Long-Term Clinical Outcome of Intensity-Modulated Radiotherapy for Inoperable Non-Small Cell Lung Cancer: The MD Anderson Experience

Journal Article · Tue May 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.06.1963· OSTI ID:22056353

Zhiqin, Jiang ^[1]; Kunyu, Yang ^[2]; Komaki, Ritsuko; Xiong, Wei ^[1]; Tucker, Susan L ^[3]; Yan, Zhuang; Martel, Mary K; Vedam, Sastray; Balter, Peter ^[4]; Guangying, Zhu ^[5]; Gomez, Daniel ^[1]; Lu, Charles ^[6]; Mohan, Radhe ^[4]; Cox, James D ^[1]

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1. Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
2. Cancer Centre, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (China)
3. Department of Bioinformatics and Computational Biology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
4. Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX (United States)
5. Department of Radiation Oncology, Peking University School of Oncology, Beiijng Cancer Hospital and Institute, Beijing (China)
6. Department of Thoracic Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

Purpose: In 2007, we published our initial experience in treating inoperable non-small-cell lung cancer (NSCLC) with intensity-modulated radiation therapy (IMRT). The current report is an update of that experience with long-term follow-up. Methods and Materials: Patients in this retrospective review were 165 patients who began definitive radiotherapy, with or without chemotherapy, for newly diagnosed, pathologically confirmed NSCLC to a dose of {>=}60 Gy from 2005 to 2006. Early and late toxicities assessed included treatment-related pneumonitis (TRP), pulmonary fibrosis, esophagitis, and esophageal stricture, scored mainly according to the Common Terminology Criteria for Adverse Events 3.0. Other variables monitored were radiation-associated dermatitis and changes in body weight and Karnofsky performance status. The Kaplan-Meier method was used to compute survival and freedom from radiation-related acute and late toxicities as a function of time. Results: Most patients (89%) had Stage III to IV disease. The median radiation dose was 66 Gy given in 33 fractions (range, 60-76 Gy, 1.8-2.3 Gy per fraction). Median overall survival time was 1.8 years; the 2-year and 3-year overall survival rates were 46% and 30%. Rates of Grade {>=}3 maximum TRP (TRP{sub max}) were 11% at 6 months and 14% at 12 months. At 18 months, 86% of patients had developed Grade {>=}1 maximum pulmonary fibrosis (pulmonary fibrosis{sub max}) and 7% Grade {>=}2 pulmonary fibrosis{sub max}. The median times to maximum esophagitis (esophagitis{sub max}) were 3 weeks (range, 1-13 weeks) for Grade 2 and 6 weeks (range, 3-13 weeks) for Grade 3. A higher percentage of patients who experienced Grade 3 esophagitis{sub max} later developed Grade 2 to 3 esophageal stricture. Conclusions: In our experience, using IMRT to treat NSCLC leads to low rates of pulmonary and esophageal toxicity, and favorable clinical outcomes in terms of survival.

• OSTI ID: 22056353
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 83; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CHEMOTHERAPY
DERMATITIS
ESOPHAGUS
FIBROSIS
LUNGS
NEOPLASMS
PATIENTS
PERFORMANCE
PNEUMONITIS
RADIATION DOSES
RADIOTHERAPY
SURVIVAL TIME
TIME DEPENDENCE
TOXICITY