Technical advancement improves survival in patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving definitive radiotherapy
10.3760/cma.j.issn.0253-3766.2016.08.008
- VernacularTitle:放疗技术进展可改善局部晚期非小细胞肺癌患者的预后
- Author:
Jingbo WANG
1
;
Wei JIANG
;
Zhe JI
;
Jianzhong CAO
;
Lipin LIU
;
Yu MEN
;
Cai XU
;
Xiaozhen WANG
;
Zhouguang HUI
;
Jun LIANG
;
Jima LYU
;
Zongmei ZHOU
;
Zefen XIAO
;
Qinfu FENG
;
Dongfu CHEN
;
Hongxing ZHANG
;
Weibo YIN
;
Lühua WANG
Author Information
1. 国家癌症中心 中国医学科学院北京协和医学院肿瘤医院放疗科
- Keywords:
Carcinoma,non-small-cell lung;
Radiotherapy;
Two-dimensional radiation therapy;
Three-dimensional conformal radiation therapy;
Intensity modulated radiation therapy;
Prognosis
- From:
Chinese Journal of Oncology
2016;38(8):607-614
- CountryChina
- Language:Chinese
-
Abstract:
Objective This study aimed to evaluate the impact of technical advancement of radiation therapy in patients with LA?NSCLC receiving definitive radiotherapy (RT). Methods Patients treated with definitive RT (≥50 Gy) between 2000 and 2010 were retrospectively reviewed. Overall survival ( OS) , cancer specific survival ( CSS) , locoregional progression?free survival ( LRPFS) , distant metastasis?free survival (DMFS) and progression?free survival (PFS) were calculated and compared among patients irradiated with different techniques. Radiation?induced lung injury ( RILI) and esophageal injury ( RIEI) were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events 3.0 ( NCI?CTCAE 3.0) . Results A total of 946 patients were eligible for analysis, including 288 treated with two?dimensional radiotherapy ( 2D?RT) , 209 with three?dimensional conformal radiation therapy ( 3D?CRT) and 449 with intensity?modulated radiation therapy ( IMRT) respectively. The median follow?up time for the whole population was 84.1 months. The median OS of 2D?RT, 3D?CRT and IMRT groups were 15.8, 19.7 and 23.3 months, respectively, with the corresponding 5?year survival rate of 8. 7%, 13. 0% and 18. 8%, respectively ( P<0.001) . The univariate analysis demonstrated significantly inferior OS, LRPFS, DMFS and PFS of 2D?RT than those provided by 3D?CRT or IMRT. The univariate analysis also revealed that the IMRT group had significantly loger LRPFS and a trend toward better OS and DMFS compared with 3D?CRT. Multivariate analysis showed that TNM stage, RT technique and KPS were independent factors correlated with all survival indexes. Compared with 2D?RT, the utilization of IMRT was associated with significantly improved OS, LRPFS, DMFS as well as PFS. Compared with 3D?CRT, IMRT provided superior DMFS ( P=0.035), a trend approaching significance with regard to LRPFS (P=0.073) but no statistically significant improvement on OS, CSS and PFS in multivariate analysis. The incidence rates of RILI were significantly decreased in the IMRT group (29.3% vs. 26.6% vs.14.0%, P<0.001) whereas that of RIET rates were similar (34.7% vs. 29.7% vs. 35.3%, P=0.342) among the three groups. Conclusions Radiation therapy technique is a factor affecting prognosis of LA?NSCLC patients. Advanced radiation therapy technique is associated with improved tumor control and survival, and decreased radiation?induced lung toxicity.
