Cancer Res Treat.  2016 Jan;48(1):106-114. 10.4143/crt.2014.131.

Effect of Radiation Therapy Techniques on Outcome in N3-positive IIIB Non-small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy

• Noh JM
• Kim JM
• Ahn YC
• Pyo H
• Kim B
• Oh D
• Ju SG
• Kim JS
• Shin JS
• Hong CS
• Park H
• Lee E

• KMID: 2152266
• DOI: http://doi.org/10.4143/crt.2014.131

Abstract

PURPOSE
This study was conducted to evaluate clinical outcomes following definitive concurrent chemoradiotherapy (CCRT) for patients with N3-positive stage IIIB (N3-IIIB) non-small cell lung cancer (NSCLC), with a focus on radiation therapy (RT) techniques.
MATERIALS AND METHODS
From May 2010 to November 2012, 77 patients with N3-IIIB NSCLC received definitive CCRT (median, 66 Gy). RT techniques were selected individually based on estimated lung toxicity, with 3-dimensional conformal RT (3D-CRT) and intensity-modulated RT (IMRT) delivered to 48 (62.3%) and 29 (37.7%) patients, respectively. Weekly docetaxel/paclitaxel plus cisplatin (67, 87.0%) was the most common concurrent chemotherapy regimen.
RESULTS
The median age and clinical target volume (CTV) were 60 years and 288.0 cm3, respectively. Patients receiving IMRT had greater disease extent in terms of supraclavicular lymph node (SCN) involvement and CTV > or = 300 cm3. The median follow-up time was 21.7 months. Fortyfive patients (58.4%) experienced disease progression, most frequently distant metastasis (39, 50.6%). In-field locoregional control, progression-free survival (PFS), and overall survival (OS) rates at 2 years were 87.9%, 38.7%, and 75.2%, respectively. Although locoregional control was similar between RT techniques, patients receiving IMRT had worse PFS and OS, and SCN metastases from the lower lobe primary tumor and CTV > or = 300 cm3were associated with worse OS. The incidence and severity of toxicities did not differ significantly between RT techniques.
CONCLUSION
IMRT could lead to similar locoregional control and toxicity, while encompassing a greater disease extent than 3D-CRT. The decision to apply IMRT should be made carefully after considering oncologic outcomes associated with greater disease extent and cost.

Keyword

Non-small cell lung carcinoma; Concurrent chemoradiotherapy; Stage IIIB-N3; Intensity-modulated radiotherapy

MeSH Terms

Carcinoma, Non-Small-Cell Lung*
Chemoradiotherapy*
Cisplatin
Disease Progression
Disease-Free Survival
Drug Therapy
Follow-Up Studies
Humans
Incidence
Lung
Lymph Nodes
Neoplasm Metastasis
Radiotherapy, Intensity-Modulated
Cisplatin

Figure

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  Fig. 1. Dose-volume parameters for lung and esophagus in patients with supraclavicular lymph node (SCN) originating from a lower lobe primary tumor. 3D-CRT, 3-dimensional conformal radiation therapy; IMRT, intensity-modulated radiation therapy; LV5 and LV20, volumes of the normal lung received ≥ 5 Gy and ≥ 20 Gy; MLD, mean lung dose; EV30 and EV45, volumes of the normal esophagus received ≥ 30 Gy and ≥ 45 Gy; MED, mean esophagus dose. Data are presented as the mean±standard error.

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  Fig. 2. Progression-free survival (PFS) and overall survival (OS) after definitive concurrent chemoradiotherapy in patients with N3-positive stage IIIB non-small cell lung cancer.

Reference

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