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Limitations and advances of thoracic radiotherapy (ID 58)
- Event: ELCC 2018
- Type: Proffered Paper session
- Presentations: 1
110O - High-dose radiation therapy based on normal tissue constraints with concurrent chemotherapy improves survival of patients with unresectable stage III non-small cell lung cancer (ID 326)
15:00 - 16:00 | Presenting Author(s): B. Li
RTOG0617 found higher radiation dose does not benefit patients with unresectable stage III non-small cell lung cancer (NSCLC). To investigate the potential benefit of individual isotoxic dose escalation based on normal tissue constraints (NTC), hypothesizing that high-dose radiation therapy would be superior to standard-dose in concurrent chemoradiotherapy for unresectable stage III NSCLC.
Data from two prospective clinical trials were merged for analysis. Individually prescribed radiation doses were calculated based on NTC. Patients with total radiation doses ≥66 Gy were assigned to the high-dose group (H-D, ≥66 Gy), and all other patients were assigned to the standard-dose group (S-D, <66 Gy). Intensity modulated radiation therapy plans were optimized to minimize the volumes of organs at risk exposed to radiation. The primary endpoint was overall survival.
From March 2006 to September 2012, 140 patients were enrolled and assigned to one of two groups: 71 patients into the H-D group and 69 patients into the S-D group. The median survival time (MST) was significantly higher in the H-D group (33.5 months) than in the S-D group (17 months), (p < 0.0001). Overall 5-year survival rates were significantly higher in the H-D group than in the S-D group (38.0% vs. 12.3%). Median progression-free survival was 19 months in the H-D group and 11 months in the S-D group (p < 0.0001). No difference in severe (grade 3–5) toxic effects was noted between the two groups.
The dose-escalated radiation concurrent with chemotherapy showed an significant advantage in MST and survival rates over standard-dose. This individualized isotoxic dose chemoradiotherapy strategy may be a promising method for unresectable stage III NSCLC patients.
Clinical trial identification:
Legal entity responsible for the study:
Shandong Cancer Hospital
This study was supported in part by National Nature Science Foundation of China (Grant NO. 81530060), and The National Key Research and Development Plan (Grant NO. 2016YFC0105106).
All authors have declared no conflicts of interest.