over / associated factors / Bone Neoplasms - radiotherapy / Bone Neoplasms - secondary / Bone Neoplasms - therapy / Brain Neoplasms - mortality / Brain Neoplasms - radiotherapy / Brain Neoplasms - secondary / Brain Neoplasms - therapy / Cancer therapies / chest tube drainage / Chest Tubes / Combination therapy / Cranial Irradiation / Data collection / Drainage - methods / Female / Humans / Immunotherapy / Kinases / Lung cancer / Lung diseases / Lung Neoplasms - mortality / Lung Neoplasms - pathology / Lung Neoplasms - radiotherapy / Lung Neoplasms - therapy / Male / Medical prognosis / Metastasis / Middle Aged / Mutation / Nervous system / Original / Palliative Care / Patients / Radiation therapy / radiotherapy / Respiratory system / Retrospective Studies / Sarcoma / Software / Surgery / Tomography / Universal Serial Bus