Involved-field radiotherapy versus elective nodal irradiation in combination with concurrent chemotherapy for locally advanced non-small cell lung cancer: A prospective randomized clinical study
10.3760/cma.j.issn.1004-4221.2012.04.007
- VernacularTitle:局部晚期非小细胞肺癌累及野和选择性淋巴结照射前瞻性随机研究
- Author:
Honglian MA
;
Yong BAO
;
Xiao HU
;
Jin WANG
;
Weihua WANG
;
Kaixin LI
;
Yuan LIU
;
Han HE
;
Zongwen SUN
;
Yan WANG
;
Tingting ZHUANG
;
Jing CHEN
;
Fang PENG
;
Qichao ZHOU
;
Shaomin HUANG
;
Zhichun HE
;
Li ZHANG
;
Xiaowu DENG
;
Ming CHEN
- Publication Type:Journal Article
- Keywords:
Carcinoma,non-small cell lung/radiochemotherapy;
Radiotherapy,involved field;
Radiotherapy,elective nodal;
Prognosis;
Prospective study
- From:
Chinese Journal of Radiation Oncology
2012;21(4):315-320
- CountryChina
- Language:Chinese
-
Abstract:
ObjectiveTo evaluate the local failure and the impact on survival by prospectively comparing involved field radiotherapy (IFRT) and elective nodal irradiation (ENI) in combination with concurrent chemotherapy for locally advanced non-small cell lung cancer ( LA-NSCLC ).Methods LANSCLC patients were treated with 2 cycles of carboplatin ( AUC =5 - 6,d1 ) combined with paclitaxel ( 175mg/m2 ),followed assessment without distant metastasis,then randomized into IFRT (45 patients) or ENI (54 patients) arm.IFRT included primary tumor,ipsilateral hilar and positive mediastinal lymph nodes;ENI included the primary lesion,ipsilateral hilar,hilateral mediastinal lymph node drainage and bilateral supraclavicular area.The prescription dose was given as high as possible with V20 ≤35％ and spinal cord dose ≤50 Gy,combined weekly paclitaxel 40 mg/m2 concurrent chemotherapy.The Kaplan-Meier method was used to estimate survival data and the log-rank method was used to test distribution of survival time between arms.ResultsThe follow-up rate was 99％.49,29 and 17 patients were followed-up for 1-,2-and 3-year,respectively.More patients from group IFRT received ＞60 Gy than ENI (49％ vs.26％,x2 =5.59,P =0.018 ).The local failure rates were 29％ and 36％,respectively ( x2 =0.46,P =0.497 ).The 1-,2-and 3-year local tumor progression-free survival rates were 76％,69％,65％ and 80％,53％,49％ ( x2 =0.74,P =0.389),respectively; the 1-,3-and 5-year overall survival rates were 80％,41％,33％ and 69％,32％,13％ (x2 =3.97,P =0.046),respectively.There were no significant differences in acute and late toxicities between the arms ( x2 =3.910 - 0.155,P =0.142 - 0.925 ).ConclusionsIFRT improved radiation dose and survival rate and did not increase the failure of elective lymph node region compared with ENI.The toxicities were no differences between IFRT and ENL Further investigation with big size sample is warranted.
