V.S. Mangona

Matched-Pair Analysis of High Dose Versus Standard Dose Definitive Chemoradiation for Locally Advanced Non–Small-Cell Lung Cancer

Background Recent data have called into question the use of dose‐escalated radiotherapy for locally advanced non–small‐cell lung cancer and the effect of cardiac radiotherapy doses. We compared the outcomes after chemoradiation using standard‐dose (SD; ≤ 64 Gy) or high‐dose (HD; > 64 Gy) radiotherapy. Patients and Methods A matched‐pair analysis was performed of 178 patients with stage IIB‐IIIB non–small‐cell lung cancer for SD versus HD groups using age ± 5 years, gender, stage, tumor size ± 2 cm, yielding 86 patients. The clinical endpoints were estimated using the Kaplan‐Meier method. Univariate and multivariate analyses were performed using the Cox regression method. Results The median follow‐up was 16.8 months for the entire cohort (HD, 21.6 months; SD, 12.1 months; P = .06). No significant differences were found in disease stage, histologic type, age, performance status, gender, or tumor size between the 2 groups. The median overall survival was 23.1 months for the HD group (95% confidence interval, 20.6‐25.5) versus 13.6 months for the SD group (95% confidence interval, 9.6‐17.5; P = .03). The 2‐year freedom from locoregional recurrence was 48.7% for the SD and 65.3% for the HD groups (P = .07). The 2‐year freedom from distant metastasis was 46.7% for the SD and 70.3% for the HD groups (P = .05). A higher cardiac V30 dose (P = .03) was the strongest predictor of survival besides clinical stage (P = .02). Conclusion Dose‐escalated radiotherapy resulted in improved survival and recurrence rates. A higher cardiac dose was a significant predictor of decreased survival. Micro‐Abstract Recent data have shown a survival detriment with dose‐escalated radiation for locally advanced non–small‐cell lung cancer with concurrent chemotherapy. Using data from a single institution, a matched‐pair analysis comparing patients treated with standard versus dose escalation was performed, yielding 86 patients. Higher dose radiotherapy was associated with improved outcomes, but a lower cardiac dose was a significant predictor of survival.