High dose radiation therapy based on normal tissue constraints with concurrent chemotherapy achieves promising survival of patients with unresectable stage III non-small cell lung cancer.

Abstract

BACKGROUND AND PURPOSE:

We aimed to investigate the potential of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS:

Individually prescribed radiation doses were calculated based on NTC. Patients with total tumour radiation doses ≥66 Gy were assigned to the high dose (HD, ≥66 Gy) group, and all other patients were assigned to the standard-dose (SD, <66 Gy) group. Each patient was retrospectively assigned an Eighth edition of American Joint Committee on Cancer disease stage based on the imaging data of initial diagnosis to avoid over- and under-staging. Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival.

RESULTS:

From March 2006 to September 2012, 140 patients were enrolled and assigned to two groups: 71 patients into the HD group and 69 patients into the SD group. The median survival time (MST) was significantly higher in the HD group (33.5 months) than in the SD group (21 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the HD group than in the SD group (37.8% vs 16.7%). Median progression-free survival was 19 months in the HD group and 11 months in the SD group (p < 0.0001). No difference in severe (grade 3-5) toxic effects was noted between the two groups.

CONCLUSIONS:

The significant positive association observed between prescribed dose and survival suggests that individualized isotoxic dose-escalated radiation based on NTC might improve survival in this cohort of stage III NSCLC Chinese patients.

• Authors: Qian Zhao, Ming Liu, Zhongtang Wang, Wei Huang, X Allen Li, Tao Zhou, Jian Zhang, Zicheng Zhang, Qiang Wang, Shuzeng Yu, Dan Han, Hongfu Sun, Hongsheng Li, Haiqun Lin, Baosheng Li
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 145 Pg. 7-12 (04 2020) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 31869678 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Elsevier B.V. All rights reserved.

Topics

• Antineoplastic Combined Chemotherapy Protocols
• Carcinoma, Non-Small-Cell Lung (pathology)
• Chemoradiotherapy
• Humans
• Lung Neoplasms (pathology)
• Neoplasm Staging
• Retrospective Studies