Optimal Radiation Dose For Stage III Lung Cancer – Should “Definitive” Radiation Doses Be Used in the Pre-Operative Setting?

18074 Background: Radiation dose is an independent prognostic factor for survival in patients with early stage non-small cell lung cancer (NSCLC). We hypothesized that radiation dose is also a significant independent factor associated with survival in patients with stage III disease treated with combined radiation and chemotherapy. Methods: This is an Institutional Review Board approved retrospective study. Eligible subjects included those with stage III NSCLC registered in the radiation oncology database at University of Michigan Hospital between January 1992 and July 2004. Radiation was given using 3-dimensional conformal technique with doses ranging from 30 to 102.9 Gy, corresponding to a bioequivalent dose (BED) of 39 to 124.5Gy. Median age was 65 years (range, 36–89). There were 80 males and 67 females. Median follow-up was 13.0 months (range, 2.7–145.9). Results: For patients treated with radiation alone (n=40), sequential chemoradiation (n=42), and concurrent chemoradiation (n=65), median survival was 8.6 (95% CI: 5.7–11.5), 12.8 (95% CI: 9.5–16.0) and 15.4 (95% CI: 12.7–18.0) months, respectively (P =0 .011). Multivariate Cox-regression analysis showed that BED (HR=0.96, 95% CI: 0.95–0.97, P<0.001) and administration of chemotherapy (HR=0.44, 95% CI: 0.28–0.70, P=0.001) were independent prognostic factors associated with the risk of death. T stage was marginally significant (P=0.065). Age, gender and N stage were not independent factors (P>0.05). To isolate the BED effect, multivariate analysis was performed separately in patients treated with and without chemotherapy: the hazard ratios of BED for the risk of death were 0.97 (95% CI: 0.95–0.99, P=0 .013) and 0.95 (95% CI: 0.93–0.98, P=0.001), respectively. BED also remained a significant independent prognostic factor in patients treated with chemotherapy and radiation in the dose range of 60–66 Gy (HR=0.91, 95% CI: 0.84–0.99, P=0.041). Conclusions: Radiation dose is significantly associated with survival in patients with stage III NSCLC treated with combined radiation and chemotherapy. No significant financial relationships to disclose.

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Comparison of Radiation Dose of Induction Chemoradiation Therapy Followed by Surgery for Potentially Resectable Stage III Non–Small Cell Lung Cancer

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2017.01.154 ◽

2017 ◽

Vol 98 (1) ◽

pp. 233-234

Author(s):

K. Takehana ◽

H. Inokuchi ◽

K. Tsutsui ◽

M. Hiraoka

Keyword(s):

Lung Cancer ◽

Radiation Dose ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Small Cell ◽

Chemoradiation Therapy ◽

Stage Iii ◽

Small Cell Lung

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Conservative treatment of stage III lung cancer using chemoradiotherapy in hypofractionation mode, case report

Medical Council ◽

10.21518/2079-701x-2020-9-271-276 ◽

2020 ◽

pp. 271-276

Author(s):

N. V. Marinichenko ◽

K. K. Laktionov ◽

A. V. Nazarenko ◽

T. N. Borisova ◽

M. S. Ardzinba ◽

...

Keyword(s):

Lung Cancer ◽

Case Report ◽

Radiation Dose ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Locally Advanced ◽

Small Cell ◽

Stage Iii ◽

Small Cell Lung ◽

Post Radiation

Lung cancer is a leader in the world in terms of morbidity and mortality. Moreover, the number of patients with locally advanced forms of non-small cell lung cancer exceeds 30% of all newly diagnosed cases. The standard of treatment for patients with inoperable stage III lung cancer is chemoradiotherapy. Currently, ways to increase the effectiveness of chemoradiotherapy are being considered, in particular, local escalation of the radiation dose to the tumor, which allows personalizing approaches in the treatment of this category of patients. One of the most common complications of chemoradiotherapy is post-radiation pulmonitis, which requires timely diagnosis and treatment with glucocorticosteroids in severe cases. We present a case report of a patient with locally advanced non-small cell lung cancer who received treatment as part of simultaneous chemoradiotherapy in the hypofraction mode, complicated by post-radiation pulmonitis. Successful treatment of complications led to the restoration of the general condition of the patient; during the follow-up examination, a complete response to the specific treatment was recorded. Thus, a promising method of treating patients with inoperable stage III non-small cell lung cancer is the option of simultaneous chemoradiotherapy with local escalation of the radiation dose to the tumor, while being wary of complications such as pulmonitis, allows for timely diagnosis and treatment of the condition.

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Long-Term Results of NRG Oncology RTOG 0617: Standard- Versus High-Dose Chemoradiotherapy With or Without Cetuximab for Unresectable Stage III Non–Small-Cell Lung Cancer

Journal of Clinical Oncology ◽

10.1200/jco.19.01162 ◽

2020 ◽

Vol 38 (7) ◽

pp. 706-714 ◽

Cited By ~ 38

Author(s):

Jeffrey D. Bradley ◽

Chen Hu ◽

Ritsuko R. Komaki ◽

Gregory A. Masters ◽

George R. Blumenschein ◽

...

Keyword(s):

Lung Cancer ◽

Radiation Dose ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Concurrent Chemotherapy ◽

Small Cell ◽

Stage Iii ◽

High Dose ◽

Small Cell Lung ◽

Grade 3

PURPOSE RTOG 0617 compared standard-dose (SD; 60 Gy) versus high-dose (HD; 74 Gy) radiation with concurrent chemotherapy and determined the efficacy of cetuximab for stage III non–small-cell lung cancer (NSCLC). METHODS The study used a 2 × 2 factorial design with radiation dose as 1 factor and cetuximab as the other, with a primary end point of overall survival (OS). RESULTS Median follow-up was 5.1 years. There were 3 grade 5 adverse events (AEs) in the SD arm and 9 in the HD arm. Treatment-related grade ≥3 dysphagia and esophagitis occurred in 3.2% and 5.0% of patients in the SD arm v 12.1% and 17.4% in the HD arm, respectively ( P = .0005 and < .0001). There was no difference in pulmonary toxicity, with grade ≥3 AEs in 20.6% and 19.3%. Median OS was 28.7 v 20.3 months ( P = .0072) in the SD and HD arms, respectively, 5-year OS and progression-free survival (PFS) rates were 32.1% and 23% and 18.3% and 13% ( P = .055), respectively. Factors associated with improved OS on multivariable analysis were standard radiation dose, tumor location, institution accrual volume, esophagitis/dysphagia, planning target volume and heart V5. The use of cetuximab conferred no survival benefit at the expense of increased toxicity. The prior signal of benefit in patients with higher H scores was no longer apparent. The progression rate within 1 month of treatment completion in the SD arm was 4.6%. For comparison purposes, the resultant 2-year OS and PFS rates allowing for that dropout rate were 59.6% and 30.7%, respectively, in the SD arms. CONCLUSION A 60-Gy radiation dose with concurrent chemotherapy should remain the standard of care, with the OS rate being among the highest reported in the literature for stage III NSCLC. Cetuximab had no effect on OS. The 2-year OS rates in the control arm are similar to the PACIFIC trial.

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