The Effect of Radiotherapy Dose on Survival in Stage III Non–Small-Cell Lung Cancer Patients Undergoing Definitive Chemoradiotherapy

Koshy, Matthew; Malik, R.; Sher, David J.; Spiotto, Michael T.; Mahmood, Usama; Aydogan, Bulent; Weichselbaum, Ralph R.

doi:10.1016/j.cllc.2014.05.004

Cited by 9 publications

(7 citation statements)

References 31 publications

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“…The difference in 2-year survival (44% vs 51%) between the patients treated with concurrent chemotherapy from the MAASTRO Clinic cohort and those from the NKI cohort could possibly be explained by the radiation dose scheme (9 Gy lower in the MAASTRO Clinic cohort), indicating a beneficial effect of dose intensification for these patients. Previously published studies have reported a slightly increased survival for intermediately escalated dose ( 28 , 29 ). The survival difference between MAASTRO Clinic and MSKCC might be attributed to a higher percentage of women and a lower percentage of smokers.…”

Section: Discussionmentioning

confidence: 86%

A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients

Oberije

Ruysscher

Houben

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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PurposeAlthough patients with stage III non-small cell lung cancer (NSCLC) are homogeneous according to the TNM staging system, they form a heterogeneous group, which is reflected in the survival outcome. The increasing amount of information for an individual patient and the growing number of treatment options facilitate personalized treatment, but they also complicate treatment decision making. Decision support systems (DSS), which provide individualized prognostic information, can overcome this but are currently lacking. A DSS for stage III NSCLC requires the development and integration of multiple models. The current study takes the first step in this process by developing and validating a model that can provide physicians with a survival probability for an individual NSCLC patient.Methods and MaterialsData from 548 patients with stage III NSCLC were available to enable the development of a prediction model, using stratified Cox regression. Variables were selected by using a bootstrap procedure. Performance of the model was expressed as the c statistic, assessed internally and on 2 external data sets (n=174 and n=130).ResultsThe final multivariate model, stratified for treatment, consisted of age, gender, World Health Organization performance status, overall treatment time, equivalent radiation dose, number of positive lymph node stations, and gross tumor volume. The bootstrapped c statistic was 0.62. The model could identify risk groups in external data sets. Nomograms were constructed to predict an individual patient’s survival probability (www.predictcancer.org). The data set can be downloaded at https://www.cancerdata.org/10.1016/j.ijrobp.2015.02.048.ConclusionsThe prediction model for overall survival of patients with stage III NSCLC highlights the importance of combining patient, clinical, and treatment variables. Nomograms were developed and validated. This tool could be used as a first building block for a decision support system.

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Section: Discussionmentioning

confidence: 86%

A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients

Oberije

Ruysscher

Houben

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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“…Patients treated with a total RT dose of less than 61 Gy experienced decreased median OS (19 months). Koshy et al 21 have also observed worse OS with total RT doses of less than 59.0 Gy.…”

Section: Discussionmentioning

confidence: 95%

Stage III Non–Small-Cell Lung Cancer Treated With Concurrent Chemoradiation Followed or Not by Consolidation Chemotherapy: A Survival Analysis From a Brazilian Multicentric Cohort

