Effect of Radiation Therapy Techniques on Outcome in N3-positive IIIB Non-small Cell Lung Cancer Treated with Concurrent Chemoradiotherapy
Cancer Research and Treatment 2016³â 48±Ç 1È£ p.106 ~ p.114
³ëÀç¸í(Noh Jae-Myoung) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
±èÁø¸¸(Kim Jin-Man) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
¾È¿ëÂù(Ahn Yong-Chan) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
ǥȫ·Ä(Pyo Hong-Ryull) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
±èº¸°æ(Kim Bo-Kyong) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
¿Àµ¿·Ä(Oh Dong-Ryul) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
ÁÖ»ó±Ô(Ju Sang-Gyu) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
±èÁø¼º(Kim Jin-Sung) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
½ÅÁ¤¼®(Shin Jung-Suk) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
ȫä¼±(Hong Chae-Seon) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
¹ÚÈ¿Á¤(Park Hyo-Jung) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
ÀÌ¿ÂÁÖ(Lee Eon-Ju) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Radiation Oncology
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 ¡Ã 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 ¡Ã 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.
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Non-small cell lung carcinoma, Concurrent chemoradiotherapy, Stage IIIB-N3, Intensity-modulated radiotherapy
KMID :
0939920160480010106
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locoregional control, progression-free survival (PFS), and overall survival (OS) rates at 2 years were 87.9%, 38.7%, and 75.2%, respectively. IMRT could lead to similar locoregional control and toxicity