The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients With Stage III Non-Small-Cell Lung Cancer

Li Wang, Candace R. Correa, Lujun Zhao, James Hayman, Gregory P. Kalemkerian, Susan Lyons, Kemp Cease, Dean Brenner, Feng Ming Kong

Research output: Contribution to journalArticle

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Abstract

Purpose: To study the effects of radiation dose, chemotherapy, and their interaction in patients with unresectable or medically inoperable Stage III non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 237 consecutive Stage III NSCLC patients were evaluated. Median follow-up was 69.0 months. Patients were treated with radiation therapy (RT) alone (n = 106), sequential chemoradiation (n = 69), or concurrent chemoradiation (n = 62). The primary endpoint was overall survival (OS). Radiation dose ranged from 30 to 102.9 Gy (median 60 Gy), corresponding to a bioequivalent dose (BED) of 39 to 124.5 Gy (median 72 Gy). Results: The median OS of the entire cohort was 12.6 months, and 2- and 5-year survival rates were 22.4% and 10.0%, respectively. Multivariable Cox regression model demonstrated that Karnofsky performance status (p = 0.020), weight loss < 5% (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs. concurrent; p < 0.001), and BED (p < 0.001) were significant predictors of OS. For patients treated with RT alone, sequential chemoradiation, and concurrent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and 5-year OS was 3.3%, 7.5%, and 19.4%, respectively (p < 0.001). The effect of higher radiation doses on survival was independent of whether chemotherapy was given. Conclusion: Radiation dose and use of chemotherapy are independent predictors of OS in Stage III NSCLC, and concurrent chemoradiation is associated with the best survival. There is no interaction between RT dose and chemotherapy.

Original languageEnglish (US)
Pages (from-to)1383-1390
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume73
Issue number5
DOIs
StatePublished - Apr 1 2009

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Radiation Effects
chemotherapy
Non-Small Cell Lung Carcinoma
lungs
cancer
Drug Therapy
dosage
Survival
radiation
Radiotherapy
radiation therapy
Radiation
Karnofsky Performance Status
Proportional Hazards Models
predictions
Weight Loss
Survival Rate
regression analysis
interactions

Keywords

  • Chemotherapy
  • Dose
  • NSCLC
  • Radiation
  • Stage III

ASJC Scopus subject areas

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

Cite this

The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients With Stage III Non-Small-Cell Lung Cancer. / Wang, Li; Correa, Candace R.; Zhao, Lujun; Hayman, James; Kalemkerian, Gregory P.; Lyons, Susan; Cease, Kemp; Brenner, Dean; Kong, Feng Ming.

In: International Journal of Radiation Oncology Biology Physics, Vol. 73, No. 5, 01.04.2009, p. 1383-1390.

Research output: Contribution to journalArticle

Wang, Li ; Correa, Candace R. ; Zhao, Lujun ; Hayman, James ; Kalemkerian, Gregory P. ; Lyons, Susan ; Cease, Kemp ; Brenner, Dean ; Kong, Feng Ming. / The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients With Stage III Non-Small-Cell Lung Cancer. In: International Journal of Radiation Oncology Biology Physics. 2009 ; Vol. 73, No. 5. pp. 1383-1390.
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abstract = "Purpose: To study the effects of radiation dose, chemotherapy, and their interaction in patients with unresectable or medically inoperable Stage III non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 237 consecutive Stage III NSCLC patients were evaluated. Median follow-up was 69.0 months. Patients were treated with radiation therapy (RT) alone (n = 106), sequential chemoradiation (n = 69), or concurrent chemoradiation (n = 62). The primary endpoint was overall survival (OS). Radiation dose ranged from 30 to 102.9 Gy (median 60 Gy), corresponding to a bioequivalent dose (BED) of 39 to 124.5 Gy (median 72 Gy). Results: The median OS of the entire cohort was 12.6 months, and 2- and 5-year survival rates were 22.4{\%} and 10.0{\%}, respectively. Multivariable Cox regression model demonstrated that Karnofsky performance status (p = 0.020), weight loss < 5{\%} (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs. concurrent; p < 0.001), and BED (p < 0.001) were significant predictors of OS. For patients treated with RT alone, sequential chemoradiation, and concurrent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and 5-year OS was 3.3{\%}, 7.5{\%}, and 19.4{\%}, respectively (p < 0.001). The effect of higher radiation doses on survival was independent of whether chemotherapy was given. Conclusion: Radiation dose and use of chemotherapy are independent predictors of OS in Stage III NSCLC, and concurrent chemoradiation is associated with the best survival. There is no interaction between RT dose and chemotherapy.",
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T1 - The Effect of Radiation Dose and Chemotherapy on Overall Survival in 237 Patients With Stage III Non-Small-Cell Lung Cancer

