Evaluating Intensity-Modulated Radiation Therapy in Locally Advanced Non–Small-Cell Lung Cancer: Results From the National Cancer Data Base

Autor: Kristin Higgins, Walter J. Curran, Joseph Lipscomb, Yuan Liu, J.L. Mikell, N. Jegadeesh, Theresa W. Gillespie, Suresh S. Ramalingam, Felix G. Fernandez
Rok vydání: 2016
Předmět:
Adult
Male
Pulmonary and Respiratory Medicine
Oncology
Cancer Research
medicine.medical_specialty
Lung Neoplasms
Databases
Factual
medicine.medical_treatment
Antineoplastic Agents
Kaplan-Meier Estimate
030218 nuclear medicine & medical imaging
Young Adult
03 medical and health sciences
0302 clinical medicine
Carcinoma
Non-Small-Cell Lung
Internal medicine
medicine
Humans
Medical physics
Lung cancer
Survival rate
Aged
Neoplasm Staging
Proportional Hazards Models
Retrospective Studies
Aged
80 and over
Proportional hazards model
business.industry
Hazard ratio
Retrospective cohort study
Middle Aged
medicine.disease
Confidence interval
Survival Rate
Radiation therapy
Treatment Outcome
030220 oncology & carcinogenesis
Propensity score matching
Quality of Life
Female
Radiotherapy
Intensity-Modulated
Radiotherapy
Conformal
business
Zdroj: Clinical Lung Cancer. 17:398-405
ISSN: 1525-7304
DOI: 10.1016/j.cllc.2016.01.007
Popis: Introduction Reports have suggested improvements in dosimetry, toxicity, and quality of life with intensity-modulated radiation therapy (IMRT) in locally advanced non–small-cell lung cancer (NSCLC). The selection criteria for those patients who may benefit is unclear. This study sought to identify subgroups of patients who may derive survival benefit from intensity modulated radiation therapy (IMRT) compared with 3D conformal radiation therapy (3DCRT). Methods and Materials The National Cancer Data Base was queried for stage III NSCLC treated with radiation and chemotherapy alone with curative intent. All received ≥ 58 Gy. Kaplan-Meier and log-rank test were performed to compare overall survival (OS) by treatment modality. A multivariable Cox proportional hazards model was used to assess association with OS. Propensity score matching was also implemented. Results A total of 2543 patients treated between 2003 and 2006 were eligible; 422 (16.6%) received IMRT, 2121 (83.4%) received 3DCRT. In patients with T3 and T4 disease, IMRT was associated with an improvement in median OS and 5-year survival rate (17.2 vs. 14.6 months; 19.9% vs. 13.4%, P = .021.) In multivariable analysis, there was an interaction between treatment type and T stage that was found to be significant ( P = .03). In the propensity matched cohort of T3 and T4 patients, the use of IMRT remained associated with improved OS (hazard ratio, 0.80; 95% confidence interval, 0.64-1.00; P = .048). Conclusions Use of IMRT in patients with T3 and T4 tumors was associated with improved overall survival in this large population-based analysis. This is a novel finding that is in concordance with the well-described dosimetric benefits of IMRT in NSCLC.
Databáze: OpenAIRE
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