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Title: A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer

Abstract

Purpose: Concerns have been raised about the potential for worse treatment outcomes because of dosimetric inaccuracies related to tumor motion and increased toxicity caused by the spread of low-dose radiation to normal tissues in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT). We therefore performed a population-based comparative effectiveness analysis of IMRT, conventional 3-dimensional conformal radiation therapy (3D-CRT), and 2-dimensional radiation therapy (2D-RT) in stage III NSCLC. Methods and Materials: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of patients diagnosed with stage III NSCLC from 2002 to 2009 treated with IMRT, 3D-CRT, or 2D-RT. Using Cox regression and propensity score matching, we compared survival and toxicities of these treatments. Results: The proportion of patients treated with IMRT increased from 2% in 2002 to 25% in 2009, and the use of 2D-RT decreased from 32% to 3%. In univariate analysis, IMRT was associated with improved overall survival (OS) (hazard ratio [HR] 0.90, P=.02) and cancer-specific survival (CSS) (HR 0.89, P=.02). After controlling for confounders, IMRT was associated with similar OS (HR 0.94, P=.23) and CSS (HR 0.94, P=.28) compared with 3D-CRT. Both techniques had superior OS compared withmore » 2D-RT. IMRT was associated with similar toxicity risks on multivariate analysis compared with 3D-CRT. Propensity score matched model results were similar to those from adjusted models. Conclusions: In this population-based analysis, IMRT for stage III NSCLC was associated with similar OS and CSS and maintained similar toxicity risks compared with 3D-CRT.« less

Authors:
 [1];  [2];  [1];  [1];  [1]
  1. Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California (United States)
  2. Department of Radiation Medicine and Applied Science, University of California– San Diego, Moores Cancer Center, La Jolla, California (United States)
Publication Date:
OSTI Identifier:
22416497
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 88; Journal Issue: 4; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPARATIVE EVALUATIONS; DIAGNOSIS; EPIDEMIOLOGY; HAZARDS; LUNGS; MEDICAL SURVEILLANCE; MULTIVARIATE ANALYSIS; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; TOXICITY

Citation Formats

Harris, Jeremy P., Murphy, James D., Hanlon, Alexandra L., University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, Le, Quynh-Thu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Loo, Billy W., E-mail: BWLoo@Stanford.edu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Diehn, Maximilian, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California. A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2013.12.010.
Harris, Jeremy P., Murphy, James D., Hanlon, Alexandra L., University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, Le, Quynh-Thu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Loo, Billy W., E-mail: BWLoo@Stanford.edu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Diehn, Maximilian, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, & Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California. A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer. United States. https://doi.org/10.1016/J.IJROBP.2013.12.010
Harris, Jeremy P., Murphy, James D., Hanlon, Alexandra L., University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, Le, Quynh-Thu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Loo, Billy W., E-mail: BWLoo@Stanford.edu, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, Diehn, Maximilian, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California. 2014. "A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer". United States. https://doi.org/10.1016/J.IJROBP.2013.12.010.
@article{osti_22416497,
title = {A Population-Based Comparative Effectiveness Study of Radiation Therapy Techniques in Stage III Non-Small Cell Lung Cancer},
author = {Harris, Jeremy P. and Murphy, James D. and Hanlon, Alexandra L. and University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania and Le, Quynh-Thu and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California and Loo, Billy W., E-mail: BWLoo@Stanford.edu and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California and Diehn, Maximilian and Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California and Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California},
abstractNote = {Purpose: Concerns have been raised about the potential for worse treatment outcomes because of dosimetric inaccuracies related to tumor motion and increased toxicity caused by the spread of low-dose radiation to normal tissues in patients with locally advanced non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy (IMRT). We therefore performed a population-based comparative effectiveness analysis of IMRT, conventional 3-dimensional conformal radiation therapy (3D-CRT), and 2-dimensional radiation therapy (2D-RT) in stage III NSCLC. Methods and Materials: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify a cohort of patients diagnosed with stage III NSCLC from 2002 to 2009 treated with IMRT, 3D-CRT, or 2D-RT. Using Cox regression and propensity score matching, we compared survival and toxicities of these treatments. Results: The proportion of patients treated with IMRT increased from 2% in 2002 to 25% in 2009, and the use of 2D-RT decreased from 32% to 3%. In univariate analysis, IMRT was associated with improved overall survival (OS) (hazard ratio [HR] 0.90, P=.02) and cancer-specific survival (CSS) (HR 0.89, P=.02). After controlling for confounders, IMRT was associated with similar OS (HR 0.94, P=.23) and CSS (HR 0.94, P=.28) compared with 3D-CRT. Both techniques had superior OS compared with 2D-RT. IMRT was associated with similar toxicity risks on multivariate analysis compared with 3D-CRT. Propensity score matched model results were similar to those from adjusted models. Conclusions: In this population-based analysis, IMRT for stage III NSCLC was associated with similar OS and CSS and maintained similar toxicity risks compared with 3D-CRT.},
doi = {10.1016/J.IJROBP.2013.12.010},
url = {https://www.osti.gov/biblio/22416497}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 88,
place = {United States},
year = {Sat Mar 15 00:00:00 EDT 2014},
month = {Sat Mar 15 00:00:00 EDT 2014}
}