High Radiation Dose May Reduce the Negative Effect of Large Gross Tumor Volume in Patients With Medically Inoperable Early-Stage Non-Small Cell Lung Cancer

Lujun Zhao, Brady T. West, James A. Hayman, Susan Lyons, Kemp Cease, Feng Ming (Spring) Kong

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine whether the effect of radiation dose varies with gross tumor volume (GTV) in patients with stage I/II non-small cell lung cancer (NSCLC). Methods and Materials: Included in the study were 114 consecutive patients with medically inoperable stage I/II NSCLC treated with three-dimensional conformal radiotherapy between 1992 and 2004. The median biologic equivalent dose (BED) was 79.2 Gy (range, 58.2-124.5 Gy). The median GTV was 51.8 cm3 (range, 2.1-727.8 cm3). The primary endpoint was overall survival (OS). Kaplan-Meier estimation and Cox regression models were used for survival analyses. Results: Multivariate analysis showed that there was a significant interaction between radiation dose and GTV (p < 0.001). In patients with BED ≤79.2 Gy (n = 68), the OS medians for patients with GTV >51.8 cm3 and ≤51.8 cm3 were 18.2 and 23.9 months, respectively (p = 0.015). If BED was >79.2 Gy (n = 46), no significant difference was found between GTV groups (p = 0.681). For patients with GTV >51.8 cm3 (n = 45), the OS medians in those with BED >79.2 Gy and ≤79.2 Gy were 30.4 and 18.2 months, respectively (p < 0.001). If GTV was ≤51.8 cm3 (n = 45), the difference was no longer significant (p = 0.577). Conclusion: High-dose radiation is more important for patients with larger tumors and may be effective in reducing the adverse outcome associated with large GTV. Further prospective studies are needed to confirm this finding.

Original languageEnglish (US)
Pages (from-to)103-110
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume68
Issue number1
DOIs
StatePublished - May 1 2007

Fingerprint

Tumor Burden
Non-Small Cell Lung Carcinoma
lungs
tumors
cancer
Radiation
dosage
radiation
Conformal Radiotherapy
Survival
Radiation Effects
Survival Analysis
Proportional Hazards Models
Multivariate Analysis
regression analysis
radiation therapy
Prospective Studies
Neoplasms

Keywords

  • Dose
  • Gross tumor volume
  • Non-small cell lung cancer

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

High Radiation Dose May Reduce the Negative Effect of Large Gross Tumor Volume in Patients With Medically Inoperable Early-Stage Non-Small Cell Lung Cancer. / Zhao, Lujun; West, Brady T.; Hayman, James A.; Lyons, Susan; Cease, Kemp; Kong, Feng Ming (Spring).

In: International Journal of Radiation Oncology Biology Physics, Vol. 68, No. 1, 01.05.2007, p. 103-110.

Research output: Contribution to journalArticle

Zhao, Lujun ; West, Brady T. ; Hayman, James A. ; Lyons, Susan ; Cease, Kemp ; Kong, Feng Ming (Spring). / High Radiation Dose May Reduce the Negative Effect of Large Gross Tumor Volume in Patients With Medically Inoperable Early-Stage Non-Small Cell Lung Cancer. In: International Journal of Radiation Oncology Biology Physics. 2007 ; Vol. 68, No. 1. pp. 103-110.
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AB - Purpose: To determine whether the effect of radiation dose varies with gross tumor volume (GTV) in patients with stage I/II non-small cell lung cancer (NSCLC). Methods and Materials: Included in the study were 114 consecutive patients with medically inoperable stage I/II NSCLC treated with three-dimensional conformal radiotherapy between 1992 and 2004. The median biologic equivalent dose (BED) was 79.2 Gy (range, 58.2-124.5 Gy). The median GTV was 51.8 cm3 (range, 2.1-727.8 cm3). The primary endpoint was overall survival (OS). Kaplan-Meier estimation and Cox regression models were used for survival analyses. Results: Multivariate analysis showed that there was a significant interaction between radiation dose and GTV (p < 0.001). In patients with BED ≤79.2 Gy (n = 68), the OS medians for patients with GTV >51.8 cm3 and ≤51.8 cm3 were 18.2 and 23.9 months, respectively (p = 0.015). If BED was >79.2 Gy (n = 46), no significant difference was found between GTV groups (p = 0.681). For patients with GTV >51.8 cm3 (n = 45), the OS medians in those with BED >79.2 Gy and ≤79.2 Gy were 30.4 and 18.2 months, respectively (p < 0.001). If GTV was ≤51.8 cm3 (n = 45), the difference was no longer significant (p = 0.577). Conclusion: High-dose radiation is more important for patients with larger tumors and may be effective in reducing the adverse outcome associated with large GTV. Further prospective studies are needed to confirm this finding.

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