Journal article
Results of a Single Institution Experience with Dose-Escalated Chemoradiation for Locally Advanced Unresectable Non-Small Cell Lung Cancer
Frontiers in oncology, v 7, pp 1-1
23 Jan 2017
PMID: 28168163
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Background: We determined factors associated with morbidity and outcomes of a series of non-small cell lung cancer (NSCLC) patients treated with dose-escalated chemoradiotherapy at the University of Pittsburgh Lung Cancer Program.
Methods and materials: The records of 170 stage III NSCLC patients treated with definitive intent were retrospectively reviewed. All patients received four-dimensional CT simulation scan and had respiratory gating if tumor movement exceeded 5 mm. Overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FFDM) were calculated using log-rank and Cox regression analysis.
Results: For the present series of patients, median follow-up was 36.6 months, median survival 27.4 months, and the 2- and 4-year OS was 56.0 and 30.7%, respectively. The 4-year LRC and FFDM were 43.9 and 40.7%, respectively. No benefit was associated with irradiation doses above 66 Gy in OS (p = 0.586), LRC (p = 0.440), or FFDM (p = 0.230). On univariate analysis, variables associated with worse survival included: clinical stage IIIB (p = 0.037), planning target volume (PTV) over 450 cc (p < 0.001), heart V-30 over 40% (p = -0.048), and esophageal mean dose over 20% (p = 0.024), V-5 (p = -0.015), and V-60 (p = -0.011). On multivariable analysis, PTV above 450 cc (52.2 vs. 25.3 months, p < 0.001) and esophageal V-60 >20% (43.8 vs. 21.3 months, p = -0.01) were associated with lower survival. Grade 2 or higher acute lung toxicity and esophagitis were detected in 9.5 and 59.7%, respectively of patients. Grade 2 or higher acute lung toxicity was reduced if lung V-5 was <= 65 (7.4 vs. 23.8%, p = 0.03). Grade 2 or higher acute esophagitis was reduced if V-60 <= 20% (62 vs. 81.3%, p = 0.018). The use of intensity -modulated radiation therapy was more frequent in stage IIIB compared to stage IIIA patients (56.5 vs. 39.5%, p = 0.048) and was associated with a higher lung V-5 and V-10.
Conclusion: The outcomes of a program of dose-escalated chemoradiotherapy for unresectable stage IIIA and IIIB NSCLC patients were consistent with other studies and showed no benefit to radiation doses above 66 Gy. Furthermore, maintaining low esophageal V-60 and lung V-5 were associated with lower morbidity and mortality.
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Details
- Title
- Results of a Single Institution Experience with Dose-Escalated Chemoradiation for Locally Advanced Unresectable Non-Small Cell Lung Cancer
- Creators
- Mark E. Bernard - UPMC Hillman Cancer CenterScott M. Glaser - UPMC Hillman Cancer CenterBeant S. Gill - UPMC Hillman Cancer CenterSushil Beriwal - UPMC Hillman Cancer CenterDwight E. Heron - UPMC Hillman Cancer CenterJames D. Luketich - University of Pittsburgh Medical CenterDavid M. Friedland - University of Pittsburgh Medical CenterMark A. Socinski - University of Pittsburgh Medical CenterJoel S. Greenberger - UPMC Hillman Cancer Center
- Publication Details
- Frontiers in oncology, v 7, pp 1-1
- Publisher
- Frontiers Media Sa
- Number of pages
- 8
- Grant note
- Department of Radiation Oncology of UPCI
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Radiation Oncology (and Nuclear Medicine)
- Web of Science ID
- WOS:000392384200001
- Scopus ID
- 2-s2.0-85012235869
- Other Identifier
- 991021897379304721
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- Web of Science research areas
- Oncology