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Definitive radiotherapy with or without chemotherapy for clinical stage T4N0-1 non-small cell lung cancer

Radiation Oncology Journal
2015년 33권 4호 p.284 ~ p.293
김연주 ( Kim Yeon-Joo ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology

송시열 ( Song Si-Yeol ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
 ( Jeong Seong-Yun ) - Asan Medical Center Institute of Innovative Science
김상위 ( Kim Sang-We ) - University of Ulsan College of Medicine Asan Medical Center Department of Medical Oncology
이정신 ( Lee Jung-Shin ) - University of Ulsan College of Medicine Asan Medical Center Department of Medical Oncology
김수산 ( Kim Su-Ssan ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology
최원식 ( Choi Won-Sik ) - Gangneung Asan Hospital Department of Radiation Oncology
최은경 ( Choi Eun-Kyung ) - University of Ulsan College of Medicine Asan Medical Center Department of Radiation Oncology

Abstract

Purpose: To determine failure patterns and survival outcomes of T4N0-1 non-small cell lung cancer (NSCLC) treated with definitive radiotherapy.

Materials and Methods: Ninety-five patients with T4N0-1 NSCLC who received definitive radiotherapy with or without chemotherapy from May 2003 to October 2014 were retrospectively reviewed. The standard radiotherapy scheme was 66 Gy in 30 fractions. The main concurrent chemotherapy regimen was 50 mg/m2 weekly paclitaxel combined with 20 mg/m2 cisplatin or AUC 2 carboplatin. The primary outcome was overall survival (OS). Secondary outcomes were failure patterns and toxicities.

Results: The median age was 64 years (range, 34 to 90 years). Eighty-eight percent of patients (n = 84) had an Eastern Cooperative Oncology Group performance status of 0-1, and 42% (n = 40) experienced pretreatment weight loss. Sixty percent of patients (n = 57) had no metastatic regional lymph nodes. The median radiation dose was EQD2 67.1 Gy (range, 56.9 to 83.3 Gy). Seventy-one patients (75%) were treated with concurrent chemotherapy; of these, 13 were also administered neoadjuvant chemotherapy. At a median follow-up of 21 months (range, 1 to 102 months), 3-year OS was 44%. The 3-year cumulative incidences of local recurrence and distant recurrence were 48.8% and 36.3%, respectively. Pretreatment weight loss and combined chemotherapy were significant factors for OS. Acute esophagitis over grade 3 occurred in three patients and grade 3 chronic esophagitis occurred in one patient. There was no grade 3-4 radiation pneumonitis.

Conclusion: Definitive radiotherapy for T4N0-1 NSCLC results in favorable survival with acceptable toxicity rates. Local recurrence is the major recurrence pattern. Intensity modulated radiotherapy and radio-sensitizing agents would be needed to improve local tumor control.

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