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Published in: Radiation Oncology 1/2012

Open Access 01-12-2012 | Research

Treatment outcome and toxicity of intensity-modulated (chemo) radiotherapy in stage III non-small cell lung cancer patients

Authors: Stephanie LA Govaert, Esther GC Troost, Olga CJ Schuurbiers, Lioe-Fee de Geus-Oei, Ariën Termeer, Paul N Span, Johan Bussink

Published in: Radiation Oncology | Issue 1/2012

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Abstract

Purpose

The aim of this retrospective cohort study was to assess treatment outcome, and acute pulmonary and esophageal toxicity using intensity modulated (sequential/concurrent chemo)radiotherapy (IMRT) in locally advanced stage III non-small cell lung cancer (NSCLC).

Methods and materials

Eighty-six patients with advanced stage NSCLC, treated with either IMRT only (66 Gy) or combined with (sequential or concurrent) chemotherapy were retrospectively included in this study. Overall survival and metastasis-free survival were assessed as well as acute pulmonary and esophageal toxicity using the RTOG Acute Radiation Morbidity Scoring Criteria.

Results

Irrespective of the treatment modality, the overall survival rate for patients receiving 66 Gy was 71% (±11%; 95% CI) after one year and 56% (±14%) after two years resulting in a median overall survival of 29.7 months. Metastasis-free survival was 73% (±11%) after both one and two years. There were no statistically significant differences between the treatment groups. Treatment related esophageal toxicity was significantly more pronounced in the concurrent chemoradiotherapy group (p = 0.013) with no differences in pulmonary toxicity.

