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Association Between Radiation Dose and Outcomes With Postoperative Radiotherapy for N0-N1 Non-Small Cell Lung Cancer.
Wang, Elyn H; Corso, Christopher D; Park, Henry S; Chen, Aileen B; Wilson, Lynn D; Kim, Anthony W; Decker, Roy H; Yu, James B.
Afiliação
  • Wang EH; Department of Therapeutic Radiology, Yale School of Medicine.
  • Corso CD; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale.
  • Park HS; Department of Therapeutic Radiology, Yale School of Medicine.
  • Chen AB; Department of Therapeutic Radiology, Yale School of Medicine.
  • Wilson LD; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale.
  • Kim AW; Department of Radiation Oncology, Harvard School of Medicine, Boston, MA.
  • Decker RH; Department of Therapeutic Radiology, Yale School of Medicine.
  • Yu JB; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center at Yale.
Am J Clin Oncol ; 41(2): 152-158, 2018 02.
Article em En | MEDLINE | ID: mdl-26523443
ABSTRACT

PURPOSE:

To review trends in the use of postoperative radiotherapy (PORT) in the modern era for N0-N1 margin-negative non-small cell lung cancer (NSCLC) following surgical resection and evaluate the association between PORT dose and overall survival. MATERIALS AND

METHODS:

We performed a retrospective study of nonmetastatic stage II and III N0-N1 margin-negative NSCLC surgically treated patients within the National Cancer Data Base from 2003 to 2011. Cox proportional hazards regression was performed for multivariable analyses of overall survival and PORT dose. Radiation modalities included nonconformal beam radiation, 3-dimensional conformal radiation (3D-CRT), and intensity-modulated radiation therapy.

RESULTS:

We identified 2167 (6.7%) and 30,269 (93.3%) patients with surgically resected stage II or III N0-N1 margin-negative NSCLC who were treated with and without PORT, respectively. The proportion of patients treated with PORT (dose range, 45 to 74 Gy) decreased from 8.9% in 2003 to 2006 to 4.1% in 2010 to 2011. Among patients receiving PORT, the use of high-dose (60 to 74 Gy) PORT rose throughout the study period, starting at 34.8% in 2003 to 2006 and rising to 49.3% in 2010 to 2011.Overall, patients who received PORT had worse survival (hazards ratio=1.30; 95% confidence interval, 1.20-1.40) compared with those not receiving PORT. This association was unchanged when limited to patients receiving modern treatment with 3-CRT or intensity-modulated radiation therapy (hazards ratio=1.35; 95% confidence interval, 1.10-1.65).

CONCLUSIONS:

The use of PORT for N0-N1 margin-negative NSCLC decreased from 2003 to 2011. We found no evidence of benefit from PORT for resected N0-N1 margin-negative NSCLC, regardless of dose or technique. PORT should be approached with caution in this group of patients, regardless of radiotherapy technique.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Pulmonar de Células não Pequenas / Neoplasias Pulmonares Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Clin Oncol Ano de publicação: 2018 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Carcinoma Pulmonar de Células não Pequenas / Neoplasias Pulmonares Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Am J Clin Oncol Ano de publicação: 2018 Tipo de documento: Article