Skip to main content
Journal cover image

Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC.

Publication ,  Journal Article
Schild, SE; Pang, HH; Fan, W; Stinchcombe, TE; Vokes, EE; Ramalingam, SS; Bradley, JD; Kelly, K; Wang, X
Published in: J Thorac Oncol
August 2018

INTRODUCTION: Concurrent chemoradiotherapy (CRT) is standard therapy for locally advanced NSCLC (LA-NSCLC) patients. This study was performed to examine thoracic radiotherapy (TRT) parameters and their impact on patient survival. METHODS: We collected individual patient data from 3600 LA-NSCLC patients participating in 16 cooperative group trials of concurrent CRT. The primary TRT parameters examined included field design strategy (elective nodal irradiation [ENI] compared to involved-field TRT (IF-TRT)), total dose, and biologically effective dose (BED). Hazard ratios (HRs) for overall survival were calculated with univariable and multivariable Cox models. RESULTS: TRT doses ranged from 60 Gy to 74 Gy with most treatments administered once-daily. ENI was associated with poorer survival than IF-TRT (univariable HR = 1.37, 95% confidence interval [CI]: 1.24-1.51, p < 0.0001; multivariable HR = 1.31, 95% CI: 1.08-1.59, p = 0.002). The median survival times of the IF and ENI patients were 24 months and 16 months, respectively. Patients were divided into three dose groups: low total dose (60 Gy), medium total dose (>60 Gy to 66 Gy), and high total dose (>66 Gy to 74 Gy). With reference to the low-dose group, the multivariable HRs were 1.08 for the medium-dose group (95% CI: 0.93-1.25) and 1.12 for the high-dose group (95% CI: 0.97-1.30).The univariate p = 0.054 and multivariable p = 0.17. BED was grouped as follows: low (<55.5 Gy10), medium (55.5 Gy10), or high (>55.5 Gy10). With reference to the low-BED group, the HR was 1.00 (95% CI: 0.85-1.18) for the medium-BED group and 1.10 (95% CI: 0.93-1.31) for the high-BED group. The univariable p = 0.076 and multivariable p = 0.16. CONCLUSIONS: For LA-NSCLC patients treated with concurrent CRT, IF-TRT was associated with significantly better survival than ENI-TRT. TRT total and BED dose levels were not significantly associated with patient survival. Future progress will require research focusing on better systemic therapy and TRT.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

August 2018

Volume

13

Issue

8

Start / End Page

1171 / 1182

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Radiotherapy Dosage
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Dose-Response Relationship, Radiation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Schild, S. E., Pang, H. H., Fan, W., Stinchcombe, T. E., Vokes, E. E., Ramalingam, S. S., … Wang, X. (2018). Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC. J Thorac Oncol, 13(8), 1171–1182. https://doi.org/10.1016/j.jtho.2018.04.011
Schild, Steven E., Herbert H. Pang, Wen Fan, Thomas E. Stinchcombe, Everett E. Vokes, Suresh S. Ramalingam, Jeffrey D. Bradley, Karen Kelly, and Xiaofei Wang. “Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC.J Thorac Oncol 13, no. 8 (August 2018): 1171–82. https://doi.org/10.1016/j.jtho.2018.04.011.
Schild SE, Pang HH, Fan W, Stinchcombe TE, Vokes EE, Ramalingam SS, et al. Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC. J Thorac Oncol. 2018 Aug;13(8):1171–82.
Schild, Steven E., et al. “Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC.J Thorac Oncol, vol. 13, no. 8, Aug. 2018, pp. 1171–82. Pubmed, doi:10.1016/j.jtho.2018.04.011.
Schild SE, Pang HH, Fan W, Stinchcombe TE, Vokes EE, Ramalingam SS, Bradley JD, Kelly K, Wang X. Exploring Radiotherapy Targeting Strategy and Dose: A Pooled Analysis of Cooperative Group Trials of Combined Modality Therapy for Stage III NSCLC. J Thorac Oncol. 2018 Aug;13(8):1171–1182.
Journal cover image

Published In

J Thorac Oncol

DOI

EISSN

1556-1380

Publication Date

August 2018

Volume

13

Issue

8

Start / End Page

1171 / 1182

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Radiotherapy Dosage
  • Proportional Hazards Models
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
  • Female
  • Dose-Response Relationship, Radiation