Prognosis and it related factors in patients of stage III non-smallcell lung cancer after three-dimensional conformal radiotherapy

Abstract

Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC). Methods From 2000 to 2010, 474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects. Those patients, consisting of 382 males and 92 females, had a median age of 63 years. In those patients, 211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC; 165 were treated with radiotherapy alone and 309 with chemoradiotherapy; 55 were treated with conventional radiotherapy plus 3DCRT, 340 with 3DCRT, and 79 with intensity-modulated radiotherapy; the median equivalent dose was 60 Gy (44-77 Gy). The Kaplan-Meier method, log-rank test, and Cox model were used for survival rate calculation, univariate analysis, and multivariate analysis, respectively. Results The follow-up rate was 96.6%.In all patients, the 1-, 3-, and 5-year overall survival rates were 63.0%, 24.9%, and 17.8%, respectively; the median survival time was 18 months. The univariate analysis showed that sex, age, immediate response, radiotherapy method, fractionation scheme, chemotherapy, and radiation pneumonitis (RP) were prognostic factors (P=0.004, 0.001, 0.000, 0.007, 0.004, 0.009, 0.049). The multivariate analysis showed that sex, age, immediate response, radiotherapy method, and RP were independent prognostic factors (P=0.006, 0.000, 0.000, 0.003, 0.048). Patients with radiation doses of 60-66 Gy had the best prognosis of all. Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT, female patients, patients at a young age, patients with satisfactory immediate response, patients treated with full-course 3DCRT, and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients. A radiation dose of 60-66 Gy is recommended. Key words: Lung neoplasms/radiotherapy; Radiotherapy, two-dimensional; Radiotherapy, three-dimensional; Prognosis