Treatment outcome and toxicity of intensity-modulated (chemo) radiotherapy in stage III non-small cell lung cancer patients.

Stephanie L A Govaert,Olga C J Schuurbiers,Paul N Span,Esther G C Troost,Ariën Termeer,Lioe-Fee De Geus-Oei,Johan Bussink

doi:10.1186/1748-717x-7-150

Abstract

PurposeThe aim of this retrospective cohort study was to assess treatment outcome, and acute pulmonary and esophageal toxicity using intensity modulated (sequential/concurrent chemo)radiotherapy (IMRT) in locally advanced stage III non-small cell lung cancer (NSCLC).Methods and materialsEighty-six patients with advanced stage NSCLC, treated with either IMRT only (66 Gy) or combined with (sequential or concurrent) chemotherapy were retrospectively included in this study. Overall survival and metastasis-free survival were assessed as well as acute pulmonary and esophageal toxicity using the RTOG Acute Radiation Morbidity Scoring Criteria.ResultsIrrespective of the treatment modality, the overall survival rate for patients receiving 66 Gy was 71% (±11%; 95% CI) after one year and 56% (±14%) after two years resulting in a median overall survival of 29.7 months. Metastasis-free survival was 73% (±11%) after both one and two years. There were no statistically significant differences between the treatment groups. Treatment related esophageal toxicity was significantly more pronounced in the concurrent chemoradiotherapy group (p = 0.013) with no differences in pulmonary toxicity.ConclusionsThis retrospective cohort study in advanced non-small cell lung cancer patients shows that IMRT is an effective technique with acceptable acute toxicity, also when (sequentially or concomitantly) combined with chemotherapy.

Highlights

Lung cancer is an increasing cause of death in developing and developed countries, accounting for 1.39 million deaths worldwide in 2008
The levels of Grade ≥3 radiation pneumonitis at 12 months according to RTOG toxicity scoring [15] were significantly (p = 0.002) lower for intensitymodulated radiation therapy (IMRT) than for 3D-CRT, being 8% and 32%, respectively [16]
The hazard ratio for 4DCT/IMRT was 0.33 for Grade ≥3 radiation pneumonitis, indicating lower toxicity rates were associated with 4DCT/IMRT

Summary

Introduction

Lung cancer is an increasing cause of death in developing and developed countries, accounting for 1.39 million deaths worldwide in 2008. The University of Texas M.D. Anderson Cancer Center investigated the rate of high-grade treatment-related pneumonitis in patients with advanced NSCLC treated with concurrent chemotherapy and IMRT. The levels of Grade ≥3 radiation pneumonitis at 12 months according to RTOG toxicity scoring [15] were significantly (p = 0.002) lower for IMRT than for 3D-CRT, being 8% (95% CI 4%–19%) and 32% (95% CI 26%–40%), respectively [16]. This initial evaluation is consistent with the conclusion of a subsequent study of the institution in larger patient groups and with longer follow-up times [17]. IMRT reduces radiation doses to the esophagus, heart and spinal cord [18,19]

Methods

Results

Discussion

Conclusion