Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer

A secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial

Stephen G. Chun, Chen Hu, Hak Choy, Ritsuko U. Komaki, Robert D. Timmerman, Steven E. Schild, Jeffrey A. Bogart, Michael C. Dobelbower, Walter Bosch, James M. Galvin, Vivek S. Kavadi, Samir Narayan, Puneeth Iyengar, Clifford G. Robinson, Raymond B. Wynn, Adam Raben, Mark E. Augspurger, Robert M. MacRae, Rebecca Paulus, Jeffrey D. Bradley

Research output: Contribution to journalArticle

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Abstract

Purpose: Although intensity-modulated radiation therapy (IMRT) is increasingly used to treat locally advanced non-small-cell lung cancer (NSCLC), IMRT and three-dimensional conformal external beam radiation therapy (3D-CRT) have not been compared prospectively. This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospective clinical trial. Patients and Methods: A secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617, in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab, and 60-versus 74-Gy radiation doses. Comparisons included 2-year overall survival (OS), progression-free survival, local failure, distant metastasis, and selected Common Terminology Criteria for Adverse Events (version 3) ≥ grade 3 toxicities. Results: The median follow-up was 21.3 months. Of 482 patients, 53% were treated with 3D-CRT and 47% with IMRT. The IMRT group had larger planning treatment volumes (median, 427 v 486 mL; P = .005); a larger planning treatment volume/volume of lung ratio (median, 0.13 v 0.15; P = .013); and more stage IIIB disease (30.3% v 38.6%, P = .056). Two-year OS, progression-free survival, local failure, and distant metastasis-free survival were not different between IMRT and 3D-CRT. IMRT was associated with less $ grade 3 pneumonitis (7.9% v 3.5%, P = .039) and a reduced risk inadjusted analyses (odds ratio, 0.41; 95% CI, 0.171 to 0.986; P = .046). IMRT also produced lower heart doses (P < .05), and the volume of heart receiving 40 Gy (V40) was significantly associated with OS on adjusted analysis (P < .05). The lung V5 was not associated with any ≥ grade 3 toxicity, whereas the lung V20 was associated with increased ≥ grade 3 pneumonitis risk on multivariable analysis (P = .026). Conclusion: IMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617, which supports routine use of IMRT for locally advanced NSCLC.

Original languageEnglish (US)
Pages (from-to)56-62
Number of pages7
JournalJournal of Clinical Oncology
Volume35
Issue number1
DOIs
StatePublished - Jan 1 2017

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Non-Small Cell Lung Carcinoma
Radiotherapy
Randomized Controlled Trials
Pneumonia
Survival
Clinical Trials
Lung
Disease-Free Survival
Neoplasm Metastasis
Radiation Dosage
Cardiac Volume
Carboplatin
Paclitaxel
Terminology
Odds Ratio
Drug Therapy

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer : A secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial. / Chun, Stephen G.; Hu, Chen; Choy, Hak; Komaki, Ritsuko U.; Timmerman, Robert D.; Schild, Steven E.; Bogart, Jeffrey A.; Dobelbower, Michael C.; Bosch, Walter; Galvin, James M.; Kavadi, Vivek S.; Narayan, Samir; Iyengar, Puneeth; Robinson, Clifford G.; Wynn, Raymond B.; Raben, Adam; Augspurger, Mark E.; MacRae, Robert M.; Paulus, Rebecca; Bradley, Jeffrey D.

In: Journal of Clinical Oncology, Vol. 35, No. 1, 01.01.2017, p. 56-62.

Research output: Contribution to journalArticle

Chun, SG, Hu, C, Choy, H, Komaki, RU, Timmerman, RD, Schild, SE, Bogart, JA, Dobelbower, MC, Bosch, W, Galvin, JM, Kavadi, VS, Narayan, S, Iyengar, P, Robinson, CG, Wynn, RB, Raben, A, Augspurger, ME, MacRae, RM, Paulus, R & Bradley, JD 2017, 'Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer: A secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial', Journal of Clinical Oncology, vol. 35, no. 1, pp. 56-62. https://doi.org/10.1200/JCO.2016.69.1378
Chun, Stephen G. ; Hu, Chen ; Choy, Hak ; Komaki, Ritsuko U. ; Timmerman, Robert D. ; Schild, Steven E. ; Bogart, Jeffrey A. ; Dobelbower, Michael C. ; Bosch, Walter ; Galvin, James M. ; Kavadi, Vivek S. ; Narayan, Samir ; Iyengar, Puneeth ; Robinson, Clifford G. ; Wynn, Raymond B. ; Raben, Adam ; Augspurger, Mark E. ; MacRae, Robert M. ; Paulus, Rebecca ; Bradley, Jeffrey D. / Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer : A secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial. In: Journal of Clinical Oncology. 2017 ; Vol. 35, No. 1. pp. 56-62.
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abstract = "Purpose: Although intensity-modulated radiation therapy (IMRT) is increasingly used to treat locally advanced non-small-cell lung cancer (NSCLC), IMRT and three-dimensional conformal external beam radiation therapy (3D-CRT) have not been compared prospectively. This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospective clinical trial. Patients and Methods: A secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617, in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab, and 60-versus 74-Gy radiation doses. Comparisons included 2-year overall survival (OS), progression-free survival, local failure, distant metastasis, and selected Common Terminology Criteria for Adverse Events (version 3) ≥ grade 3 toxicities. Results: The median follow-up was 21.3 months. Of 482 patients, 53{\%} were treated with 3D-CRT and 47{\%} with IMRT. The IMRT group had larger planning treatment volumes (median, 427 v 486 mL; P = .005); a larger planning treatment volume/volume of lung ratio (median, 0.13 v 0.15; P = .013); and more stage IIIB disease (30.3{\%} v 38.6{\%}, P = .056). Two-year OS, progression-free survival, local failure, and distant metastasis-free survival were not different between IMRT and 3D-CRT. IMRT was associated with less $ grade 3 pneumonitis (7.9{\%} v 3.5{\%}, P = .039) and a reduced risk inadjusted analyses (odds ratio, 0.41; 95{\%} CI, 0.171 to 0.986; P = .046). IMRT also produced lower heart doses (P < .05), and the volume of heart receiving 40 Gy (V40) was significantly associated with OS on adjusted analysis (P < .05). The lung V5 was not associated with any ≥ grade 3 toxicity, whereas the lung V20 was associated with increased ≥ grade 3 pneumonitis risk on multivariable analysis (P = .026). Conclusion: IMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617, which supports routine use of IMRT for locally advanced NSCLC.",
author = "Chun, {Stephen G.} and Chen Hu and Hak Choy and Komaki, {Ritsuko U.} and Timmerman, {Robert D.} and Schild, {Steven E.} and Bogart, {Jeffrey A.} and Dobelbower, {Michael C.} and Walter Bosch and Galvin, {James M.} and Kavadi, {Vivek S.} and Samir Narayan and Puneeth Iyengar and Robinson, {Clifford G.} and Wynn, {Raymond B.} and Adam Raben and Augspurger, {Mark E.} and MacRae, {Robert M.} and Rebecca Paulus and Bradley, {Jeffrey D.}",
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TY - JOUR

