AUTHOR=Bernard Mark E. , Glaser Scott M. , Gill Beant S. , Beriwal Sushil , Heron Dwight E. , Luketich James D. , Friedland David M. , Socinski Mark A. , Greenberger Joel S. 

TITLE=Results of a Single Institution Experience with Dose-Escalated Chemoradiation for Locally Advanced Unresectable Non-Small Cell Lung Cancer

JOURNAL=Frontiers in Oncology

VOLUME=7

YEAR=2017

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2017.00001

DOI=10.3389/fonc.2017.00001

ISSN=2234-943X

ABSTRACT=<sec id="ST1"><title>Background</title><p>We determined factors associated with morbidity and outcomes of a series of non-small cell lung cancer (NSCLC) patients treated with dose-escalated chemoradiotherapy at the University of Pittsburgh Lung Cancer Program.</p></sec><sec id="ST2"><title>Methods and materials</title><p>The records of 170 stage III NSCLC patients treated with definitive intent were retrospectively reviewed. All patients received four-dimensional CT simulation scan and had respiratory gating if tumor movement exceeded 5 mm. Overall survival (OS), locoregional control (LRC), and freedom from distant metastasis (FFDM) were calculated using log-rank and Cox regression analysis.</p></sec><sec id="ST3"><title>Results</title><p>For the present series of patients, median follow-up was 36.6 months, median survival 27.4 months, and the 2- and 4-year OS was 56.0 and 30.7%, respectively. The 4-year LRC and FFDM were 43.9 and 40.7%, respectively. No benefit was associated with irradiation doses above 66 Gy in OS (<italic>p</italic> = 0.586), LRC (<italic>p</italic> = 0.440), or FFDM (<italic>p</italic> = 0.230). On univariate analysis, variables associated with worse survival included: clinical stage IIIB (<italic>p</italic> = 0.037), planning target volume (PTV) over 450 cc (<italic>p</italic> &lt; 0.001), heart V<sub>30</sub> over 40% (<italic>p</italic> = −0.048), and esophageal mean dose over 20% (<italic>p</italic> = 0.024), V<sub>5</sub> (<italic>p</italic> = −0.015), and V<sub>60</sub> (<italic>p</italic> = −0.011). On multivariable analysis, PTV above 450 cc (52.2 vs. 25.3 months, <italic>p</italic> &lt; 0.001) and esophageal V<sub>60</sub> &gt;20% (43.8 vs. 21.3 months, <italic>p</italic> = −0.01) were associated with lower survival. Grade 2 or higher acute lung toxicity and esophagitis were detected in 9.5 and 59.7%, respectively of patients. Grade 2 or higher acute lung toxicity was reduced if lung V<sub>5</sub> was ≤65 (7.4 vs. 23.8%, <italic>p</italic> = 0.03). Grade 2 or higher acute esophagitis was reduced if V<sub>60</sub> ≤ 20% (62 vs. 81.3%, <italic>p</italic> = 0.018). The use of intensity-modulated radiation therapy was more frequent in stage IIIB compared to stage IIIA patients (56.5 vs. 39.5%, <italic>p</italic> = 0.048) and was associated with a higher lung V<sub>5</sub> and V<sub>10</sub>.</p></sec><sec id="ST4"><title>Conclusion</title><p>The outcomes of a program of dose-escalated chemoradiotherapy for unresectable stage IIIA and IIIB NSCLC patients were consistent with other studies and showed no benefit to radiation doses above 66 Gy. Furthermore, maintaining low esophageal V<sub>60</sub> and lung V<sub>5</sub> were associated with lower morbidity and mortality.</p></sec>