Conclusions

This retrospective cohort study in advanced non-small cell lung cancer patients shows that IMRT is an effective technique with acceptable acute toxicity, also when (sequentially or concomitantly) combined with chemotherapy.
Appendix
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Literature
1.
go back to reference Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, et al.: SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations). In Book SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations). National Cancer Institute, City; 2012. Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, et al.: SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations). In Book SEER Cancer Statistics Review, 1975–2009 (Vintage 2009 Populations). National Cancer Institute, City; 2012.
2.
go back to reference Robinson LA, Ruckdeschel JC, Wagner H, Stevens CW: Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 243S-265S. 10.1378/chest.07-1379CrossRefPubMed Robinson LA, Ruckdeschel JC, Wagner H, Stevens CW: Treatment of non-small cell lung cancer-stage IIIA: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 243S-265S. 10.1378/chest.07-1379CrossRefPubMed
3.
go back to reference Jett JR, Schild SE, Keith RL, Kesler KA: Treatment of non-small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 266S-276S. 10.1378/chest.07-1380CrossRefPubMed Jett JR, Schild SE, Keith RL, Kesler KA: Treatment of non-small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 266S-276S. 10.1378/chest.07-1380CrossRefPubMed
4.
go back to reference Scott WJ, Howington J, Feigenberg S, Movsas B, Pisters K: Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 234S-242S. 10.1378/chest.07-1378CrossRefPubMed Scott WJ, Howington J, Feigenberg S, Movsas B, Pisters K: Treatment of non-small cell lung cancer stage I and stage II: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007, 132: 234S-242S. 10.1378/chest.07-1378CrossRefPubMed
5.
go back to reference Auperin A, Le Pechoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, et al.: Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 2010, 28: 2181-2190. 10.1200/JCO.2009.26.2543CrossRefPubMed Auperin A, Le Pechoux C, Rolland E, Curran WJ, Furuse K, Fournel P, Belderbos J, Clamon G, Ulutin HC, Paulus R, et al.: Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol 2010, 28: 2181-2190. 10.1200/JCO.2009.26.2543CrossRefPubMed
6.
go back to reference De Ruysscher D, Botterweck A, Dirx M, Pijls-Johannesma M, Wanders R, Hochstenbag M, Dingemans AM, Bootsma G, Geraedts W, Simons J, et al.: Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study. Ann Oncol 2009, 20: 98-102.CrossRefPubMed De Ruysscher D, Botterweck A, Dirx M, Pijls-Johannesma M, Wanders R, Hochstenbag M, Dingemans AM, Bootsma G, Geraedts W, Simons J, et al.: Eligibility for concurrent chemotherapy and radiotherapy of locally advanced lung cancer patients: a prospective, population-based study. Ann Oncol 2009, 20: 98-102.CrossRefPubMed
7.
go back to reference Perez CA, Bauer M, Edelstein S, Gillespie BW, Birch R: Impact of tumor control on survival in carcinoma of the lung treated with irradiation. Int J Radiat Oncol Biol Phys 1986, 12: 539-547. 10.1016/0360-3016(86)90061-1CrossRefPubMed Perez CA, Bauer M, Edelstein S, Gillespie BW, Birch R: Impact of tumor control on survival in carcinoma of the lung treated with irradiation. Int J Radiat Oncol Biol Phys 1986, 12: 539-547. 10.1016/0360-3016(86)90061-1CrossRefPubMed
8.
go back to reference Rengan R, Rosenzweig KE, Venkatraman E, Koutcher LA, Fox JL, Nayak R, Amols H, Yorke E, Jackson A, Ling CC, Leibel SA: Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004, 60: 741-747. 10.1016/j.ijrobp.2004.04.013CrossRefPubMed Rengan R, Rosenzweig KE, Venkatraman E, Koutcher LA, Fox JL, Nayak R, Amols H, Yorke E, Jackson A, Ling CC, Leibel SA: Improved local control with higher doses of radiation in large-volume stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004, 60: 741-747. 10.1016/j.ijrobp.2004.04.013CrossRefPubMed
9.
