Matthew Koshy1, Renuka Malik2, Michael Spiotto3, Usama Mahmood4, Chad G Rusthoven5, David J Sher6. 1. Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA. Electronic address: mkoshy@radonc.uchicago.edu. 2. Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA. 3. Department of Radiation Oncology, University of Illinois at Chicago, Chicago, IL, USA; Department of Radiation and Cellular Oncology, The University of Chicago, Chicago, IL, USA. 4. Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 5. Department of Radiation Oncology, University of Colorado, Aurora, CO, USA. 6. Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, TX, USA.
Abstract
PURPOSE: To determine the effect of radiotherapy (RT) technique on treatment compliance and overall survival (OS) in patients with stage III non-small lung cancer (NSCLC) treated with definitive chemoradiotherapy (CRT). METHODS AND MATERIALS: This study included patients with stage III NSCLC in the National Cancer Database treated between 2003 and 2011 with definitive CRT to 60-63 Gray (Gy). Radiation treatment interruption (RTI) was defined as a break of ≥4 days. Treatment technique was dichotomized as intensity modulated (IMRT) or non-IMRT techniques. RESULTS: Out of the cohort of 7492, 35% had a RTI and 10% received IMRT. With a median follow-up of surviving patients of 32 months, the median survival for those with non-IMRT vs. IMRT was 18.2 months vs. 20 months (p<0.0001). Median survival for those with and without an RTI≥4 days was 16.1 months vs. 19.8 months (p<0.0001). Use of IMRT predicted for a decreased likelihood of RTI (odds ratio, 0.84, p=0.04). On multivariable analysis for OS, IMRT had a HR of 0.89 (95% CI: 0.80-0.98, p=0.01) and RTI had a HR of 1.2 (95% confidence interval (CI): 1.14-1.27, p=0.001). CONCLUSIONS: IMRT was associated with small but significant survival advantage for patients with stage III NSCLC treated with CRT. A RTI led to inferior survival, and both IMRT and RTI were independently associated with OS. Additional research should investigate whether improved tolerability, reduced normal tissue exposure, or superior coverage drives the association between IMRT and improved survival.
PURPOSE: To determine the effect of radiotherapy (RT) technique on treatment compliance and overall survival (OS) in patients with stage III non-small lung cancer (NSCLC) treated with definitive chemoradiotherapy (CRT). METHODS AND MATERIALS: This study included patients with stage III NSCLC in the National Cancer Database treated between 2003 and 2011 with definitive CRT to 60-63 Gray (Gy). Radiation treatment interruption (RTI) was defined as a break of ≥4 days. Treatment technique was dichotomized as intensity modulated (IMRT) or non-IMRT techniques. RESULTS: Out of the cohort of 7492, 35% had a RTI and 10% received IMRT. With a median follow-up of surviving patients of 32 months, the median survival for those with non-IMRT vs. IMRT was 18.2 months vs. 20 months (p<0.0001). Median survival for those with and without an RTI≥4 days was 16.1 months vs. 19.8 months (p<0.0001). Use of IMRT predicted for a decreased likelihood of RTI (odds ratio, 0.84, p=0.04). On multivariable analysis for OS, IMRT had a HR of 0.89 (95% CI: 0.80-0.98, p=0.01) and RTI had a HR of 1.2 (95% confidence interval (CI): 1.14-1.27, p=0.001). CONCLUSIONS: IMRT was associated with small but significant survival advantage for patients with stage III NSCLC treated with CRT. A RTI led to inferior survival, and both IMRT and RTI were independently associated with OS. Additional research should investigate whether improved tolerability, reduced normal tissue exposure, or superior coverage drives the association between IMRT and improved survival.
Authors: Núria Rodríguez De Dios; Arturo Navarro-Martin; Cristina Cigarral; Rodolfo Chicas-Sett; Rafael García; Virginia Garcia; Jose Antonio Gonzalez; Susana Gonzalo; Mauricio Murcia-Mejía; Rogelio Robaina; Amalia Sotoca; Carmen Vallejo; German Valtueña; Felipe Couñago Journal: World J Clin Oncol Date: 2022-04-24
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Authors: Eric D Miller; James L Fisher; Karl E Haglund; John C Grecula; Meng Xu-Welliver; Erin M Bertino; Kai He; Peter G Shields; David P Carbone; Terence M Williams; Gregory A Otterson; Jose G Bazan Journal: Radiat Oncol Date: 2018-10-05 Impact factor: 3.481