title: Long-term clinical outcome of intensity-modulated radiotherapy for inoperable non-small cell lung cancer: the MD Anderson experience.
abstract: OBJECTIVE
  In 2007, we published our initial experience in treating inoperable non-small-cell lung cancer (NSCLC) with intensity-modulated radiation therapy (IMRT). The current report is an update of that experience with long-term follow-up.
  
  
  METHODS
  Patients in this retrospective review were 165 patients who began definitive radiotherapy, with or without chemotherapy, for newly diagnosed, pathologically confirmed NSCLC to a dose of ≥60 Gy from 2005 to 2006. Early and late toxicities assessed included treatment-related pneumonitis (TRP), pulmonary fibrosis, esophagitis, and esophageal stricture, scored mainly according to the Common Terminology Criteria for Adverse Events 3.0. Other variables monitored were radiation-associated dermatitis and changes in body weight and Karnofsky performance status. The Kaplan-Meier method was used to compute survival and freedom from radiation-related acute and late toxicities as a function of time.
  
  
  RESULTS
  Most patients (89%) had Stage III to IV disease. The median radiation dose was 66 Gy given in 33 fractions (range, 60-76 Gy, 1.8-2.3 Gy per fraction). Median overall survival time was 1.8 years; the 2-year and 3-year overall survival rates were 46% and 30%. Rates of Grade ≥3 maximum TRP (TRP(max)) were 11% at 6 months and 14% at 12 months. At 18 months, 86% of patients had developed Grade ≥1 maximum pulmonary fibrosis (pulmonary fibrosis(max)) and 7% Grade ≥2 pulmonary fibrosis(max). The median times to maximum esophagitis (esophagitis(max)) were 3 weeks (range, 1-13 weeks) for Grade 2 and 6 weeks (range, 3-13 weeks) for Grade 3. A higher percentage of patients who experienced Grade 3 esophagitis(max) later developed Grade 2 to 3 esophageal stricture.
  
  
  CONCLUSIONS
  In our experience, using IMRT to treat NSCLC leads to low rates of pulmonary and esophageal toxicity, and favorable clinical outcomes in terms of survival.
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Zhi-Qin
authors.initials: ZQ
authors.lastname: Jiang
authors.forename: Kunyu
authors.initials: K
authors.lastname: Yang
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Komaki
authors.forename: Xiong
authors.initials: X
authors.lastname: Wei
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhuang
authors.forename: Mary K
authors.initials: MK
authors.lastname: Martel
authors.forename: Sastray
authors.initials: S
authors.lastname: Vedam
authors.forename: Peter
authors.initials: P
authors.lastname: Balter
authors.forename: Guangying
authors.initials: G
authors.lastname: Zhu
authors.forename: Daniel
authors.initials: D
authors.lastname: Gomez
authors.forename: Charles
authors.initials: C
authors.lastname: Lu
authors.forename: Radhe
authors.initials: R
authors.lastname: Mohan
authors.forename: James D
authors.initials: JD
authors.lastname: Cox
authors.forename: Zhongxing
authors.initials: Z
authors.lastname: Liao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D004940:Esophageal Stenosis / Q000209:etiology; D004941:Esophagitis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011658:Pulmonary Fibrosis / Q000209:etiology; D011832:Radiation Injuries / Q000150:complications; D017564:Radiation Pneumonitis / Q000209:etiology; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas