Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer
Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall sur...
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| Format: | Article |
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MDPI AG
2021-11-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/23/5923 |
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| author | Isabel F. Remmerts de Vries Merle I. Ronden Idris Bahce Femke O. B. Spoelstra Patricia F. De Haan Cornelis J. A. Haasbeek Birgit I. Lissenberg-Witte Ben J. Slotman Max Dahele Wilko F. A. R. Verbakel |
| author_facet | Isabel F. Remmerts de Vries Merle I. Ronden Idris Bahce Femke O. B. Spoelstra Patricia F. De Haan Cornelis J. A. Haasbeek Birgit I. Lissenberg-Witte Ben J. Slotman Max Dahele Wilko F. A. R. Verbakel |
| author_sort | Isabel F. Remmerts de Vries |
| collection | DOAJ |
| description | Concurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection. We performed an institutional analysis to study the relationship between dosimetric parameters, toxicity, and OS in inoperable patients with stage III NSCLC treated with (hybrid) IMRT/VMAT-based techniques in routine clinical practice. Eligible patients had undergone treatment with radical intent using cCRT, sCRT, or RT alone, planned to a total dose ≥ 50 Gy delivered in ≥15 fractions. All analyses were performed for two patient groups, (1) cCRT (<i>n</i> = 64) and (2) sCRT/RT (<i>n</i> = 65). The toxicity rate differences between the two groups were not significant, and OS was 29 and 17 months, respectively. For sCRT/RT, no dosimetric factors were associated with OS, whereas for cCRT, PTV-volume, esophagus V50 Gy, and contralateral lung V5 Gy were associated. cCRT OS was significantly lower in patients with esophagitis ≥ G2. The overall rate of ≥G3 pneumonitis was low (3%), and the rate of high-grade esophagitis the OS in this real-world patient population was comparable to those reported in clinical trials. Based on this hypothesis-generating data, more aggressive esophageal sparing merits consideration. Institutional auditing and benchmarking of the planning strategy, dosimetry, and outcome have an important role to play in the continuous quality improvement process. |
| first_indexed | 2024-03-10T04:56:34Z |
| format | Article |
| id | doaj.art-c2cc8fd8b69c4e8d96300e8340c534b1 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T04:56:34Z |
| publishDate | 2021-11-01 |
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| record_format | Article |
| series | Cancers |
| spelling | doaj.art-c2cc8fd8b69c4e8d96300e8340c534b12023-11-23T02:11:32ZengMDPI AGCancers2072-66942021-11-011323592310.3390/cancers13235923Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung CancerIsabel F. Remmerts de Vries0Merle I. Ronden1Idris Bahce2Femke O. B. Spoelstra3Patricia F. De Haan4Cornelis J. A. Haasbeek5Birgit I. Lissenberg-Witte6Ben J. Slotman7Max Dahele8Wilko F. A. R. Verbakel9Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsDepartment of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, 1081 HV Amsterdam, The NetherlandsConcurrent chemoradiotherapy (cCRT) is the preferred treatment for stage III NSCLC because surgery containing multimodality treatment is often not appropriate. Alternatives, often for less fit patients, include sequential CRT and RT alone. Many reports describing the relationship between overall survival (OS), toxicity, and dosimetry are based on clinical trials, with strict criteria for patient selection. We performed an institutional analysis to study the relationship between dosimetric parameters, toxicity, and OS in inoperable patients with stage III NSCLC treated with (hybrid) IMRT/VMAT-based techniques in routine clinical practice. Eligible patients had undergone treatment with radical intent using cCRT, sCRT, or RT alone, planned to a total dose ≥ 50 Gy delivered in ≥15 fractions. All analyses were performed for two patient groups, (1) cCRT (<i>n</i> = 64) and (2) sCRT/RT (<i>n</i> = 65). The toxicity rate differences between the two groups were not significant, and OS was 29 and 17 months, respectively. For sCRT/RT, no dosimetric factors were associated with OS, whereas for cCRT, PTV-volume, esophagus V50 Gy, and contralateral lung V5 Gy were associated. cCRT OS was significantly lower in patients with esophagitis ≥ G2. The overall rate of ≥G3 pneumonitis was low (3%), and the rate of high-grade esophagitis the OS in this real-world patient population was comparable to those reported in clinical trials. Based on this hypothesis-generating data, more aggressive esophageal sparing merits consideration. Institutional auditing and benchmarking of the planning strategy, dosimetry, and outcome have an important role to play in the continuous quality improvement process.https://www.mdpi.com/2072-6694/13/23/5923NSCLCdosimetric parametersoverall survivaltoxicity |
| spellingShingle | Isabel F. Remmerts de Vries Merle I. Ronden Idris Bahce Femke O. B. Spoelstra Patricia F. De Haan Cornelis J. A. Haasbeek Birgit I. Lissenberg-Witte Ben J. Slotman Max Dahele Wilko F. A. R. Verbakel Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer Cancers NSCLC dosimetric parameters overall survival toxicity |
| title | Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer |
| title_full | Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer |
| title_fullStr | Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer |
| title_full_unstemmed | Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer |
| title_short | Relationship between Treatment Plan Dosimetry, Toxicity, and Survival following Intensity-Modulated Radiotherapy, with or without Chemotherapy, for Stage III Inoperable Non-Small Cell Lung Cancer |
| title_sort | relationship between treatment plan dosimetry toxicity and survival following intensity modulated radiotherapy with or without chemotherapy for stage iii inoperable non small cell lung cancer |
| topic | NSCLC dosimetric parameters overall survival toxicity |
| url | https://www.mdpi.com/2072-6694/13/23/5923 |
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