AU - Wang, Li

AU - Correa, Candace R.

AU - Zhao, Lujun

AU - Hayman, James

AU - Kalemkerian, Gregory P.

AU - Lyons, Susan

AU - Cease, Kemp

AU - Brenner, Dean

AU - Kong, Feng Ming

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N2 - Purpose: To study the effects of radiation dose, chemotherapy, and their interaction in patients with unresectable or medically inoperable Stage III non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 237 consecutive Stage III NSCLC patients were evaluated. Median follow-up was 69.0 months. Patients were treated with radiation therapy (RT) alone (n = 106), sequential chemoradiation (n = 69), or concurrent chemoradiation (n = 62). The primary endpoint was overall survival (OS). Radiation dose ranged from 30 to 102.9 Gy (median 60 Gy), corresponding to a bioequivalent dose (BED) of 39 to 124.5 Gy (median 72 Gy). Results: The median OS of the entire cohort was 12.6 months, and 2- and 5-year survival rates were 22.4% and 10.0%, respectively. Multivariable Cox regression model demonstrated that Karnofsky performance status (p = 0.020), weight loss < 5% (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs. concurrent; p < 0.001), and BED (p < 0.001) were significant predictors of OS. For patients treated with RT alone, sequential chemoradiation, and concurrent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and 5-year OS was 3.3%, 7.5%, and 19.4%, respectively (p < 0.001). The effect of higher radiation doses on survival was independent of whether chemotherapy was given. Conclusion: Radiation dose and use of chemotherapy are independent predictors of OS in Stage III NSCLC, and concurrent chemoradiation is associated with the best survival. There is no interaction between RT dose and chemotherapy.

AB - Purpose: To study the effects of radiation dose, chemotherapy, and their interaction in patients with unresectable or medically inoperable Stage III non-small-cell lung cancer (NSCLC). Methods and Materials: A total of 237 consecutive Stage III NSCLC patients were evaluated. Median follow-up was 69.0 months. Patients were treated with radiation therapy (RT) alone (n = 106), sequential chemoradiation (n = 69), or concurrent chemoradiation (n = 62). The primary endpoint was overall survival (OS). Radiation dose ranged from 30 to 102.9 Gy (median 60 Gy), corresponding to a bioequivalent dose (BED) of 39 to 124.5 Gy (median 72 Gy). Results: The median OS of the entire cohort was 12.6 months, and 2- and 5-year survival rates were 22.4% and 10.0%, respectively. Multivariable Cox regression model demonstrated that Karnofsky performance status (p = 0.020), weight loss < 5% (p = 0.017), chemotherapy (yes vs. no), sequence of chemoradiation (sequential vs. concurrent; p < 0.001), and BED (p < 0.001) were significant predictors of OS. For patients treated with RT alone, sequential chemoradiation, and concurrent chemoradiation, median survival was 7.4, 14.9, and 15.8 months, and 5-year OS was 3.3%, 7.5%, and 19.4%, respectively (p < 0.001). The effect of higher radiation doses on survival was independent of whether chemotherapy was given. Conclusion: Radiation dose and use of chemotherapy are independent predictors of OS in Stage III NSCLC, and concurrent chemoradiation is associated with the best survival. There is no interaction between RT dose and chemotherapy.

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KW - Dose

KW - NSCLC

KW - Radiation

KW - Stage III

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