The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients With Stage III Non–Small-Cell Lung Cancer
Received 28 March 2008; received in revised form 29 April 2008; accepted 9 June 2008. published online 17 October 2008.
Purpose
To study the effects of radiation dose, chemotherapy, and their interaction in patients with unresectable or medically inoperable Stage III non–small–cell lung cancer (NSCLC).
Methods and Materials
A total of 237 consecutive Stage III NSCLC patients were evaluated. Median follow-up was 69.0 months. Patients were treated with radiation therapy (RT) alone (n = 106), sequential chemoradiation (n = 69), or concurrent chemoradiation (n = 62). The primary endpoint was overall survival (OS). Radiation dose ranged from 30 to 102.9 Gy (median 60 Gy), corresponding to a bioequivalent dose (BED) of 39 to 124.5 Gy (median 72 Gy).
Results
The median OS of the entire cohort was 12.6 months, and 2- and 5-year survival rates were 22.4% and 10.0%, respectively. Multivariable Cox regression model demonstrated that Karnofsky performance status (p = 0.020), weight loss < 5% (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs. concurrent; p < 0.001), and BED (p < 0.001) were significant predictors of OS. For patients treated with RT alone, sequential chemoradiation, and concurrent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and 5-year OS was 3.3%, 7.5%, and 19.4%, respectively (p < 0.001). The effect of higher radiation doses on survival was independent of whether chemotherapy was given.
Conclusion
Radiation dose and use of chemotherapy are independent predictors of OS in Stage III NSCLC, and concurrent chemoradiation is associated with the best survival. There is no interaction between RT dose and chemotherapy.
∗Department of Radiation Oncology, University of Michigan Medical Center, Ann Arbor, MI
†Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, MI
‡Department of Radiation Oncology, Veterans Administration Health Center, Ann Arbor, MI
§Department of Radiation Oncology, Cancer Center, Fudan University, Shanghai, China
Address reprint requests to: Feng-Ming (Spring) Kong, M.D., Ph.D., University of Michigan, Department of Radiation Oncology, UH-B2C490, Box 0010, 1500 E. Medical Center Dr., Ann Arbor, MI 48109. Tel: (734) 936-7810; Fax: (734) 763-7370
Note—An online CME test for this article can be taken at http://asro.astro.org under Continuing Education.
The study was presented at the 49th annual American Society for Therapeutic Radiology and Oncology (ASTRO) meeting, held October 30, 2007, in Los Angeles. It was named “Best of ASTRO 2007,” and was quoted at the third Annual Mid-Atlantic ASTRO Review Course on January 10, 2008, at the University of Maryland.
ABSTRACT
The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients With Stage III Non–Small-Cell Lung Cancer