J. Crawford

Pulmonary toxicity in Stage III non-small cell lung cancer patients treated with high-dose (74 Gy) 3-dimensional conformal thoracic radiotherapy and concurrent chemotherapy following induction chemotherapy: a secondary analysis of Cancer and Leukemia Group B (CALGB) trial 30105.

PURPOSEnCancer and Leukemia Group B (CALGB) 30105 tested two different concurrent chemoradiotherapy platforms with high-dose (74 Gy) three-dimensional conformal radiotherapy (3D-CRT) after two cycles of induction chemotherapy for Stage IIIA/IIIB non-small cell lung cancer (NSCLC) patients to determine if either could achieve a primary endpoint of >18-month median survival. Final results of 30105 demonstrated that induction carboplatin and gemcitabine and concurrent gemcitabine 3D-CRT was not feasible because of treatment-related toxicity. However, induction and concurrent carboplatin/paclitaxel with 74 Gy 3D-CRT had a median survival of 24 months, and is the basis for the experimental arm in CALGB 30610/RTOG 0617/N0628. We conducted a secondary analysis of all patients to determine predictors of treatment-related pulmonary toxicity.nnnMETHODS AND MATERIALSnPatient, tumor, and treatment-related variables were analyzed to determine their relation with treatment-related pulmonary toxicity.nnnRESULTSnOlder age, higher N stage, larger planning target volume (PTV)1, smaller total lung volume/PTV1 ratio, larger V20, and larger mean lung dose were associated with increasing pulmonary toxicity on univariate analysis. Multivariate analysis confirmed that V20 and nodal stage as well as treatment with concurrent gemcitabine were associated with treatment-related toxicity. A high-risk group comprising patients with N3 disease and V20 >38% was associated with 80% of Grades 3-5 pulmonary toxicity cases.nnnCONCLUSIONSnElevated V20 and N3 disease status are important predictors of treatment related pulmonary toxicity in patients treated with high-dose 3D-CRT and concurrent chemotherapy. Further studies may use these metrics in considering patients for these treatments.

Does the revised TNM staging system for lung cancer better estimate actuarial rates of local/regional recurrence after surgery?

7072 Background: The International Association for the Study of Lung Cancer (IASLC) recently recommended changes to the TNM classification of lung cancers. For early-stage disease, increasing tumor...

Trends in chemotherapy use and survival for patients with metastatic non-small cell lung cancer

7072 Background: In clinical trials chemotherapy improves survival in patients with Stage IV non-small cell lung cancer (NSCLC). We searched the National Cancer Database (NCDB) to analyze the effects of age, race and sex on the use of chemotherapy and to see if chemotherapy improves survival on a population basis.nnnMETHODSnThe NCDB was searched for newly reported cases of metastatic NSCLC in 1985,1990, 1995, and 2000. Data was recorded for histology, age, sex, race, whether chemotherapy was given, and survival. The Pearson Chi-Square test was used to analyze the effect of age, race, and gender on patients receiving chemotherapy. The relative survival rates of patients undergoing chemotherapy were compared to patients not receiving this treatment modality.nnnRESULTSn79,436 cases of metastatic NSCLC were identified. The percentage of all patients who received chemotherapy increased from 26.8% (95% Confidence interval 25.7%-28.0%) in 1985 to 45.9% (CI: 45.3%-46.6%) in 2000. The use of chemotherapy in patients greater than 70 yrs old increased from 15.7% (CI: 13.6%-17.9%) in 1985 to 34.6% (CI: 33.7%-35.5%) in 2000. In patients less than 70 yrs old, white women (58.5%) were most likely to receive chemotherapy; whereas, non-white men (47.1%) were least likely. For patients greater than 70 yrs old, white men (37.1%) were most likely to receive chemotherapy as compared to other demographic groups. Survival data is presented in the table below.nnnCONCLUSIONSnOver the last 15 years, chemotherapy is being used more frequently in patients with metastatic NSCLC with an associated survival benefit at one and two years. Patient age, gender and race impact the likelihood of receiving chemotherapy and warrant further study. [Figure: see text] No significant financial relationships to disclose.