The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R)

Autor: Edith Dieleman, Lisa van der Woude, Rob van Os, Liselotte van Bockel, Ida Coremans, Corine van Es, Katrien De Jaeger, Hans Peter Knol, Willemijn Kolff, Frederike Koppe, Jacqueline Pomp, Bart Reymen, Dominic Schinagl, Femke Spoelstra, Caroline Tissing-Tan, Noelle van der Voort van Zyp, Antoinet van der Wel, Robin Wijsman, Michel Dielwart, Erwin Wiegman, Ronald Damhuis, Jose Belderbos
Přispěvatelé: RS: GROW - R3 - Innovative Cancer Diagnostics & Therapy, Maastro clinic, Radiotherapy, CCA - Cancer Treatment and Quality of Life
Jazyk: angličtina
Rok vydání: 2023
Předmět:
Zdroj: Clinical Lung Cancer, 24, 2, pp. 130-136
Clinical Lung Cancer, 24, 130-136
Clinical lung cancer, 24(2), 130-136. CIG MEDIA GROUP, LP
Clinical Lung Cancer, 24(2), 130-136. CIG Media Group, L.P.
Clinical lung cancer. Elsevier
ISSN: 1525-7304
Popis: In this national lung cancer audit of inoperable NSCLC patients, acute toxicity and 3-month mortality of curative chemoradiation was analyzed. Another important question was whether concurrent chemoradiation for elderly stage III NSCLC patients is safe. The results showed that 3-month toxicity was significantly higher in patients treated with concurrent chemoradiation, higher TNM stage IIIC and poor performance (WHO >= 2) patients. Introduction: Chemoradiotherapy (CRT) is the standard of care in inoperable non-small-cell lung cancer (NSCLC) patients, favoring concurrent (cCRT) over sequential CRT (seqCRT), with adjuvant immunotherapy in responders. Elderly and frail NSCLC patients have generally been excluded from trials in the past. In elderly patients however, the higher treatment related morbidity of cCRT, may outweigh the possible lower tumor control of seqCRT. For elderly patients with locally advanced NSCLC real-world data is essential to be able to balance treatment toxicity and treatment outcome. The aim of this study is to analyze acute toxicit y and 3-month mortalit y of curative chemoradiation (CRT) in patients with stage III NSCLC and to analyze whether cCRT for elderly stage III NSCLC patients is safe. Methods: The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R) is a national lung cancer audit that started in 2013 for patients treated with curative intent radiotherapy. All Dutch patients treated for stage III NSCLC between 2015 and 2018 with seqCRT or cCRT for (primary or recurrent) stage III lung cancer are included in this population-based study. Information was collected on patient, tumor- and treatment characteristics and the incidence and severity of acute non-hematological toxicity (CTCAE-4 version 4.03) and mortality within 3 months after the end of radiotherapy. To evaluate the association between prognostic factors and outcome (acute toxicity and mortality within 3 months), an univariable and multivariable analysis was performed. The definition of cCRT was:radiotherapy started within 30 days after the start of chemotherapy. Results: Out of all 20 Dutch departments of radiation oncology, 19 centers participated in the registry. A total of 2942 NSCLC stage III patients were treated with CRT. Of these 67.2% (n = 1977) were treated with cCRT (median age 66 years) and 32.8% (n = 965) were treated with seqCRT (median age 69 years). Good performance status (WHO 0-1) was scored in 88.6% for patients treated with cCRT and in 71.0% in the patients treated with seqCRT. Acute nonhema-tological 3-month toxicity (CTCAE grade >3 or radiation pneumonitis grade >2) was scored in 21.9% of the patients treated with cCRT and in 17.7% of the patients treated with seqCRT. The univariable analysis for acute toxicity showed significantly increased toxicity for cCRT (P = .008), WHO >2 (P = .006), and TNM IIIC (P = .031). The multivari-able analysis for acute toxicity was significant for cCRT (P = .015), WHO >2 (P = .001) and TNM IIIC (P = .016). The univariable analysis for 3-month mortality showed significance for seqCRT (P = .025), WHO >2 (P < .001), higher cumulative radiotherapy dose (P < .001), higher gross tumor volume total (P = .020) and male patients (p < .001). None of these variables reached significance in the multivariable analysis for 3-month mortality. Conclusion: In this national lung cancer audit of inoperable NSCLC patients, 3-month toxicity was significantly higher in patients treated with cCRT (21.9% vs.17.7% for seqCRT) higher TNM stage IIIC, and poor performance (WHO >2) patients.The 3-months mortality was not significantly different for tested parameters. Age was not a risk factor for acute toxicity, nor 3 months mortality.
Databáze: OpenAIRE
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