Pulmonary toxicity in Stage III non-small cell lung cancer patients treated with high-dose (74 Gy) 3-dimensional conformal thoracic radiotherapy and concurrent chemotherapy following induction chemotherapy: a secondary analysis of Cancer and Leukemia Group B (CALGB) trial 30105
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Authors
Salama, Joseph K.Stinchcombe, Thomas E.
Gu, Lin
Wang, Xiaofei
Morano, Karen
Bogart, Jeffrey A.
Crawford, Jeffrey C.
Socinski, Mark A.
Blackstock, A. William
Vokes, Everett E.
Document Type
Journal ArticlePublication Date
2011-11-15Keywords
AdultAged
Analysis of Variance
Antineoplastic Combined Chemotherapy Protocols
Area Under Curve
Carboplatin
Carcinoma, Non-Small-Cell Lung
Chemoradiotherapy
Deoxycytidine
Female
Humans
Induction Chemotherapy
Lung
Lung Neoplasms
Male
Middle Aged
Organs at Risk
Paclitaxel
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Conformal
Neoplasms
Oncology
Metadata
Show full item recordAbstract
PURPOSE: Cancer and Leukemia Group B (CALGB) 30105 tested two different concurrent chemoradiotherapy platforms with high-dose (74 Gy) three-dimensional conformal radiotherapy (3D-CRT) after two cycles of induction chemotherapy for Stage IIIA/IIIB non-small cell lung cancer (NSCLC) patients to determine if either could achieve a primary endpoint of >18-month median survival. Final results of 30105 demonstrated that induction carboplatin and gemcitabine and concurrent gemcitabine 3D-CRT was not feasible because of treatment-related toxicity. However, induction and concurrent carboplatin/paclitaxel with 74 Gy 3D-CRT had a median survival of 24 months, and is the basis for the experimental arm in CALGB 30610/RTOG 0617/N0628. We conducted a secondary analysis of all patients to determine predictors of treatment-related pulmonary toxicity. METHODS AND MATERIALS: Patient, tumor, and treatment-related variables were analyzed to determine their relation with treatment-related pulmonary toxicity. RESULTS: Older age, higher N stage, larger planning target volume (PTV)1, smaller total lung volume/PTV1 ratio, larger V20, and larger mean lung dose were associated with increasing pulmonary toxicity on univariate analysis. Multivariate analysis confirmed that V20 and nodal stage as well as treatment with concurrent gemcitabine were associated with treatment-related toxicity. A high-risk group comprising patients with N3 disease and V20 >38% was associated with 80% of Grades 3-5 pulmonary toxicity cases. CONCLUSIONS: Elevated V20 and N3 disease status are important predictors of treatment related pulmonary toxicity in patients treated with high-dose 3D-CRT and concurrent chemotherapy. Further studies may use these metrics in considering patients for these treatments.Source
Int J Radiat Oncol Biol Phys. 2011 Nov 15;81(4):e269-74. doi: 10.1016/j.ijrobp.2011.01.056. Epub 2011 Apr 7. Link to article on publisher's siteDOI
10.1016/j.ijrobp.2011.01.056Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47941PubMed ID
21477940Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1016/j.ijrobp.2011.01.056