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Objective To assess the therapeutic efficacy and prognostic factors in elderly patients with stage Ⅲ non-small cell lung cancer (NSCLC) after three-dimensional conformal radiotherapy (3DCRT).Methods A retrospective analysis of 124 stage Ⅲ NSCLC patients aged 70 or over who had received treatment with 3DCRT was conducted retrospectively in this study.There were 99 male and 25 female patients,with a median age of 74 years(range:70-84).The median dose was 60 Gy(range 50-72 Gy).Eighty-three patients were treated with radiotherapy alone,27 with sequential and 14 with concurrent radiochemotherapy.Results The end date of follow-up was August 30,2013.After 3DCRT,the 1-,3-and 5-year overall survival (OS) were 61.1％,23.8％ and13.2 ％,respectively,and the median survival time was 18 months.Univariate analysis revealed that gender,obstructive pneumonia,dosage,method of therapy and immediate effect were related to OS(x2 =3.957,6.398,7.147,12.307 and 11.035,respectively;P=0.047,0.011,0.008,0.002 and 0.001,respectively).Multi-variable analysis indicated that age,gender,obstructive pneumonia,dosage and method of therapy were independent prognostic factors for OS.The OS time was longer inpatients who were female,aged over 75,with no obstructive pneumonia or dosage≥ 60 Gy.Compared with radiotherapy alone,sequential radiochemotherapy increased OS while concurrent radiochemotherapy decreased OS.Conclusions Sex,age,obstructive pneumonia and dosage affect the survival of elderly stage Ⅲ NSCLC patients treated with three-dimensional conformal radiotherapy.Concurrent radiochemotherapy should be considered with caution
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Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3DCRT) and prognostic factors for stage Ⅲ non-small cell lung cancer (NSCLC).Methods From 2000 to 2010,474 patients with stage Ⅲ NSCLC undergoing 3DCRT were enrolled as subjects.Those patients,consisting of 382 males and 92 females,had a median age of 63 years.In those patients,211 had stage ⅢA NSCLC and 263 had stage ⅢB NSCLC;165 were treated with radiotherapy alone and 309 with chemoradiotherapy;55 were treated with conventional radiotherapy plus 3DCRT,340 with 3DCRT,and 79 with intensity-modulated radiotherapy;the median equivalent dose was 60 Gy (44-77 Gy).The Kaplan-Meier method,log-rank test,and Cox model were used for survival rate calculation,univariate analysis,and multivariate analysis,respectively.Results The follow-up rate was 96.6％.In all patients,the 1-,3-,and 5-year overall survival rates were 63.0％,24.9％,and 17.8％,respectively;the median survival time was 18 months.The univariate analysis showed that sex,age,immediate response,radiotherapy method,fractionation scheme,chemotherapy,and radiation pneumonitis (RP) were prognostic factors (P=0.004,0.001,0.000,0.007,0.004,0.009,0.049).The multivariate analysis showed that sex,age,immediate response,radiotherapy method,and RP were independent prognostic factors (P=0.006,0.000,0.000,0.003,0.048).Patients with radiation doses of 60-66 Gy had the best prognosis of all.Conclusions In patients with stage Ⅲ NSCLC undergoing 3DCRT,female patients,patients at a young age,patients with satisfactory immediate response,patients treated with full-course 3DCRT,and patients with grade 0-1 RP have better prognosis than others.3DCRT combined with chemotherapy improves survival in patients.A radiation dose of 60-66 Gy is recommended.
