Safety and efficacy of reduced dose and margins to involved lymph node metastases in locally advanced NSCLC patients.
Radiother Oncol
; 143: 66-72, 2020 02.
Article
en En
| MEDLINE
| ID: mdl-31431389
ABSTRACT
BACKGROUND AND PURPOSE:
(Chemo)Radiotherapy for locally advanced non-small lung cancer (LA-NSCLC) causes severe dysphagia due to the radiation dose to the mediastinal lymphadenopathy. Reducing the dose to the mediastinum and the margins to the planning target volume (PTV) might reduce severe toxicity rates. The results of both adaptations in LA-NSCLC patients receiving (chemo)radiotherapy were analysed. MATERIALS ANDMETHODS:
308 LA-NSCLC patients were included in an observational study. Both cohorts received hypofractionated RT (24â¯×â¯2.75â¯Gy) of 70â¯Gy (EQD210) to the primary tumour. The reference-cohort (Nâ¯=â¯170) received the same dose of 70â¯Gy (EQD210) to the involved lymph nodes, while the reduction-cohort (Nâ¯=â¯138) received 24â¯×â¯2.42â¯Gy, biologically equivalent to 60â¯Gy (EQD210). Furthermore, the patient-specific PTV-margins for both the primary tumour and lymph nodes were reduced by 2-3â¯mm in the reduction-cohort after implementing a carina based correction strategy. The effects on toxicity, regional failure and overall survival (OS) were assessed.RESULTS:
The acute grade 3 (G3) dysphagia and G3 pulmonary toxicity decreased significantly from 12.9% to 3.6% and 4.1% versus 0%, respectively. The regional failures were comparable 5.9% versus 4.3% (pâ¯=â¯0.546). The median OS was significantly different 26â¯months (reference-cohort) versus 35â¯months (reduction-cohort). After correction for confounders, the association between the reduction-cohort and OS remained significant (HR 0.63 versus HR 0.70).CONCLUSION:
A reduction in PTV-margins and dose from 70â¯Gy to 60â¯Gy to the involved lymph nodes in LA-NSCLC patients receiving (chemo)radiotherapy did not result in an increase in regional failures. Moreover, significantly lower acute toxicities and an improved OS were observed in the reduction-cohort.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Carcinoma de Pulmón de Células no Pequeñas
/
Radioterapia de Intensidad Modulada
/
Neoplasias Pulmonares
Tipo de estudio:
Observational_studies
Límite:
Humans
Idioma:
En
Revista:
Radiother Oncol
Año:
2020
Tipo del documento:
Article
País de afiliación:
Países Bajos