Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting?
Introduction: 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 man...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-08-01
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| Series: | JTO Clinical and Research Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666364321000606 |
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| author | Areo G. Saffarzadeh, MD, MS Maureen Canavan, PhD, MPH Benjamin J. Resio, MD Samantha L. Walters, MHS Kaitlin M. Flores Roy H. Decker, MD, PhD Daniel J. Boffa, MD |
| author_facet | Areo G. Saffarzadeh, MD, MS Maureen Canavan, PhD, MPH Benjamin J. Resio, MD Samantha L. Walters, MHS Kaitlin M. Flores Roy H. Decker, MD, PhD Daniel J. Boffa, MD |
| author_sort | Areo G. Saffarzadeh, MD, MS |
| collection | DOAJ |
| description | Introduction: 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. Methods: 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. Results: 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, p = 0.951) compared with a lower dose. There was no significant association between radiation dose and 90-day mortality (p = 0.982), 30-day readmission (p = 0.931), or prolonged length of stay (p = 0.052) in the surgical cohort. A total of 17,904 clinical-stage IIIA-N2 patients were treated nonsurgically, including 15,945 receiving higher and 1959 treated with a lower dose. A higher dose was associated with a reduction in long-term mortality risk (hazard ratio = 0.64, 95% confidence interval: 0.60–0.67, p < 0.001) compared with a lower dose. Conclusions: 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. |
| first_indexed | 2024-12-16T09:00:19Z |
| format | Article |
| id | doaj.art-a3d86e08809e49dba414c585279f634c |
| institution | Directory Open Access Journal |
| issn | 2666-3643 |
| language | English |
| last_indexed | 2024-12-16T09:00:19Z |
| publishDate | 2021-08-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTO Clinical and Research Reports |
| spelling | doaj.art-a3d86e08809e49dba414c585279f634c2022-12-21T22:37:12ZengElsevierJTO Clinical and Research Reports2666-36432021-08-0128100201Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting?Areo G. Saffarzadeh, MD, MS0Maureen Canavan, PhD, MPH1Benjamin J. Resio, MD2Samantha L. Walters, MHS3Kaitlin M. Flores4Roy H. Decker, MD, PhD5Daniel J. Boffa, MD6Section of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, ConnecticutHunter Radiation Therapy Center, Department of Therapeutic Radiology, Yale School of Medicine, New Haven, ConnecticutSection of Thoracic Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut; Corresponding author Address for correspondence: Daniel J. Boffa, MD, Section of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, 330 Cedar Street BB205, New Haven, CT 06510-8062.Introduction: 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. Methods: 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. Results: 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, p = 0.951) compared with a lower dose. There was no significant association between radiation dose and 90-day mortality (p = 0.982), 30-day readmission (p = 0.931), or prolonged length of stay (p = 0.052) in the surgical cohort. A total of 17,904 clinical-stage IIIA-N2 patients were treated nonsurgically, including 15,945 receiving higher and 1959 treated with a lower dose. A higher dose was associated with a reduction in long-term mortality risk (hazard ratio = 0.64, 95% confidence interval: 0.60–0.67, p < 0.001) compared with a lower dose. Conclusions: 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.http://www.sciencedirect.com/science/article/pii/S2666364321000606Non–small cell lung cancer (NSCLC)Radiation doseStage IIINational Cancer Database (NCDB)ChemoradiotherapyNeoadjuvant |
| spellingShingle | Areo G. Saffarzadeh, MD, MS Maureen Canavan, PhD, MPH Benjamin J. Resio, MD Samantha L. Walters, MHS Kaitlin M. Flores Roy H. Decker, MD, PhD Daniel J. Boffa, MD Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting? JTO Clinical and Research Reports Non–small cell lung cancer (NSCLC) Radiation dose Stage III National Cancer Database (NCDB) Chemoradiotherapy Neoadjuvant |
| title | Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting? |
| title_full | Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting? |
| title_fullStr | Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting? |
| title_full_unstemmed | Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting? |
| title_short | Optimal Radiation Dose for Stage III Lung Cancer—Should “Definitive” Radiation Doses Be Used in the Preoperative Setting? |
| title_sort | optimal radiation dose for stage iii lung cancer should definitive radiation doses be used in the preoperative setting |
| topic | Non–small cell lung cancer (NSCLC) Radiation dose Stage III National Cancer Database (NCDB) Chemoradiotherapy Neoadjuvant |
| url | http://www.sciencedirect.com/science/article/pii/S2666364321000606 |
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