Abstract
Introduction
The role of postoperative radiotherapy (PORT) in patients with resected locally advanced
non-small-cell lung cancer (NSCLC) remains controversial due to the radiation techniques
used in randomized trials. We conducted a retrospective cohort study evaluating contemporary
PORT techniques to evaluate the safety of PORT and risk of death from intercurrent
disease .
Materials and Methods
We analyzed consecutive patients with NSCLC treated in a single center that underwent
PORT for pN2 disease and/or positive margin, with 3-dimensional conformal radiotherapy
(3DRT), intensity modulated radiotherapy , or proton RT (PRT), between 2008 and 2019.
Clinical details were collected including intercurrent deaths, defined as death without
cancer recurrence. Kaplan-Meier and Cox-Proportional Hazards Models were used.
Results
Of 119 patients, 21 (17.6%) received 3DRT, 47 (39.5%) intensity modulated radiotherapy,
and 51 (42.9%) PRT. Median follow-up was 40 months (range 8-136) and median RT dose
was 5040cGy. Most patients (65.5%) received sequential adjuvant chemoRT; 18.5% received
concurrent chemoRT. The rate of grade 3 toxicities was 9.2%. There were 13 (10.9%)
deaths from intercurrent diseases, including 6 from second primary cancers and 2 from
cardiopulmonary diseases. There were 2 additional deaths from cardiopulmonary disease
in patients with cancer progression at time of death. Mean, V5Gy, V30Gy heart doses
and mean lung doses were significantly lower with PRT. Three-year OS and disease-free-survival
were 70.1% and 49.9%.
Conclusion
PORT using contemporary techniques was well tolerated with acceptable toxicity and
low rates of intercurrent deaths. Proton therapy significantly reduced heart and lung
doses, but radiotherapy modality was not associated with differences in intercurrent
disease.
Keywords
Abbreviations:
(NSCLC) (Non-small-cell lung cancer), (PORT) (Postoperative adjuvant radiation therapy), (DFS) (disease-free-survival), (HR) (Hazard ratio), (3DRT) (Three-dimensional radiotherapy), (IMRT) (Intensity-modulated radiotherapy), (PRT) (Proton therapy), (OARs) (Organs-at-risk), (DID) (Deaths from intercurrent diseases), (ECOG) (Eastern Cooperative Oncology Group), (PET) (Positron emission tomography), (AJCC) (American Joint Committee on Cancer), (Vx) (Percentage volume receiving at least x Gy), (CTCAE) (Common Terminology Criteria for Adverse Events), (OS) (Overall survival), (COPD) (Chronic obstructive pulmonary disease)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 24, 2022
Accepted:
December 16,
2022
Received in revised form:
December 4,
2022
Received:
September 17,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
