Long-term survival of stage T4N0-1 and single station IIIA-N2 NSCLC patients treated with definitive chemo-radiotherapy using individualised isotoxic accelerated radiotherapy (INDAR).
BACKGROUND
Non-small cell lung cancer (NSCLC) stage T4N0-1 or single nodal station IIIA-N2 are two stage III sub-groups for which the outcome of non-surgical therapy is not well known. We investigated the results of individualised isotoxic accelerated radiotherapy (INDAR) and chemotherapy in this setting.


METHODS
Analysis of NSCLC patients included in 2 prospective trials (NCT00573040 and NCT00572325) stage T4N0-1 or IIIA-N2 with 1 pathologic nodal station, treated with chemo-radiotherapy (CRT) using INDAR with concurrent or sequential platinum-based chemotherapy. Overall survival (OS) was updated and calculated from date of diagnosis (Kaplan-Meier). Toxicity was scored following CTCAEv3.0. To allow comparison with other articles the subgroups were also analysed separately for toxicity, progression free and overall survival.


RESULTS
83 patients (42 T4N0-1 and 41 IIIA-N2) were identified: the median radiotherapy dose was 65Gy. Thirty-seven percent of patients received sequential CRT and 63% received concurrent CRT. At a median follow-up of 48 months the median OS for T4N0-1 patients was 34 months with 55% 2-year survival and 25% 5-year survival. For stage IIIA-N2 at a median follow-up of 50 months the median OS was 26 months with 2- and 5-year survival rates of 53% and 24%, respectively.


CONCLUSIONS
Chemo-radiation using INDAR yields promising survival results in patients with single-station stage IIIA-N2 or T4N0-1 NSCLC.
Department of Radiation Oncology (MAASTRO Clinic), The Netherlands. Electronic address: bart.reymen@maastro.nl.
Bart
B
Reymen
Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
Angela
A
van Baardwijk
Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
Rinus
R
Wanders
Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
Jacques
J
Borger
Department of Pulmonology, University Medical Centre Maastricht, GROW-School for Oncology and Developmental Biology, The Netherlands.
Anne-Marie C
AM
Dingemans
Department of Pulmonology, Atrium Medical Centre, Heerlen, The Netherlands.
Gerben
G
Bootsma
Department of Pulmonology, Laurentius Hospital, Roermond, The Netherlands.
Cordula
C
Pitz
Department of Pulmonology, St. Jansgasthuis, Weert, The Netherlands.
Ragnar
R
Lunde
Department of Pulmonology, Orbis Medical Centre, Sittard, The Netherlands.
Wiel
W
Geraedts
Department of Radiation Oncology (MAASTRO Clinic), The Netherlands.
Philippe
P
Lambin
Department of Radiation Oncology (MAASTRO Clinic), The Netherlands; University Hospital Leuven/KU Leuven, Belgium.
Dirk
D
De Ruysscher
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D016896:Treatment Outcome
Chemotherapy; Combined modality treatment; Non-small cell lung cancer; Radiotherapy; T4