Long-term results of high-dose conformal radiotherapy for patients with medically inoperable T1-3N0 non-small-cell lung cancer: Is low incidence of regional failure due to incidental nodal irradiation?

Journal Article · Sun Jan 01 04:00:00 EST 2006 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2005.0· OSTI ID:20788275

Ming, Chen ^[1]; Hayman, James A ^[1]; Haken, Randall K. ten ^[1]; Tatro, Daniel ^[1]; Fernando, Shaneli ^[2]; Kong, F -M ^[3]

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1. Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (United States)
2. Department of Radiation Oncology, Veterans Administration Medical Center, Ann Arbor, MI (United States)
3. Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI (United States) and Department of Radiation Oncology, Veterans Administration Medical Center, Ann Arbor, MI (United States)

Purpose: To report the results of high-dose conformal irradiation and examine incidental nodal irradiation and nodal failure in patients with inoperable early-stage non-small-cell lung cancer (NSCLC). Methods and Materials: This analysis included patients with inoperable CT-staged T1-3N0M0 NSCLC treated on our prospective dose-escalation trial. Patients were treated with radiation alone (total dose, 63-102.9 Gy in 2.1-Gy daily fractions) with a three-dimensional conformal technique without intentional nodal irradiation. Bilateral highest mediastinal and upper/lower paratracheal, prevascular and retrotracheal, sub- and para-aortic, subcarinal, paraesophageal, and ipsilateral hilar regions were delineated individually. Nodal failure and doses of incidental irradiation were studied. Results: The potential median follow-up was 104 months. For patients who completed protocol treatment, median survival was 31 months. The actuarial overall survival rate was 86%, 61%, 43%, and 21% and the cause-specific survival rate was 89%, 70%, 53%, and 35% at 1, 2, 3, and 5 years, respectively. Weight loss (p = 0.008) and radiation dose in Gy (p = 0.013) were significantly associated with overall survival. In only 22% and 13% of patients examined did ipsilateral hilar and paratracheal (and subaortic for left-sided tumor) nodal regions receive a dose of {>=}40 Gy, respectively. Less than 10% of all other nodal regions received a dose of {>=}40 Gy. No patients failed initially at nodal sites. Conclusions: Radiation dose is positively associated with overall survival in patients with medically inoperable T1-3N0 NSCLC, though long-term results remain poor. The nodal failure rate is low and does not seem to be due to high-dose incidental irradiation.

• OSTI ID: 20788275
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 64; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
FAILURES
IRRADIATION
LUNGS
PATIENTS
RADIATION DOSES
RADIOTHERAPY