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Identifying the Optimal Radiation Dose in Locally Advanced Non-Small-cell Lung Cancer Treated With Definitive Radiotherapy Without Concurrent Chemotherapy.
- Source :
-
Clinical lung cancer [Clin Lung Cancer] 2018 Jan; Vol. 19 (1), pp. e131-e140. Date of Electronic Publication: 2017 Jul 06. - Publication Year :
- 2018
-
Abstract
- Introduction: The optimal radiation dose for locally advanced non-small-cell lung cancer (NSCLC) is not known for patients who receive sequential chemoradiation (CRT) or definitive radiotherapy (RT) only. Our objective was to determine whether a benefit exists for radiation dose escalation for these patients.<br />Materials and Methods: The patients included in our retrospective analysis had undergone RT for NSCLC from 2004 to 2013, had not undergone surgery, and received a dose ≥ 50.0 Gy. Patients who received concurrent CRT were excluded from the analysis, leaving 336 patients for analysis. The primary outcomes were overall survival (OS), local failure (LF), and distant failure (DF).<br />Results: On multivariate analysis, after adjusting for age, Karnofsky performance status, gross tumor volume, and treatment modality, patients treated with a radiation dose > 66 Gy had significantly improved OS compared with those treated with < 60 Gy (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.39-0.87; P = .008). After adjusting for smoking history and radiologic tumor size, patients treated with a radiation dose > 66 Gy had a significantly decreased risk of LF compared with those treated with < 60 Gy (HR, 0.59; 95% CI, 0.38-0.91; P = .02). The radiation dose was not an independent prognostic factor of DF on multivariate analysis.<br />Conclusion: When controlling for tumor volume and/or dimensions and other independent prognostic factors, patients with locally advanced NSCLC who were not candidates for concurrent CRT benefited from a radiation dose > 66 Gy versus < 60 Gy with improved OS and reduced LF. An increased radiation dose did not appear to affect the incidence of DF.<br /> (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung mortality
Carcinoma, Non-Small-Cell Lung pathology
Chemoradiotherapy
Cigarette Smoking adverse effects
Female
Humans
Lung Neoplasms mortality
Lung Neoplasms pathology
Male
Middle Aged
Neoplasm Staging
Prognosis
Retrospective Studies
Survival Analysis
Tumor Burden
Carcinoma, Non-Small-Cell Lung radiotherapy
Lung Neoplasms radiotherapy
Radiotherapy Dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1938-0690
- Volume :
- 19
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Clinical lung cancer
- Publication Type :
- Academic Journal
- Accession number :
- 28756051
- Full Text :
- https://doi.org/10.1016/j.cllc.2017.06.019