Matthew Koshy1, Renu Malik2, David J Sher3, Michael Spiotto4, Usama Mahmood5, Bulent Aydogan4, Ralph R Weichselbaum4. 1. Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL. Electronic address: mkoshy@radonc.uchicago.edu. 2. Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL. 3. Department of Radiation Oncology, Rush University Medical Center, Chicago, IL. 4. Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL. 5. Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX.
Abstract
BACKGROUND: In this study, we examined trends in the radiotherapy dose prescribed and the effect of dose escalation on survival in patients with stage III lung cancer. MATERIALS AND METHODS: Radiation dose prescription patterns were analyzed for 38,848 patients in the National Cancer Database with clinical stage III disease who underwent concurrent chemoradiation between 2004 and 2011 to a dose between 57 and 80 Gy. Survival information was available for patients diagnosed from 2004 to 2006 (n = 12,024). Overall survival (OS) was estimated using Kaplan-Meier methods. Cox proportional hazard regression was used to estimate hazard ratios (HRs). RESULTS: The percentage of patients treated to ≥ 64 Gy increased from 50% in 2004 to 62% in 2011 (P < .001). The 5-year OS was 12% for patients treated between 57 and 59.3 Gy, 14% for patients treated at 59.4 to 62.9 Gy, 16% for patients treated at 63 to 66 Gy and 66.1 to 73.9 Gy, and 13% for patients treated at 74 to 80 Gy (P < .0001). In multivariate analysis, the estimated HR (95% confidence interval) was 1.3 (1.1-1.6) for 57 to 59.3 Gy, 1.0 (0.9-1.2) for 59.4 to 62.9 Gy, 0.9 (0.9-1.2) for 63 to 66 Gy, 0.9 (0.8-1.1) for 66.1 to 73.9 Gy, and 1.0 (referent) for the 74 to 80 Gy cohort. There was no significant difference in the HR for the dose groups > 59.4 Gy compared with the 74 to 80 Gy cohort. CONCLUSION: There was no improvement in OS with radiotherapy dose escalation beyond 59.4 Gy for patients with unresectable clinical stage III lung cancer treated with chemoradiation.
BACKGROUND: In this study, we examined trends in the radiotherapy dose prescribed and the effect of dose escalation on survival in patients with stage III lung cancer. MATERIALS AND METHODS: Radiation dose prescription patterns were analyzed for 38,848 patients in the National Cancer Database with clinical stage III disease who underwent concurrent chemoradiation between 2004 and 2011 to a dose between 57 and 80 Gy. Survival information was available for patients diagnosed from 2004 to 2006 (n = 12,024). Overall survival (OS) was estimated using Kaplan-Meier methods. Cox proportional hazard regression was used to estimate hazard ratios (HRs). RESULTS: The percentage of patients treated to ≥ 64 Gy increased from 50% in 2004 to 62% in 2011 (P < .001). The 5-year OS was 12% for patients treated between 57 and 59.3 Gy, 14% for patients treated at 59.4 to 62.9 Gy, 16% for patients treated at 63 to 66 Gy and 66.1 to 73.9 Gy, and 13% for patients treated at 74 to 80 Gy (P < .0001). In multivariate analysis, the estimated HR (95% confidence interval) was 1.3 (1.1-1.6) for 57 to 59.3 Gy, 1.0 (0.9-1.2) for 59.4 to 62.9 Gy, 0.9 (0.9-1.2) for 63 to 66 Gy, 0.9 (0.8-1.1) for 66.1 to 73.9 Gy, and 1.0 (referent) for the 74 to 80 Gy cohort. There was no significant difference in the HR for the dose groups > 59.4 Gy compared with the 74 to 80 Gy cohort. CONCLUSION: There was no improvement in OS with radiotherapy dose escalation beyond 59.4 Gy for patients with unresectable clinical stage III lung cancer treated with chemoradiation.
Authors: Cary Oberije; Dirk De Ruysscher; Ruud Houben; Michel van de Heuvel; Wilma Uyterlinde; Joseph O Deasy; Jose Belderbos; Anne-Marie C Dingemans; Andreas Rimner; Shaun Din; Philippe Lambin Journal: Int J Radiat Oncol Biol Phys Date: 2015-04-30 Impact factor: 7.038
Authors: Areo G Saffarzadeh; Maureen Canavan; Benjamin J Resio; Samantha L Walters; Kaitlin M Flores; Roy H Decker; Daniel J Boffa Journal: JTO Clin Res Rep Date: 2021-06-24
Authors: Vladmir C Cordeiro de Lima; Clarissa S Baldotto; Carlos H Barrios; Eldsamira M Sobrinho; Mauro Zukin; Clarissa Mathias; Facundo Zaffaroni; Rodrigo C Nery; Gabriel Madeira; Alex V Amadio; Juliano C Coelho; Guilherme Geib; Maria Fernanda Simões; Gilberto Castro Journal: J Glob Oncol Date: 2018-09