Individualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: A prospective population-based study

doi:10.1016/j.radonc.2011.10.010

Radiotherapy and Oncology

Volume 102, Issue 2, February 2012, Pages 228-233

https://doi.org/10.1016/j.radonc.2011.10.010 Get rights and content

Abstract

Background

Individualised, isotoxic, accelerated radiotherapy (INDAR) allows the delivery of high biological radiation doses, but the long-term survival associated with this approach is unknown.

Methods

Patients with stage III NSCLC in the Netherlands Cancer Registry/Limburg from January 1, 2002 to December 31, 2008 were included.

Results

Patients (1002) with stage III NSCLC were diagnosed, of which 938 had T4 and/or N2–N3 disease. Patients treated with curative intent were staged with FDG-PET scans and a contrast-enhanced CT or an MRI of the brain. There were no shifts over time in the patient or tumour characteristics at diagnosis. The number of stage III NSCLC patients remained stable over time, but the proportion treated with palliative intent decreased from 47% in 2002 to 37% in 2008, and the percentage treated with chemo-radiation (RT) increased from 24.6% in 2002 to 47.8% in 2008 (p < 0.001). The proportion of surgical patients remained below 5%. Sequential chemotherapy and conventional RT resulted in a median and a 5-year survival of 17.5 months and 8.4%, respectively, whereas with sequential chemotherapy and INDAR this was 23.6 months and 31%, respectively (p < 0.001). Concurrent chemotherapy and INDAR was associated with a median and 2-year survival that was not reached and 66.7%, respectively (p = 0.004).

Conclusions

The proportion of patients treated with a curative intention with chemo-RT has increased markedly over time of observation. INDAR is associated with longer survival when compared to standard dose RT alone given with or without chemotherapy.

Section snippets

Netherlands Cancer Registry/Limburg (NCR/L)

All patients with a pathological diagnosis of NSCLC [13] in South- and Middle Limburg and with stage III (UICC 6th Edition) [14] from January 1, 2002 to December 31, 2008 were included. Data were obtained from the population-based Netherlands Cancer Registry (NCR) of the Comprehensive Cancer Centre the Netherlands. The NCR/L is a population-based cancer registry, which was established in 1984 and is a department of the Comprehensive Cancer Centre Netherlands-Location Maastricht. The NCR/L covers

Results

From January 1, 2002 to December 31, 2008, 1002 patients with stage III NSCLC were diagnosed. From this group, 64 had a T3N1 tumour. Because this group is considered to be a surgical indication, unless co-morbid conditions preclude this, these patients were omitted from the present analysis.

Patient characteristics are summarised in Table 1.

Only 27.8% of the patients did not have co-morbidities, with 26.9% having Chronic Obstructive Pulmonary Disease (COPD), 18.3% a myocardial infarction, 16.4%

Discussion

Even with the current standard treatment of choice, concurrent chemo-radiotherapy to a radiation dose of about 60 Gy in 30 fractions, a median survival of about 24 months and a five-year survival of approximately 15% can be achieved in patients with stage III NSCLC [5], [6]. Sequential chemotherapy and 60 Gy in 30 fractions results in a median survival of 18 months and a 5-year survival of 10% [5]. Moreover, a significant proportion of patients is believed not to be able to receive this aggressive

Conflict of interest statement

None declared.

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In our data, implementing the AJCC 8th Edition for stage IIIA cancer patients improved stage-specific OS by as much as 3.5 months, whereas there was no survival improvement in patients with stage IIIB cancer. The incidence of pneumonitis in the current study was similar to that in previous trials [28,30]. In the setting of individualized and concurrent chemoradiation doses, Baardwijk et al. [7] reported that severe pulmonary complaints were less frequent; that is, Grades 3 and 4 severe pulmonary toxicity were observed in 1.5% patients.
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Lung cancerIndividualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: A prospective population-based study

Abstract

Background

Methods

Results

Conclusions

Section snippets

Netherlands Cancer Registry/Limburg (NCR/L)

Results

Discussion

Conflict of interest statement

Lancet

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Lung cancer
Individualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: A prospective population-based study