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Dose response relation
THE EFFECT OF RADIATION DOSE AND CHEMOTHERAPY ONOVERALL SURVIVAL
IN 237 PATIENTSWITH STAGE I I I NON–SMALL-CELL LUNG CANCER
L
I
W
ANG
, M.D. P
H
.D.,
*
x
C
ANDACE
R. C
ORREA
, M.D.,
*
L
UJUN
Z
HAO
, M.D. P
H
.D.,
*
J
AMES
H
AYMAN
, M.D.,
*
G
REGORY
P. K
ALEMKERIAN
, M.D.,
y
S
USAN
L
YONS
, M.D. P
H
.D.,
y
K
EMP
C
EASE
, M.D.,
y
D
EAN
B
RENNER
, M.D.,
y
AND
F
ENG
-M
ING
K
ONG
, M.D. P
H
.D.
*
z
Departments of *Radiation Oncology and
y
Internal Medicine, University of Michigan Medical Center, and
z
Radiation Oncology,
Veterans Administration Health Center, Ann Arbor, MI; and
x
Department of Radiation Oncology, Cancer Center,
Fudan University, Shanghai, China
Purpose: To study theeffects of radiation dose, chemotherapy, and their interaction in patients with unr esectable
or medically inoperable Stage I I I non–small–cell lung cancer (NSCLC).
Methods and Mater ials: A total of 237 consecutive Stage I I I 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 concur rent chemoradiation (n = 62). The pr imary endpoint was overall survival (OS). Radiation
dose ranged from 30 to 102.9 Gy (median 60 Gy), cor responding to a bioequivalent dose (BED) of 39 to 124.5
Gy (median 72 Gy).
Results: The median OS of the entir e cohor t was 12.6 months, and 2- and 5-year survival rates were 22.4%
and 10.0%, respectively. Multivar iable Cox regression model demonstrated that Karnofsky per formance status
(p = 0.020), weight loss < 5% (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs.
concur r ent; p < 0.001), and BED (p < 0.001) weresignificant predictors of OS. For patients treated with RT alone,
sequential chemoradiation, and concur r ent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and
5-year OSwas3.3%, 7.5%, and 19.4%, respectively (p< 0.001). Theeffect of higher radiation doseson survival was
independent of whether chemotherapy was given.
Conclusion: Radiation dose and use of chemotherapy are independent predictors of OS in Stage I I I NSCLC, and
concur r ent chemoradiation is associated with the best survival. There is no interaction between RT dose and
chemotherapy. Ó 2009 Elsevier Inc.
NSCLC, Stage I I I , Dose, Chemotherapy, Radiation.
Wang L. et al. IJROBP 2009;73
Retr spectiv study
Median RT dose:
•
60 Gy
(range 30-102.9)
Median BED:
•
72 Gy
(range 39-124.5)
RT dose
is an independent
predictor od OS
i stage
III NSCLC