207_Combined course Presentations

THE EFFECT OF RADIATION DOSE AND CHEMOTHERAPY ONOVERALL SURVIVAL IN 237 PATIENTSWITH STAGE I I I NON–SMALL-CELL LUNG CANCER

Dose response relation 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  Retr spectiv study 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.  Median BED: •  RT dose is an independent predictor od OS i stage III NSCLC  Median RT dose:

• 60 Gy (range 30-102.9)

72 Gy (range 39-124.5)

NSCLC, Stage I I I , Dose, Chemotherapy, Radiation.

Wang L. et al. IJROBP 2009;73