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Objective To compare the target dosimetric distribution and clinical outcome in patients with stage Ⅲ non-small cell lung cancer (NSCLC) treated with three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT).Methods The clinical data of 419 patients with stage Ⅲ NSCLC treated with either 3DCRT or IMRT were retrospectively analyzed.Among them,there were 338 male and 81 female patients,and the median age was 63 years (range:32-84 years).There were 340 patients treated with 3DCRT and 79 with IMRT,and the median prescribed dose was 60 Gy (range:50-76Gy).One hundred and forty patients were treated with radiotherapy alone and 279 were treated with chemoradiotherapy.The target dosimetric distribution was evaluated with dose-volume histogram (DVH)parameters.The overall survival (OS) rate was calculated using the Kaplan-Meier method and analyzed by the log-rank test.Results When comparing the clinical data,the patients treated with 3DCRT were in older ages,and had advanced N and clinical stages (P =0.01,0.00,and 0.00,respectively).When comparing the target DVH parameters,the patients treated with IMRT had larger planning target volume (PTV) (P =0.01),significantly lower clinical target volume (CTV) D CTV D90,PTV D and PTV V65-V60 (P =0.05-0.01),significantly higher V5-V20 in both lungs,higher esophagus D longer esophagus in the radiation field,higher linear energy transfer between 45 and 55 keV/μm (LET45-LET55),and higher spinal cord Dmean(P =0.03-0.00).The follow-up rate was 97.4％.After radiotherapy,the 1-,3-,and 5-year OS rates were 65.5％,26.1％,and 18.5％,respectively,and the median survival time was 20 months.There were no significant differences in OS rate and the incidence of acute radiation pneumonitis and radiation esophagitis between patients treated with IMRT and 3DCRT (P =0.06,0.73,0.13).Stratified analysis showed that,when comparing the patients treated with IMRT with those treated with 3DCRT,the survival rate was only lower in male patients,patients in stage T3-T4 or N0-N2,and those without chemotherapy (P =0.04,0.04,0.02,0.00).Conclusions The treatment outcomes of patients with stage Ⅲ NSCLC undergoing IMRT and 3DCRT are comparable.IMRT shows a potential dosimetric advantage,but the result needs further investigation.
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Objective To explore radiation-induced esophagitis and its related factors in the patients with local advanced non-small cell lung cancer ( NSCLC ) which were treated with three-dimensional conformal radiation therapy (3D-CRT). Methods From January 2001 to December 2008, 203 patients who suffered from stageⅢNSCLC were achieved, including 163 males and 40 females, with a median age of 63 years old, while 79 cases were in stageⅢa and 124 in stageⅢb . The equivalent median dose of tumor was 62 Gy( range of 50-78 Gy) . Among them, 74 cases were administered with radiotherapy alone, 45 with sequential radiotherapy and chemotherapy, 87 cases with concurrent radiochemotherapy. Radiation esophagitis was evaluated with RTOG standard. The dosimetric parameters was estimated from dose volume histogrma ( DVH ) . The clinical and dosimetric parameters of radiation esophagitis were evaluated by spearman correlatived univariate and Logistic multivariable analysis. Results After radiotherapy, out of 203 patients, 87 had acute radiation esophagitis(RE), 47 in grade 1, 37 in grade 2, and 3 in grade 3 RE. According to spearman correlatived analysis, the correlatived factors included ages, chemotherapy, GTV, PTV, the mean doses of PTV and lung, the max and mean dose of esophagus, V40 , V45 ,V50 ,V55 ,V60 , length of esophagus( total circumference) treated with 45 Gy ( LETT45 ) , and LETT50 ( r=-0. 162-0. 235,P0. 05). There were 21 factors, such as gender, age, smoking, clinical stage, site of tumor, chemotherapy, GTV, PTV, mean dose of PTV and lung, max and mean dose of esophagus, V40 -V60 of esophagus, LETT45-60 , incorporated into multivariable analysis, only chemotherapy and V45 of esophagus were independent predicted factors(Wald=4. 626, 9?882, P<0. 05). Conclusions In local advanced NSCLC after 3D-CRT, chemotherapy ( especially concurrent radiochemotherapy) could increase radiation-induced esophagitis. The parameter of DVH could also be used to predict radiation-induced esophagitis, V45 of esophagus may be the most valuable predictor.