Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer
BackgroundLung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. I...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.835844/full |
| _version_ | 1817976421508710400 |
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| author | Isabella Fornacon-Wood Clara Chan Neil Bayman Kathryn Banfill Kathryn Banfill Joanna Coote Alex Garbett Margaret Harris Andrew Hudson Jason Kennedy Laura Pemberton Ahmed Salem Ahmed Salem Hamid Sheikh Philip Whitehurst David Woolf Gareth Price Gareth Price Corinne Faivre-Finn Corinne Faivre-Finn |
| author_facet | Isabella Fornacon-Wood Clara Chan Neil Bayman Kathryn Banfill Kathryn Banfill Joanna Coote Alex Garbett Margaret Harris Andrew Hudson Jason Kennedy Laura Pemberton Ahmed Salem Ahmed Salem Hamid Sheikh Philip Whitehurst David Woolf Gareth Price Gareth Price Corinne Faivre-Finn Corinne Faivre-Finn |
| author_sort | Isabella Fornacon-Wood |
| collection | DOAJ |
| description | BackgroundLung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. In this study, we evaluated whether the introduction of IMRT had an influence on the proportion of patients treated with curative-intent radiotherapy over time, and whether this had an effect on patient survival.Materials and MethodsPatients treated with thoracic radiotherapy at our institute between 2005 and 2020 were retrospectively identified and grouped into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012 (selective use of IMRT), and C) 2013-2020 (full access to IMRT). Data on performance status (PS), stage, age, gross tumour volume (GTV), planning target volume (PTV) and survival were collected. The proportion of patients treated with a curative dose between these periods was compared. Multivariable survival models were fitted to evaluate the hazard for patients treated in each time period, adjusting for PS, stage, age and tumour volume.Results12,499 patients were included in the analysis (n=2675 (A), n=3127 (B), and n=6697 (C)). The proportion of patients treated with curative-intent radiotherapy increased between the 3 time periods, from 38.1% to 50.2% to 65.6% (p<0.001). When stage IV patients were excluded, this increased to 40.1% to 58.1% to 82.9% (p<0.001). This trend was seen across all PS and stages. The GTV size increased across the time periods and PTV size decreased. Patients treated with curative-intent during period C had a survival improvement compared to time period A when adjusting for clinical variables (HR=0.725 (0.632-0.831), p<0.001).ConclusionIMRT was associated with to more patients receiving curative-intent radiotherapy. In addition, it facilitated the treatment of larger tumours that historically would have been treated palliatively. Despite treating larger, more complex tumours with curative-intent, a survival benefit was seen for patients treated when full access to IMRT was available (2013-2020). This study highlights the impact of IMRT on thoracic oncology practice, accepting that improved survival may also be attributed to a number of other contributing factors, including improvements in staging, other technological radiotherapy advances and changes to systemic treatment. |
| first_indexed | 2024-04-13T22:02:21Z |
| format | Article |
| id | doaj.art-b6de1db0ec034b1b9b2bb83e3cc94d7d |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-13T22:02:21Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-b6de1db0ec034b1b9b2bb83e3cc94d7d2022-12-22T02:28:03ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-05-011210.3389/fonc.2022.835844835844Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung CancerIsabella Fornacon-Wood0Clara Chan1Neil Bayman2Kathryn Banfill3Kathryn Banfill4Joanna Coote5Alex Garbett6Margaret Harris7Andrew Hudson8Jason Kennedy9Laura Pemberton10Ahmed Salem11Ahmed Salem12Hamid Sheikh13Philip Whitehurst14David Woolf15Gareth Price16Gareth Price17Corinne Faivre-Finn18Corinne Faivre-Finn19Division of Cancer Sciences, University of Manchester, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDivision of Cancer Sciences, University of Manchester, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomRadiotherapy Related Research, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDivision of Cancer Sciences, University of Manchester, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomChristie Medical Physics and Engineering, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDivision of Cancer Sciences, University of Manchester, Manchester, United KingdomChristie Medical Physics and Engineering, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomDivision of Cancer Sciences, University of Manchester, Manchester, United KingdomDepartment of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, United KingdomBackgroundLung cancer survival remains poor. The introduction of Intensity-Modulated Radiotherapy (IMRT) allows treatment of more complex tumours as it improves conformity around the tumour and greater normal tissue sparing. However, there is limited evidence assessing the clinical impact of IMRT. In this study, we evaluated whether the introduction of IMRT had an influence on the proportion of patients treated with curative-intent radiotherapy over time, and whether this had an effect on patient survival.Materials and MethodsPatients treated with thoracic radiotherapy at our institute between 2005 and 2020 were retrospectively identified and grouped into three time periods: A) 2005-2008 (pre-IMRT), B) 2009-2012 (selective use of IMRT), and C) 2013-2020 (full access to IMRT). Data on performance status (PS), stage, age, gross tumour volume (GTV), planning target volume (PTV) and survival were collected. The proportion of patients treated with a curative dose between these periods was compared. Multivariable survival models were fitted to evaluate the hazard for patients treated in each time period, adjusting for PS, stage, age and tumour volume.Results12,499 patients were included in the analysis (n=2675 (A), n=3127 (B), and n=6697 (C)). The proportion of patients treated with curative-intent radiotherapy increased between the 3 time periods, from 38.1% to 50.2% to 65.6% (p<0.001). When stage IV patients were excluded, this increased to 40.1% to 58.1% to 82.9% (p<0.001). This trend was seen across all PS and stages. The GTV size increased across the time periods and PTV size decreased. Patients treated with curative-intent during period C had a survival improvement compared to time period A when adjusting for clinical variables (HR=0.725 (0.632-0.831), p<0.001).ConclusionIMRT was associated with to more patients receiving curative-intent radiotherapy. In addition, it facilitated the treatment of larger tumours that historically would have been treated palliatively. Despite treating larger, more complex tumours with curative-intent, a survival benefit was seen for patients treated when full access to IMRT was available (2013-2020). This study highlights the impact of IMRT on thoracic oncology practice, accepting that improved survival may also be attributed to a number of other contributing factors, including improvements in staging, other technological radiotherapy advances and changes to systemic treatment.https://www.frontiersin.org/articles/10.3389/fonc.2022.835844/fullIMRTlung cancerradiotherapyreal-world databig data |
| spellingShingle | Isabella Fornacon-Wood Clara Chan Neil Bayman Kathryn Banfill Kathryn Banfill Joanna Coote Alex Garbett Margaret Harris Andrew Hudson Jason Kennedy Laura Pemberton Ahmed Salem Ahmed Salem Hamid Sheikh Philip Whitehurst David Woolf Gareth Price Gareth Price Corinne Faivre-Finn Corinne Faivre-Finn Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer Frontiers in Oncology IMRT lung cancer radiotherapy real-world data big data |
| title | Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer |
| title_full | Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer |
| title_fullStr | Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer |
| title_full_unstemmed | Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer |
| title_short | Impact of Introducing Intensity Modulated Radiotherapy on Curative Intent Radiotherapy and Survival for Lung Cancer |
| title_sort | impact of introducing intensity modulated radiotherapy on curative intent radiotherapy and survival for lung cancer |
| topic | IMRT lung cancer radiotherapy real-world data big data |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.835844/full |
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