go back to reference Wang L, Correa CR, Zhao L, Hayman J, Kalemkerian GP, Lyons S, Cease K, Brenner D, Kong FM: The effect of radiation dose and chemotherapy on overall survival in 237 patients with Stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2009, 73: 1383-1390. 10.1016/j.ijrobp.2008.06.1935PubMedCentralCrossRefPubMed Wang L, Correa CR, Zhao L, Hayman J, Kalemkerian GP, Lyons S, Cease K, Brenner D, Kong FM: The effect of radiation dose and chemotherapy on overall survival in 237 patients with Stage III non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2009, 73: 1383-1390. 10.1016/j.ijrobp.2008.06.1935PubMedCentralCrossRefPubMed
10.
go back to reference Belderbos JS, Heemsbergen WD, De Jaeger K, Baas P, Lebesque JV: Final results of a Phase I/II dose escalation trial in non-small-cell lung cancer using three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2006, 66: 126-134. 10.1016/j.ijrobp.2006.04.034CrossRefPubMed Belderbos JS, Heemsbergen WD, De Jaeger K, Baas P, Lebesque JV: Final results of a Phase I/II dose escalation trial in non-small-cell lung cancer using three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2006, 66: 126-134. 10.1016/j.ijrobp.2006.04.034CrossRefPubMed
11.
go back to reference van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AM, Bootsma G, Geraedts W, Pitz C, Lunde R, et al.: Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 2010, 28: 1380-1386. 10.1200/JCO.2009.24.7221CrossRefPubMed van Baardwijk A, Wanders S, Boersma L, Borger J, Ollers M, Dingemans AM, Bootsma G, Geraedts W, Pitz C, Lunde R, et al.: Mature results of an individualized radiation dose prescription study based on normal tissue constraints in stages I to III non-small-cell lung cancer. J Clin Oncol 2010, 28: 1380-1386. 10.1200/JCO.2009.24.7221CrossRefPubMed
12.
go back to reference Kong FM, Hayman JA, Griffith KA, Kalemkerian GP, Arenberg D, Lyons S, Turrisi A, Lichter A, Fraass B, Eisbruch A, et al.: Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): predictors for radiation pneumonitis and fibrosis. Int J Radiat Oncol Biol Phys 2006, 65: 1075-1086. 10.1016/j.ijrobp.2006.01.051CrossRefPubMed Kong FM, Hayman JA, Griffith KA, Kalemkerian GP, Arenberg D, Lyons S, Turrisi A, Lichter A, Fraass B, Eisbruch A, et al.: Final toxicity results of a radiation-dose escalation study in patients with non-small-cell lung cancer (NSCLC): predictors for radiation pneumonitis and fibrosis. Int J Radiat Oncol Biol Phys 2006, 65: 1075-1086. 10.1016/j.ijrobp.2006.01.051CrossRefPubMed
13.
go back to reference Nakayama H, Satoh H, Kurishima K, Ishikawa H, Tokuuye K: High-dose conformal radiotherapy for patients with stage III non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 2010, 78: 645-650. 10.1016/j.ijrobp.2009.08.037CrossRefPubMed Nakayama H, Satoh H, Kurishima K, Ishikawa H, Tokuuye K: High-dose conformal radiotherapy for patients with stage III non-small-cell lung carcinoma. Int J Radiat Oncol Biol Phys 2010, 78: 645-650. 10.1016/j.ijrobp.2009.08.037CrossRefPubMed
14.
go back to reference Christian JA, Bedford JL, Webb S, Brada M: Comparison of inverse-planned three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2007, 67: 735-741. 10.1016/j.ijrobp.2006.09.047CrossRefPubMed Christian JA, Bedford JL, Webb S, Brada M: Comparison of inverse-planned three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2007, 67: 735-741. 10.1016/j.ijrobp.2006.09.047CrossRefPubMed
16.
go back to reference Yom SS, Liao Z, Liu HH, Tucker SL, Hu CS, Wei X, Wang X, Wang S, Mohan R, Cox JD, Komaki R: Initial evaluation of treatment-related pneumonitis in advanced-stage non-small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2007, 68: 94-102. 10.1016/j.ijrobp.2006.12.031CrossRefPubMed Yom SS, Liao Z, Liu HH, Tucker SL, Hu CS, Wei X, Wang X, Wang S, Mohan R, Cox JD, Komaki R: Initial evaluation of treatment-related pneumonitis in advanced-stage non-small-cell lung cancer patients treated with concurrent chemotherapy and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 2007, 68: 94-102. 10.1016/j.ijrobp.2006.12.031CrossRefPubMed
17.
