Factors Associated With Early Mortality in Patients Treated With Concurrent Chemoradiation Therapy for Locally Advanced Non-Small Cell Lung Cancer
- Department of Radiation Oncology, London Health Sciences Centre, London, Ontario (Canada)
- Department of Radiation Oncology, VU University Medical Center, Amsterdam (Netherlands)
- Department of Radiation Oncology, MAASTRO Clinic, Maastricht (Netherlands)
- Department of Radiation Oncology, Hyogo Cancer Center, Akashi (Japan)
- Department of Oncology, Clínica Universidad, Universidad de Navarra, Pamplona (Spain)
- Department of Radiation Oncology, National Cancer Center, Goyang-si, Gyeonggi (Korea, Republic of)
- Department of Radiation Oncology, University of North Carolina Chapel Hill, Chapel Hill, North Carolina (United States)
- Department of Radiation Oncology, University of Washington, Seattle, Washington (United States)
- Department of Oncology and Pathology, Karolinska University Hospital, Stockholm (Sweden)
- Department of Radiation Oncology, Campus Bio-Medico University, Rome (Italy)
- Department of Basic Medical Sciences, Ghent University, Ghent (Belgium)
- Department of Radiation Oncology, Hospital de la Esperanza, Parc de Salut Mar, Barcelona (Spain)
- Department of Radiation Oncology, Washington University School of Medicine, St Louis, Missouri (United States)
Purpose: Concurrent chemoradiation therapy (con-CRT) is recommended for fit patients with locally advanced non-small cell lung cancer (LA-NSCLC) but is associated with toxicity, and observed survival continues to be limited. Identifying factors associated with early mortality could improve patient selection and identify strategies to improve prognosis. Methods and Materials: Analysis of a multi-institutional LA-NSCLC database consisting of 1245 patients treated with con-CRT in 13 institutions was performed to identify factors predictive of 180-day survival. Recursive partitioning analysis (RPA) was performed to identify prognostic groups for 180-day survival. Multivariate logistic regression analysis was used to create a clinical nomogram predicting 180-day survival based on important predictors from RPA. Results: Median follow-up was 43.5 months (95% confidence interval [CI]: 40.3-48.8) and 127 patients (10%) died within 180 days of treatment. Median, 180-day, and 1- to 5-year (by yearly increments) actuarial survival rates were 20.9 months, 90%, 71%, 45%, 32%, 27%, and 22% respectively. Multivariate analysis adjusted by region identified gross tumor volume (GTV) (odds ratio [OR] ≥100 cm{sup 3}: 2.61; 95% CI: 1.10-6.20; P=.029) and pulmonary function (forced expiratory volume in 1 second [FEV{sub 1}], defined as the ratio of FEV{sub 1} to forced vital capacity [FVC]) (OR <80%: 2.53; 95% CI: 1.09-5.88; P=.030) as significant predictors of 180-day survival. RPA resulted in a 2-class risk stratification system: low-risk (GTV <100 cm{sup 3} or GTV ≥100 cm{sup 3} and FEV{sub 1} ≥80%) and high-risk (GTV ≥100 cm{sup 3} and FEV{sub 1} <80%). The 180-day survival rates were 93% for low risk and 79% for high risk, with an OR of 4.43 (95% CI: 2.07-9.51; P<.001), adjusted by region. A clinical nomogram predictive of 180-day survival, incorporating FEV{sub 1}, GTV, N stage, and maximum esophagus dose yielded favorable calibration (R{sup 2} = 0.947). Conclusions: This analysis identified several risk factors associated with early mortality and suggests that future research in the optimization of pretreatment pulmonary function and/or functional lung avoidance treatment may alter the therapeutic ratio in this patient population.
- OSTI ID:
- 22645112
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 94, Issue 3; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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