Lima

Baldotto

Barrios

et al. 2018

JGO

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PurposeOf newly diagnosed patients with non–small-cell lung cancer (NSCLC), stage III accounts for 30%. Most patients are treated with concurrent chemoradiation therapy, but the addition of consolidation chemotherapy (CC) is debatable. We examined the effect of CC in Brazilian patients with stage III NSCLC treated in routine clinical practice.MethodsWe retrospectively collected data for patients from five different Brazilian cancer institutions who had stage III NSCLC and who were treated with chemoradiation therapy followed or not by CC. Eligible patients were age 18 years or older and must have been treated with cisplatin-carboplatin plus etoposide, paclitaxel, or vinorelbine, concurrently with thoracic radiation therapy (RT). Patients treated with surgery or neoadjuvant chemotherapy were excluded. The primary end point was overall survival (OS). Associations between CC and clinical variables and demographics were evaluated by using Pearson’s χ2 test. Survival curves were calculated by using the Kaplan-Meier method and were compared using the log-rank test. Univariable and multivariable analysis used a Cox proportional hazards model.ResultsWe collected data from 165 patients. Median age was 60 years. Most patients were male (69.1%), white (77.9%), current or former smokers (93.3%), and had stage IIIB disease (52.7%). Adenocarcinoma was the most common histology (47.9%). Weight loss of more than 5% was observed in 39.1% and Eastern Cooperative Oncology Group performance status of 2 was observed in 14.6%. The only variable associated with CC was T stage (P = .022). We observed no statistically significant difference in OS between patients treated or not with CC (P = .128). A total delivered RT dose ≥ 61 Gy was the only variable independently associated with improved survival (P = .012).ConclusionBrazilian patients with locally advanced NSCLC who were treated with standard treatment achieved OS similar to that reported in randomized trials. CC did not improve OS in patients with stage III NSCLC after concurrent chemoradiation therapy. An RT dose of less than 61 Gy had a negative effect on OS.

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“…However, to mitigate radiotherapy variation, treatment was limited to IMRT or 3D-CRT and models were adjusted for treatment year. Furthermore, we included only patients with 30–40 daily radiation treatment claims, as prior studies have shown that treatment with at least ~60 Gy results in improved survival [36, 37]. …”

Section: Discussionmentioning

confidence: 99%

A population-based comparative effectiveness study of chemoradiation regimens and sequences in stage III non-small cell lung cancer

et al. 2017

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Objectives In patients receiving concurrent chemoradiation for locally advanced non-small cell lung cancer (NSCLC), consolidation chemotherapy is frequently given even though several randomized trials have failed to show a benefit. We explored the potential benefits of consolidation chemotherapy using a population-based comparative effectiveness approach. Materials and Methods Surveillance, Epidemiology, and End Results-Medicare was used to identify patients with Stage III NSCLC aged ≥65 and diagnosed 2002–2009. We selected patients who received concurrent chemoradiotherapy and determined whether they were (concurrent-consolidation) or were not (concurrent-alone) treated with consolidation chemotherapy. Outcomes were overall and cancer specific survival using a conditional landmark analysis approach. Results 1,688 patients treated with concurrent-alone or concurrent-consolidation were identified with a median follow up of 29 months. Choice of chemotherapy agents did not correlate with outcome. For concurrent-consolidation versus concurrent-alone, the median overall survival was 21 months versus 18 months, respectively (log-rank p = 0.008) and the median cancer specific survival was 23 months versus 19 months, respectively (log-rank p = 0.03). On multivariate analysis, concurrent-consolidation remained associated with improved overall survival (HR 0.85, p = 0.04), and there was a trend for improved cancer specific survival (HR 0.87, p = 0.12). Inverse probability of treatment weighting using propensity scores demonstrated similar findings. Importantly, the benefit of concurrent-consolidation held only for patients treated with carboplatin-taxane but not with cisplatin-etoposide. Conclusion Survival outcomes were similar among the five most commonly employed platinum-based doublets. We found that patients receiving cisplatin during radiation do not appear to benefit from additional chemotherapy. However, for patients receiving carboplatin, consolidation chemotherapy was associated with improved overall and cancer specific survival.

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The Effect of Radiotherapy Dose on Survival in Stage III Non–Small-Cell Lung Cancer Patients Undergoing Definitive Chemoradiotherapy

Cited by 9 publications

References 31 publications

A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients

A Validated Prediction Model for Overall Survival From Stage III Non-Small Cell Lung Cancer: Toward Survival Prediction for Individual Patients

Stage III Non–Small-Cell Lung Cancer Treated With Concurrent Chemoradiation Followed or Not by Consolidation Chemotherapy: A Survival Analysis From a Brazilian Multicentric Cohort

A population-based comparative effectiveness study of chemoradiation regimens and sequences in stage III non-small cell lung cancer

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