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B. Li



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    Limitations and advances of thoracic radiotherapy (ID 58)

    • Event: ELCC 2018
    • Type: Proffered Paper session
    • Track:
    • Presentations: 1
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      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

      • Abstract

      Background:
      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.

      Methods:
      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.

      Results:
      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.

      Conclusions:
      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

      Funding:
      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).

      Disclosure:
      All authors have declared no conflicts of interest.