Comparison of efficacy and safety between simultaneous integrated boost intensity-modulated radiotherapy and conventional intensity-modulated radiotherapy in locally advanced non-small-cell lung cancer: a retrospective study

Daquan Wang,Xiaotong Lu,Xin Wang,Lizhong Wu ,Jun Liang,Zhouguang Hui,Wei Xue ,Xiaozhen Wang,Dongfu Chen,Qinfu Feng,Jima Lv,Zefen Xiao,Kuo Xu ,Tao Zhang,Lei Deng,Wenqing Wang,Chunyu Wang,Zongmei Zhou,Nan Bi,Jingbo Wang,Lühua Wang

doi:10.1186/s13014-019-1259-3

Abstract

BackgroundConsistent results are lacking as regards the comparative effectiveness of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) versus conventional intensity-modulated radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). Therefore, we conducted a retrospective analysis to demonstrate the role of SIB-IMRT for patients.MethodsPatients who had histologically confirmed NSCLC, stage III disease and received thoracic IMRT between 2014 and 2016 were retrospectively reviewed. The survival, toxicities and dose to organs at risk (OAR) were compared among patients irradiated with different techniques. The SIB-IMRT plans were designed to deliver 45–59.4Gy (median: 50.4Gy) to PTV while simultaneously delivering 50-70Gy (median: 59.92Gy) to PGTV. As for conventional IMRT plans, a total dose of 50-70Gy (median: 60Gy) was delivered to PTV.Results426 patients with stage III NSCLC were eligible for analysis, including 128 with SIB-IMRT and 298 with conventional IMRT. The SIB-IMRT group had more stage IIIB disease (69.5% vs. 53%, P = 0.002), larger planning treatment volumes (median: 504 ml vs. 402 ml, P<0.001), and a larger planning treatment volume/volume of lung ratio (median, 0.18 vs. 0.12, P<0.001). The median OS of the SIB-IMRT and conventional IMRT groups were 34.5 and 31.7 months, with the 2-year rate of 60.4 and 59%, respectively (P = 0.797). No difference in PFS, LRFS or DMFS was observed between the two techniques. Patients treated with SIB-IMRT got similar lung and esophageal toxicities versus those with conventional IMRT.ConclusionsSIB-IMRT may be an effective and safe option for patients with locally advanced NSCLC, especially for those with large mass or wide lymph node metastasis.

Highlights

Consistent results are lacking as regards the comparative effectiveness of simultaneous integrated boost intensity-modulated radiotherapy (SIB-Intensity-modulated radiation technique (IMRT)) versus conventional intensity-modulated radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-non-small cell lung cancer (NSCLC))
Patient characteristics A total of 426 patients with stage III NSCLC were eligible for analysis, including 128 with simultaneously integrated boost (SIB)-IMRT and 298 with conventional IMRT
SIB-IMRT group had more stage IIIB disease (69.5% vs. 53%, P = 0.002), larger planning treatment volumes, and a larger planning treatment volume/volume of lung ratio

Summary

Introduction

Consistent results are lacking as regards the comparative effectiveness of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) versus conventional intensity-modulated radiotherapy in patients with locally advanced non-small-cell lung cancer (LA-NSCLC). 30% of patients with non-small cell lung cancer (NSCLC) belong to the locally advanced stage [1], and definitive thoracic radiotherapy concurrently with chemotherapy is the standard care [2] [3]. The incidence of symptomatic RP was reported to be about 20–30% in NSCLC patients treated with concurrent chemoradiotherapy [4, 5] It might result in a decreased treatment intensification, such as interruption of radiotherapy or low tolerance of chemotherapy. Intensity-modulated radiation technique (IMRT) has been proven to improve tumor control and to reduce lung toxicities and lower cardiac doses [5, 6]. An increased death risk by 38% was observed, which might due to increased radiation-induced toxicities [7]

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