Identifying the Optimal Radiation Dose in Locally Advanced Non–Small-cell Lung Cancer Treated With Definitive Radiotherapy Without Concurrent Chemotherapy

Sonnick, Mark A.; Oro, F.; Yan, Benjamin C.; Desai, A.Y.; Wu, Abraham J.; Shi, Wei; Zhang, Zhigang; Gelblum, Daphna Y.; Paik, Paul K.; Rosenzweig, Kenneth E.; Chaft, Jamie E.

doi:10.1016/j.cllc.2017.06.019

Cited by 13 publications

(8 citation statements)

References 21 publications

(31 reference statements)

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“…Patients who refuse or are not candidates for chemotherapy often receive RT alone. RT alone, however, confers a 5-year OS rate of about 5-6% [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated vs. conventional radiation therapy for stage III non-small cell lung cancer treated without chemotherapy

et al. 2019

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Background: Patients with unresectable locally advanced NSCLC who refuse or are not candidates for chemotherapy often receive radiation therapy (RT) alone. Hypofractionated RT (HFRT) regimens are becoming increasingly common. An analysis of the National Cancer Database (NCDB) was performed to evaluate the practice patterns and outcomes of HFRT vs. conventionally fractionated RT (CFRT) in patients with stage III NSCLC undergoing definitive RT alone. Material and methods: The NCDB was queried for all patients with stage III NSCLC diagnosed between 2004 and 2014 who received RT alone. CFRT was defined as patients treated to a total dose of 60-80 Gy in 1.8-2 Gy daily fractions. HFRT was defined as patients treated to a total dose of 50-80 Gy in 2.25-4 Gy fractions. Logistic regression, univariable and multivariable analyses (MVAs) for overall survival (OS) and propensity score matched analyses (PSMAs) were performed. Results: A total of 6490 patients were evaluated: 5378 received CFRT and 1112 received HFRT. Median CFRT dose was 66 Gy in 2 Gy fractions vs. 58.5 Gy in 2.5 Gy fractions for HFRT. HFRT was associated with older age, lower biological effective dose (BED 10 ), academic facility type, higher T-stage and lower N-stage. On initial analysis, HFRT was associated with inferior OS (median 9.9 vs. 11.1 months, p<.001), but after adjusting for the imbalance in covariates such as age, BED 10 , T-stage and N-stage using PSMA, the difference in survival was no longer significant (p¼.1). Conclusions: In the appropriate clinical context, HFRT can be an option for patients with locally advanced NSCLC who are not candidates for chemotherapy or surgical resection. HFRT needs to be further studied in prospective trials to evaluate toxicity and tumor control.

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“…Patients who refuse or are not candidates for chemotherapy often receive RT alone. RT alone, however, confers a 5-year OS rate of about 5-6% [4,7,8].…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated vs. conventional radiation therapy for stage III non-small cell lung cancer treated without chemotherapy

et al. 2019

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“…In this study, shrinking field radiation slightly reduced overall survival, though this difference was not statistically different. One reason that may partly explain this phenomenon is the larger tumor volume of the patients with tumor shrinkage may negatively impact prognosis [ 22 , 23 ]. Moreover, different treatment after disease progression may influence OS.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study of shrinking field radiation therapy during chemoradiotherapy in stage III non-small cell lung cancer

et al. 2018

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Backgroundand purpose: This retrospective study aimed to investigate the feasibility of shrinking field radiotherapy during chemoradiotherapy in non-small cell lung cancer (NSCLC).Patients and methodsNinety-seven patients with stage III NSCLC who achieved a good response to chemoradiation were analyzed. Computed tomography was performed after 40-50 Gy dose radiation to evaluate curative effect. Patients in the shrinking field group underwent resimulation CT scans and shrinking field radiotherapy. Acute symptomatic irradiation-induced pneumonia (ASIP), progression patterns and survival were assessed.ResultsOf the 97 patients who achieved response after a median total dose of 60 Gy, fifty patients received shrinking field radiotherapy. The incidence of acute symptomatic irradiation-induced pneumonia tended to be lower for the shrinking field group (18.0% vs. 23.4%, P = 0.51). The rate of disease progression was significantly higher in the non-shrinking than shrinking field group (95.7% vs. 66.0%, P < 0.001). Compared to the non-shrinking field group, the shrinking field group had similar overall survival (30.0 vs. 30.0 months, P = 0.58) but significantly better median progression-free survival (14.0 vs. 11.0 months, P = 0.006).ConclusionsShrinking field radiotherapy during chemoradiotherapy in stage III non-small cell lung cancer seems safe with acceptable toxicities and relapse, and potentially spares normal tissues and enables dose escalation. Prospective trials are warranted.

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“…From a total of 241 inoperable stage III LA-NSCLC patients treated with IMRT in combination with concurrent/sequential chemotherapy between 2004 and 2014 at the Memorial Sloan Kettering Cancer Center [36], [37], this Institutional Review Board approved retrospective study included the 155 patients that had ECG acquired before and after RT. Among these patients, 65% received concurrent chemotherapy, while 35% received sequential chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

Dose to the cardio-pulmonary system and treatment-induced electrocardiogram abnormalities in locally advanced non-small cell lung cancer

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et al. 2019

Clinical and Translational Radiation Oncology

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Identifying the Optimal Radiation Dose in Locally Advanced Non–Small-cell Lung Cancer Treated With Definitive Radiotherapy Without Concurrent Chemotherapy

Cited by 13 publications

References 21 publications

Hypofractionated vs. conventional radiation therapy for stage III non-small cell lung cancer treated without chemotherapy

Hypofractionated vs. conventional radiation therapy for stage III non-small cell lung cancer treated without chemotherapy

A retrospective study of shrinking field radiation therapy during chemoradiotherapy in stage III non-small cell lung cancer

Dose to the cardio-pulmonary system and treatment-induced electrocardiogram abnormalities in locally advanced non-small cell lung cancer

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