go back to reference Liao ZX, Komaki RR, Thames HD, Liu HH, Tucker SL, Mohan R, Martel MK, Wei X, Yang K, Kim ES, et al.: Influence of technologic advances on outcomes in patients with unresectable, locally advanced non-small-cell lung cancer receiving concomitant chemoradiotherapy. Int J Radiat Oncol Biol Phys 2010, 76: 775-781. 10.1016/j.ijrobp.2009.02.032CrossRefPubMed Liao ZX, Komaki RR, Thames HD, Liu HH, Tucker SL, Mohan R, Martel MK, Wei X, Yang K, Kim ES, et al.: Influence of technologic advances on outcomes in patients with unresectable, locally advanced non-small-cell lung cancer receiving concomitant chemoradiotherapy. Int J Radiat Oncol Biol Phys 2010, 76: 775-781. 10.1016/j.ijrobp.2009.02.032CrossRefPubMed
18.
go back to reference Scrimger RA, Tome WA, Olivera GH, Reckwerdt PJ, Mehta MP, Fowler JF: Reduction in radiation dose to lung and other normal tissues using helical tomotherapy to treat lung cancer, in comparison to conventional field arrangements. Am J Clin Oncol 2003, 26: 70-78. 10.1097/00000421-200302000-00014CrossRefPubMed Scrimger RA, Tome WA, Olivera GH, Reckwerdt PJ, Mehta MP, Fowler JF: Reduction in radiation dose to lung and other normal tissues using helical tomotherapy to treat lung cancer, in comparison to conventional field arrangements. Am J Clin Oncol 2003, 26: 70-78. 10.1097/00000421-200302000-00014CrossRefPubMed
19.
go back to reference Liu HH, Wang X, Dong L, Wu Q, Liao Z, Stevens CW, Guerrero TM, Komaki R, Cox JD, Mohan R: Feasibility of sparing lung and other thoracic structures with intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004, 58: 1268-1279. 10.1016/j.ijrobp.2003.09.085CrossRefPubMed Liu HH, Wang X, Dong L, Wu Q, Liao Z, Stevens CW, Guerrero TM, Komaki R, Cox JD, Mohan R: Feasibility of sparing lung and other thoracic structures with intensity-modulated radiotherapy for non-small-cell lung cancer. Int J Radiat Oncol Biol Phys 2004, 58: 1268-1279. 10.1016/j.ijrobp.2003.09.085CrossRefPubMed
20.
go back to reference Prescribing, Recording, and Reporting Photon Beam Therapy (Report 50) In Book Prescribing, Recording, and Reporting Photon Beam Therapy (Report 50). International Commission on Radiation Units & Measurements, City; 1993. Prescribing, Recording, and Reporting Photon Beam Therapy (Report 50) In Book Prescribing, Recording, and Reporting Photon Beam Therapy (Report 50). International Commission on Radiation Units & Measurements, City; 1993.
21.
go back to reference Prescribing, Recording and Reporting Photon Beam Therapy (Report 62); Supplement to ICRU Report 50 In Book Prescribing, Recording and Reporting Photon Beam Therapy (Report 62); Supplement to ICRU Report 50. International Commission on Radiation Units and Measurements, City; 1999. Prescribing, Recording and Reporting Photon Beam Therapy (Report 62); Supplement to ICRU Report 50 In Book Prescribing, Recording and Reporting Photon Beam Therapy (Report 62); Supplement to ICRU Report 50. International Commission on Radiation Units and Measurements, City; 1999.
22.
go back to reference de Boer HC, Heijmen BJ: A protocol for the reduction of systematic patient setup errors with minimal portal imaging workload. Int J Radiat Oncol Biol Phys 2001, 50: 1350-1365. 10.1016/S0360-3016(01)01624-8CrossRefPubMed de Boer HC, Heijmen BJ: A protocol for the reduction of systematic patient setup errors with minimal portal imaging workload. Int J Radiat Oncol Biol Phys 2001, 50: 1350-1365. 10.1016/S0360-3016(01)01624-8CrossRefPubMed
23.
go back to reference Sura S, Gupta V, Yorke E, Jackson A, Amols H, Rosenzweig KE: Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience. Radiother Oncol 2008, 87: 17-23. 10.1016/j.radonc.2008.02.005PubMedCentralCrossRefPubMed Sura S, Gupta V, Yorke E, Jackson A, Amols H, Rosenzweig KE: Intensity-modulated radiation therapy (IMRT) for inoperable non-small cell lung cancer: the Memorial Sloan-Kettering Cancer Center (MSKCC) experience. Radiother Oncol 2008, 87: 17-23. 10.1016/j.radonc.2008.02.005PubMedCentralCrossRefPubMed
25.
go back to reference Fenwick JD, Nahum AE, Malik ZI, Eswar CV, Hatton MQ, Laurence VM, Lester JF, Landau DB: Escalation and intensification of radiotherapy for stage III non-small cell lung cancer: opportunities for treatment improvement. Clin Oncol (R Coll Radiol) 2009, 21: 343-360. 10.1016/j.clon.2008.12.011CrossRef Fenwick JD, Nahum AE, Malik ZI, Eswar CV, Hatton MQ, Laurence VM, Lester JF, Landau DB: Escalation and intensification of radiotherapy for stage III non-small cell lung cancer: opportunities for treatment improvement. Clin Oncol (R Coll Radiol) 2009, 21: 343-360. 10.1016/j.clon.2008.12.011CrossRef
