title: Individualised isotoxic accelerated radiotherapy and chemotherapy are associated with improved long-term survival of patients with stage III NSCLC: a prospective population-based study.
abstract: BACKGROUND
  Individualised, isotoxic, accelerated radiotherapy (INDAR) allows the delivery of high biological radiation doses, but the long-term survival associated with this approach is unknown.
  
  
  METHODS
  Patients with stage III NSCLC in the Netherlands Cancer Registry/Limburg from January 1, 2002 to December 31, 2008 were included.
  
  
  RESULTS
  Patients (1002) with stage III NSCLC were diagnosed, of which 938 had T4 and/or N2-N3 disease. Patients treated with curative intent were staged with FDG-PET scans and a contrast-enhanced CT or an MRI of the brain. There were no shifts over time in the patient or tumour characteristics at diagnosis. The number of stage III NSCLC patients remained stable over time, but the proportion treated with palliative intent decreased from 47% in 2002 to 37% in 2008, and the percentage treated with chemo-radiation (RT) increased from 24.6% in 2002 to 47.8% in 2008 (p<0.001). The proportion of surgical patients remained below 5%. Sequential chemotherapy and conventional RT resulted in a median and a 5-year survival of 17.5 months and 8.4%, respectively, whereas with sequential chemotherapy and INDAR this was 23.6 months and 31%, respectively (p<0.001). Concurrent chemotherapy and INDAR was associated with a median and 2-year survival that was not reached and 66.7%, respectively (p=0.004).
  
  
  CONCLUSIONS
  The proportion of patients treated with a curative intention with chemo-RT has increased markedly over time of observation. INDAR is associated with longer survival when compared to standard dose RT alone given with or without chemotherapy.
authors.affiliation: Department of Radiation Oncology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands. dirk.deruysscher@maastro.nl
authors.forename: Dirk
authors.initials: D
authors.lastname: De Ruysscher
authors.forename: Angela
authors.initials: A
authors.lastname: van Baardwijk
authors.forename: Jessie
authors.initials: J
authors.lastname: Steevens
authors.forename: Anita
authors.initials: A
authors.lastname: Botterweck
authors.forename: Geert
authors.initials: G
authors.lastname: Bosmans
authors.forename: Bart
authors.initials: B
authors.lastname: Reymen
authors.forename: Rinus
authors.initials: R
authors.lastname: Wanders
authors.forename: Jacques
authors.initials: J
authors.lastname: Borger
authors.forename: Anne-Marie C
authors.initials: AM
authors.lastname: Dingemans
authors.forename: Gerben
authors.initials: G
authors.lastname: Bootsma
authors.forename: Cordula
authors.initials: C
authors.lastname: Pitz
authors.forename: Ragnar
authors.initials: R
authors.lastname: Lunde
authors.forename: Wiel
authors.initials: W
authors.lastname: Geraedts
authors.forename: Michel
authors.initials: M
authors.lastname: Oellers
authors.forename: Andre
authors.initials: A
authors.lastname: Dekker
authors.forename: Philippe
authors.initials: P
authors.lastname: Lambin
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000532:radiotherapy*; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D057285:Precision Medicine; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18