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Title: Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: Analysis of the Radiation Therapy Oncology Group (RTOG) experience

Abstract

Purpose: To determine whether overall treatment time affects outcomes after definitive concurrent chemoradiotherapy for locally advanced non-small-cell lung carcinoma (NSCLC). Methods and Materials: Data were analyzed from 3 prospective Radiation Therapy Oncology Group trials (RTOG 91-06, 92-04, and 94-10) in which immediate concurrent chemoradiation (cisplatin-based) was the primary therapy for good-performance status Stage III (and selected inoperable Stage II) NSCLC. 'Short' overall treatment time (per protocol) was defined as completing treatment within 5 days of plan; other patients were considered to have had 'prolonged' treatment time (protocol violation); treatment time was also analyzed as a continuous variable in a multivariate model. Actuarial analysis was performed for overall survival, progression-free survival, freedom from local-regional progression, and toxicity. Results: A total of 474 patients were analyzed. Median follow-up for surviving patients was 6.1 years. Treatment time was delivered per protocol in 387 (82%), whereas 87 patients (18%) had a prolonged treatment time. Long treatment time was significantly associated with severe acute esophagitis. Median survival was slightly better in patients completing treatment on time (19.5 months vs. 14.8 months), but this did not reach statistical significance (p = 0.15) in the univariate analysis. However, in the multivariate analysis of treatment time as amore » continuous variable, prolonged treatment time was significantly associated with poorer survival (p = 0.02), indicating a 2% increase in the risk of death for each day of prolongation in therapy. Histology (squamous fared worse) and performance status were also significant in the multivariate model. Conclusions: This retrospective analysis demonstrates a correlation between prolonged overall radiotherapy treatment time and survival in patients with locally advanced NSCLC, even when concurrent chemotherapy is used. Further study of novel radiation-chemotherapy dose/fractionation regimens is warranted.« less

Authors:
 [1];  [2];  [3];  [4];  [2];  [5];  [6];  [1]
  1. Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA (United States)
  2. RTOG Headquarters and Statistical Center, Philadelphia, PA (United States)
  3. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
  4. Department of Radiation Oncology, LDS Hospital, Salt Lake City, UT (United States)
  5. Department of Medical Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)
  6. Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States)
Publication Date:
OSTI Identifier:
20702177
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 3; Other Information: DOI: 10.1016/j.ijrobp.2005.03.037; PII: S0360-3016(05)00571-7; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; CHEMOTHERAPY; COMBINED THERAPY; DEATH; FRACTIONATED IRRADIATION; HISTOLOGY; LUNGS; PATIENTS; PERFORMANCE; RADIOTHERAPY; TOXICITY

Citation Formats

Machtay, Mitchell, Hsu Chuanchieh, Komaki, Ritsuko, Sause, William T., Swann, R. Suzanne, Langer, Corey J., Byhardt, Roger W., and Curran, Walter J. Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: Analysis of the Radiation Therapy Oncology Group (RTOG) experience. United States: N. p., 2005. Web. doi:10.1016/j.ijrobp.2005.03.037.
Machtay, Mitchell, Hsu Chuanchieh, Komaki, Ritsuko, Sause, William T., Swann, R. Suzanne, Langer, Corey J., Byhardt, Roger W., & Curran, Walter J. Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: Analysis of the Radiation Therapy Oncology Group (RTOG) experience. United States. doi:10.1016/j.ijrobp.2005.03.037.
Machtay, Mitchell, Hsu Chuanchieh, Komaki, Ritsuko, Sause, William T., Swann, R. Suzanne, Langer, Corey J., Byhardt, Roger W., and Curran, Walter J. Tue . "Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: Analysis of the Radiation Therapy Oncology Group (RTOG) experience". United States. doi:10.1016/j.ijrobp.2005.03.037.
@article{osti_20702177,
title = {Effect of overall treatment time on outcomes after concurrent chemoradiation for locally advanced non-small-cell lung carcinoma: Analysis of the Radiation Therapy Oncology Group (RTOG) experience},
author = {Machtay, Mitchell and Hsu Chuanchieh and Komaki, Ritsuko and Sause, William T. and Swann, R. Suzanne and Langer, Corey J. and Byhardt, Roger W. and Curran, Walter J.},
abstractNote = {Purpose: To determine whether overall treatment time affects outcomes after definitive concurrent chemoradiotherapy for locally advanced non-small-cell lung carcinoma (NSCLC). Methods and Materials: Data were analyzed from 3 prospective Radiation Therapy Oncology Group trials (RTOG 91-06, 92-04, and 94-10) in which immediate concurrent chemoradiation (cisplatin-based) was the primary therapy for good-performance status Stage III (and selected inoperable Stage II) NSCLC. 'Short' overall treatment time (per protocol) was defined as completing treatment within 5 days of plan; other patients were considered to have had 'prolonged' treatment time (protocol violation); treatment time was also analyzed as a continuous variable in a multivariate model. Actuarial analysis was performed for overall survival, progression-free survival, freedom from local-regional progression, and toxicity. Results: A total of 474 patients were analyzed. Median follow-up for surviving patients was 6.1 years. Treatment time was delivered per protocol in 387 (82%), whereas 87 patients (18%) had a prolonged treatment time. Long treatment time was significantly associated with severe acute esophagitis. Median survival was slightly better in patients completing treatment on time (19.5 months vs. 14.8 months), but this did not reach statistical significance (p = 0.15) in the univariate analysis. However, in the multivariate analysis of treatment time as a continuous variable, prolonged treatment time was significantly associated with poorer survival (p = 0.02), indicating a 2% increase in the risk of death for each day of prolongation in therapy. Histology (squamous fared worse) and performance status were also significant in the multivariate model. Conclusions: This retrospective analysis demonstrates a correlation between prolonged overall radiotherapy treatment time and survival in patients with locally advanced NSCLC, even when concurrent chemotherapy is used. Further study of novel radiation-chemotherapy dose/fractionation regimens is warranted.},
doi = {10.1016/j.ijrobp.2005.03.037},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 3,
volume = 63,
place = {United States},
year = {Tue Nov 01 00:00:00 EST 2005},
month = {Tue Nov 01 00:00:00 EST 2005}
}