26.
go back to reference Bortfeld T, Jokivarsi K, Goitein M, Kung J, Jiang SB: Effects of intra-fraction motion on IMRT dose delivery: statistical analysis and simulation. Phys Med Biol 2002, 47: 2203-2220. 10.1088/0031-9155/47/13/302CrossRefPubMed Bortfeld T, Jokivarsi K, Goitein M, Kung J, Jiang SB: Effects of intra-fraction motion on IMRT dose delivery: statistical analysis and simulation. Phys Med Biol 2002, 47: 2203-2220. 10.1088/0031-9155/47/13/302CrossRefPubMed
27.
go back to reference Duan J, Shen S, Fiveash JB, Popple RA, Brezovich IA: Dosimetric and radiobiological impact of dose fractionation on respiratory motion induced IMRT delivery errors: a volumetric dose measurement study. Med Phys 2006, 33: 1380-1387. 10.1118/1.2192908CrossRefPubMed Duan J, Shen S, Fiveash JB, Popple RA, Brezovich IA: Dosimetric and radiobiological impact of dose fractionation on respiratory motion induced IMRT delivery errors: a volumetric dose measurement study. Med Phys 2006, 33: 1380-1387. 10.1118/1.2192908CrossRefPubMed
28.
go back to reference Jiang SB, Pope C, Al Jarrah KM, Kung JH, Bortfeld T, Chen GT: An experimental investigation on intra-fractional organ motion effects in lung IMRT treatments. Phys Med Biol 2003, 48: 1773-1784. 10.1088/0031-9155/48/12/307CrossRefPubMed Jiang SB, Pope C, Al Jarrah KM, Kung JH, Bortfeld T, Chen GT: An experimental investigation on intra-fractional organ motion effects in lung IMRT treatments. Phys Med Biol 2003, 48: 1773-1784. 10.1088/0031-9155/48/12/307CrossRefPubMed
29.
go back to reference Kwa SL, Lebesque JV, Theuws JC, Marks LB, Munley MT, Bentel G, Oetzel D, Spahn U, Graham MV, Drzymala RE, et al.: Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998, 42: 1-9.CrossRefPubMed Kwa SL, Lebesque JV, Theuws JC, Marks LB, Munley MT, Bentel G, Oetzel D, Spahn U, Graham MV, Drzymala RE, et al.: Radiation pneumonitis as a function of mean lung dose: an analysis of pooled data of 540 patients. Int J Radiat Oncol Biol Phys 1998, 42: 1-9.CrossRefPubMed
30.
go back to reference Intensity-modulated radiotherapy: current status and issues of interest Int J Radiat Oncol Biol Phys 2001, 51: 880-914. Intensity-modulated radiotherapy: current status and issues of interest Int J Radiat Oncol Biol Phys 2001, 51: 880-914.
31.
go back to reference Hall EJ: Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys 2006, 65: 1-7. 10.1016/j.ijrobp.2006.01.027CrossRefPubMed Hall EJ: Intensity-modulated radiation therapy, protons, and the risk of second cancers. Int J Radiat Oncol Biol Phys 2006, 65: 1-7. 10.1016/j.ijrobp.2006.01.027CrossRefPubMed
32.
go back to reference Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, et al.: Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 2003, 100: 13761-13766. 10.1073/pnas.2235592100PubMedCentralCrossRefPubMed Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, Lubin JH, Preston DL, Preston RJ, Puskin JS, et al.: Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 2003, 100: 13761-13766. 10.1073/pnas.2235592100PubMedCentralCrossRefPubMed
33.
go back to reference Hoffmann AL, Troost EG, Huizenga H, Kaanders JH, Bussink J: Individualized Dose Prescription for Hypofractionation in Advanced Non-Small-Cell Lung Cancer Radiotherapy: an in silico Trial. Int J Radiat Oncol Biol Phys 2012, 83: 1596-1602. 10.1016/j.ijrobp.2011.10.032CrossRefPubMed Hoffmann AL, Troost EG, Huizenga H, Kaanders JH, Bussink J: Individualized Dose Prescription for Hypofractionation in Advanced Non-Small-Cell Lung Cancer Radiotherapy: an in silico Trial. Int J Radiat Oncol Biol Phys 2012, 83: 1596-1602. 10.1016/j.ijrobp.2011.10.032CrossRefPubMed
Metadata
Title
Treatment outcome and toxicity of intensity-modulated (chemo) radiotherapy in stage III non-small cell lung cancer patients
Authors
Stephanie LA Govaert
Esther GC Troost
Olga CJ Schuurbiers
Lioe-Fee de Geus-Oei
Ariën Termeer
Paul N Span
Johan Bussink
Publication date
01-12-2012
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2012
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-7-150

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