Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer-Reference-Cited by-同舟云学术

Long-Term Prospective Outcomes of Intensity Modulated Radiotherapy for Locally Advanced Lung Cancer

Published:2024-08-01 Issue:8 Volume:10 Page:1111
ISSN:2374-2437
Container-title:JAMA Oncology
language:en
Short-container-title:JAMA Oncol

Author:

Chun Stephen G.¹,Hu Chen²³,Komaki Ritsuko U.⁴,Timmerman Robert D.⁵,Schild Steven E.⁶,Bogart Jeffrey A.⁷,Dobelbower Michael C.⁸,Bosch Walter⁹,Kavadi Vivek S.¹⁰,Narayan Samir¹¹,Iyengar Puneeth¹²,Robinson Clifford⁹,Rothman Jan¹³,Raben Adam¹⁴,Augspurger Mark E.¹⁵,MacRae Robert M.¹⁶,Paulus Rebecca²³,Bradley Jeffrey D.¹⁷

Affiliation:

1. The University of Texas MD Anderson Cancer Center, Houston

2. NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania

3. Johns Hopkins University School of Medicine, Baltimore, Maryland

4. Baylor College of Medicine, Houston, Texas

5. The University of Texas at Southwestern Medical Center, Dallas

6. Mayo Clinic Phoenix, Phoenix, Arizona

7. State University of New York Upstate Medical University, Syracuse

8. University of Alabama at Birmingham Medical Center

9. Washington University, St Louis, Missouri

10. Texas Oncology Cancer Center Sugar Land, Sugar Land

11. Trinity Health Saint Joseph Mercy Hospital, Ann Arbor, Michigan

12. Memorial Sloan Kettering Cancer Center, New York, New York

13. University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, Pennsylvania

14. Christiana Care Health System, Christiana Hospital, Newark, Delaware

15. Baptist Medical Center South, Jacksonville, Florida

16. Ottawa Hospital and Cancer Center, Ottawa, Ontario, Canada

17. University of Pennsylvania Abramson Cancer Center, Philadelphia

Abstract

ImportanceThe optimal radiotherapy technique for unresectable locally advanced non–small cell lung cancer (NSCLC) is controversial, so evaluating long-term prospective outcomes of intensity-modulated radiotherapy (IMRT) is important.ObjectiveTo compare long-term prospective outcomes of patients receiving IMRT and 3-dimensional conformal radiotherapy (3D-CRT) with concurrent carboplatin/paclitaxel for locally advanced NSCLC.Design, Setting, and ParticipantsA secondary analysis of a prospective phase 3 randomized clinical trial NRG Oncology–RTOG 0617 assessed 483 patients receiving chemoradiotherapy (3D-CRT vs IMRT) for locally advanced NSCLC based on stratification.Main Outcomes and MeasuresLong-term outcomes were analyzed, including overall survival (OS), progression-free survival (PFS), time to local failure, development of second cancers, and severe grade 3 or higher adverse events (AEs) per Common Terminology Criteria for Adverse Events, version 3. The percentage of an organ volume (V) receiving a specified amount of radiation in units of Gy is reported as V(radiation dose).ResultsOf 483 patients (median [IQR] age, 64 [57-70] years; 194 [40.2%] female), 228 (47.2%) received IMRT, and 255 (52.8%) received 3D-CRT (median [IQR] follow-up, 5.2 [4.8-6.0] years). IMRT was associated with a 2-fold reduction in grade 3 or higher pneumonitis AEs compared with 3D-CRT (8 [3.5%] vs 21 [8.2%]; P = .03). On univariate analysis, heart V20, V40, and V60 were associated with worse OS (hazard ratios, 1.06 [95% CI, 1.04-1.09]; 1.09 [95% CI, 1.05-1.13]; 1.16 [95% CI, 1.09-1.24], respectively; all P &lt; .001). IMRT significantly reduced heart V40 compared to 3D-CRT (16.5% vs 20.5%; P &lt; .001). Heart V40 (&lt;20%) had better OS than V40 (≥20%) (median [IQR], 2.5 [2.1-3.1] years vs 1.7 [1.5-2.0] years; P &lt; .001). On multivariable analysis, heart V40 (≥20%), was associated with worse OS (hazard ratio, 1.34 [95% CI, 1.06-1.70]; P = .01), whereas lung V5 and age had no association with OS. Patients receiving IMRT and 3D-CRT had similar rates of developing secondary cancers (15 [6.6%] vs 14 [5.5%]) with long-term follow-up.Conclusions and RelevanceThese findings support the standard use of IMRT for locally advanced NSCLC. IMRT should aim to minimize lung V20 and heart V20 to V60, rather than constraining low-dose radiation bath. Lung V5 and age were not associated with survival and should not be considered a contraindication for chemoradiotherapy.Trial RegistrationClinicalTrials.gov Identifier: NCT00533949

Publisher

American Medical Association (AMA)

Link

https://jamanetwork.com/journals/jamaoncology/articlepdf/2820532/jamaoncology_chun_2024_br_240011_1723659903.95101.pdf

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