Optimal Radiation Dose for Stage III Lung Cancer-Should "Definitive" Radiation Doses Be Used in the Preoperative Setting?
Chemoradiotherapy
National Cancer Database (NCDB)
Neoadjuvant
Non–small cell lung cancer (NSCLC)
Radiation dose
Stage III
Journal
JTO clinical and research reports
ISSN: 2666-3643
Titre abrégé: JTO Clin Res Rep
Pays: United States
ID NLM: 101769967
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
02
04
2021
revised:
01
06
2021
accepted:
15
06
2021
entrez:
30
9
2021
pubmed:
1
10
2021
medline:
1
10
2021
Statut:
epublish
Résumé
There are currently two recommended radiation strategies for clinical stage III NSCLC: a lower "preoperative" (45-54 Gy) and a higher "definitive/nonsurgical" (60-70 Gy) dose. We sought to determine if definitive radiation doses should be used in the preoperative setting given that many clinical stage III patients planned for surgery are ultimately managed with chemoradiation alone. Using the National Cancer Database data from 2006 to 2016, we performed a comparative effectiveness analysis of stage III N2 patients who received chemoradiotherapy. Patients were stratified into subgroups across 2 parameters: (1) radiation dose: lower (45-54 Gy) and higher (60-70 Gy); and (2) the use of surgery (i.e., surgical and nonsurgical treatment approaches). Long-term survival and perioperative outcomes were evaluated using multivariable Cox proportional hazards and logistic regression models. A cohort of 961 patients received radiation before surgery including 321 who received a higher dose and 640 who received a lower dose. A higher preoperative dose revealed similar long-term mortality risk (hazard ratio = 0.99, 95% confidence interval: 0.82-1.21, For clinical stage III NSCLC, the administration of 60 to 70 Gy of radiation seems to be more effective than the lower dose for nonsurgical patients without compromising surgical safety for those that undergo resection. This evidence supports the implementation of 60 to 70 Gy as a single-dose strategy for both preoperative and definitive chemoradiotherapy.
Identifiants
pubmed: 34590044
doi: 10.1016/j.jtocrr.2021.100201
pii: S2666-3643(21)00060-6
pmc: PMC8474436
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100201Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Informations de copyright
© 2021 The Authors.
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