T1 - Impact of intensity-modulated radiation therapy technique for locally advanced non-small-cell lung cancer

T2 - A secondary analysis of the NRG oncology RTOG 0617 randomized clinical trial

AU - Chun, Stephen G.

AU - Hu, Chen

AU - Choy, Hak

AU - Komaki, Ritsuko U.

AU - Timmerman, Robert D.

AU - Schild, Steven E.

AU - Bogart, Jeffrey A.

AU - Dobelbower, Michael C.

AU - Bosch, Walter

AU - Galvin, James M.

AU - Kavadi, Vivek S.

AU - Narayan, Samir

AU - Iyengar, Puneeth

AU - Robinson, Clifford G.

AU - Wynn, Raymond B.

AU - Raben, Adam

AU - Augspurger, Mark E.

AU - MacRae, Robert M.

AU - Paulus, Rebecca

AU - Bradley, Jeffrey D.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Purpose: Although intensity-modulated radiation therapy (IMRT) is increasingly used to treat locally advanced non-small-cell lung cancer (NSCLC), IMRT and three-dimensional conformal external beam radiation therapy (3D-CRT) have not been compared prospectively. This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospective clinical trial. Patients and Methods: A secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617, in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab, and 60-versus 74-Gy radiation doses. Comparisons included 2-year overall survival (OS), progression-free survival, local failure, distant metastasis, and selected Common Terminology Criteria for Adverse Events (version 3) ≥ grade 3 toxicities. Results: The median follow-up was 21.3 months. Of 482 patients, 53% were treated with 3D-CRT and 47% with IMRT. The IMRT group had larger planning treatment volumes (median, 427 v 486 mL; P = .005); a larger planning treatment volume/volume of lung ratio (median, 0.13 v 0.15; P = .013); and more stage IIIB disease (30.3% v 38.6%, P = .056). Two-year OS, progression-free survival, local failure, and distant metastasis-free survival were not different between IMRT and 3D-CRT. IMRT was associated with less $ grade 3 pneumonitis (7.9% v 3.5%, P = .039) and a reduced risk inadjusted analyses (odds ratio, 0.41; 95% CI, 0.171 to 0.986; P = .046). IMRT also produced lower heart doses (P < .05), and the volume of heart receiving 40 Gy (V40) was significantly associated with OS on adjusted analysis (P < .05). The lung V5 was not associated with any ≥ grade 3 toxicity, whereas the lung V20 was associated with increased ≥ grade 3 pneumonitis risk on multivariable analysis (P = .026). Conclusion: IMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617, which supports routine use of IMRT for locally advanced NSCLC.

AB - Purpose: Although intensity-modulated radiation therapy (IMRT) is increasingly used to treat locally advanced non-small-cell lung cancer (NSCLC), IMRT and three-dimensional conformal external beam radiation therapy (3D-CRT) have not been compared prospectively. This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospective clinical trial. Patients and Methods: A secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617, in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab, and 60-versus 74-Gy radiation doses. Comparisons included 2-year overall survival (OS), progression-free survival, local failure, distant metastasis, and selected Common Terminology Criteria for Adverse Events (version 3) ≥ grade 3 toxicities. Results: The median follow-up was 21.3 months. Of 482 patients, 53% were treated with 3D-CRT and 47% with IMRT. The IMRT group had larger planning treatment volumes (median, 427 v 486 mL; P = .005); a larger planning treatment volume/volume of lung ratio (median, 0.13 v 0.15; P = .013); and more stage IIIB disease (30.3% v 38.6%, P = .056). Two-year OS, progression-free survival, local failure, and distant metastasis-free survival were not different between IMRT and 3D-CRT. IMRT was associated with less $ grade 3 pneumonitis (7.9% v 3.5%, P = .039) and a reduced risk inadjusted analyses (odds ratio, 0.41; 95% CI, 0.171 to 0.986; P = .046). IMRT also produced lower heart doses (P < .05), and the volume of heart receiving 40 Gy (V40) was significantly associated with OS on adjusted analysis (P < .05). The lung V5 was not associated with any ≥ grade 3 toxicity, whereas the lung V20 was associated with increased ≥ grade 3 pneumonitis risk on multivariable analysis (P = .026). Conclusion: IMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617, which supports routine use of IMRT for locally advanced NSCLC.

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