The Therapeutic Value of Volumetric-Modulated Arc Therapy In Advanced Non-Small Cell Lung Cancer Primary Tumors: A Multicenter Retrospective Analysis Based On Propensity Score Matching And Comparison With Intensity-Modulated Radiotherapy

Abstract

Objective:.To explore the feasibility of volumetric-modulated arc therapy (VMAT) instead of intensity-modulated radiotherapy (IMRT) for primary tumors of advanced non–small-cell lung cancer (A-NSCLC). Methods:.We used propensity score matching (PSM) and multicenter retrospective analysis to study the efficacy and toxicity of VMAT technology in radiotherapy for primary tumors of A-NSCLC.We used the chi-squared test to analyze the response rate(RR), local control (LC), acute radiation injury, and dose-volume parameters; the Kaplan–Meier and log-rank tests were used to determine local-regional progression-free survival (LRPFS) and overall survival (OS). Results: LRPFS was significantly prolonged in stage III patients treated with IMRT before PSM (P< .05) and cases of grade 1 or 2 acute radiation esophagitis (RE) or radiation pneumonia(RP) in the IMRT than the VMAT(P< .05), but cases of grade 3 or 4 RE and RP were not significantly different between the groups (P> .05). Before PSM, there was no significant difference in the LRPFS and OS rates of the whole study group and the RR, LC, and stage IV subgroups, respectively (P> .05). After PSM, there was no significant difference in the RR, LC, LRPFS, OS, RP, or RE of patients treated with VMAT and IMRT (P> .05), normal whole-lung (V5, V20, MLD), heart (V30, V40, MHD), and equal dose-volume parameters were significantly lower in the VMAT group (P< .05).Conclusion:.Radiation therapy of A-NSCLC primary tumors using VMAT can achieve a similar efficacy to that of IMRT but with significantly lower low-dose volume parameters of normal tissues and organs; this is true especially in stage N2 cases, where the reduction in radiation damage may be more favorable.

Treatment patterns and prognosis of patients with inoperable stage III NSCLC after completion of concurrent chemoradiotherapy ± immune checkpoint inhibition: a decade-long single-center historical analysis

“…A post hoc analysis by Chen et al, regarding radiation treatment technique in RTOG 0617 observed that while survival is similar between patients receiving IMRT vs. 3D-CRT, IMRT was associated with significantly lower rates of severe pneumonitis and cardiac doses. Additionally, Liu et al further reported that the use of VMAT led to significantly lower dose-volume parameters in normal tissue while achieving similar efficacy compared to IMRT (Chun et al 2017 ; Liu et al 2021 ).…”