title: Pulmonary artery invasion, high-dose radiation, and overall survival in patients with non-small cell lung cancer.
abstract: OBJECTIVE
  To investigate whether high-dose radiation to the pulmonary artery (PA) affects overall survival (OS) in patients with non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Patients with medically inoperable/unresectable NSCLC treated with definitive radiation therapy in prospective studies were eligible for this study. Pulmonary artery involvement was defined on the basis of pretreatment chest CT and positron emission tomography/CT fusion. Pulmonary artery was contoured according to the Radiation Therapy Oncology Group protocol 1106 atlas, and dose-volume histograms were generated.
  
  
  RESULTS
  A total of 100 patients with a minimum follow-up of 1 year for surviving patients were enrolled: 82.0% underwent concurrent chemoradiation therapy. Radiation dose ranged from 60 to 85.5 Gy in 30-37 fractions. Patients with PA invasion of grade ≤2, 3, 4, and 5 had 1-year OS and median survival of 67% and 25.4 months (95% confidence interval [CI] 15.7-35.1), 62% and 22.2 months (95% CI 5.8-38.6), 90% and 35.8 months (95% CI 28.4-43.2), and 50% and 7.0 months, respectively (P=.601). Two of the 4 patients with grade 5 PA invasion died suddenly from massive hemorrhage at 3 and 4.5 months after completion of radiation therapy. Maximum and mean doses to PA were not significantly associated with OS. The V45, V50, V55, and V60 of PA were correlated significantly with a worse OS (P<.05). Patients with V45 >70% or V60 >37% had significantly worse OS (13.3 vs 37.9 months, P<.001, and 13.8 vs 37.9 months, P=.04, respectively).
  
  
  CONCLUSIONS
  Grade 5 PA invasion and PA volume receiving more than 45-60 Gy may be associated with inferior OS in patients with advanced NSCLC treated with concurrent chemoradiation.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Oncology, Shengjing Hospital of China Medical University, Shenyang, China.
authors.forename: Cheng-Bo
authors.initials: CB
authors.lastname: Han
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Radiation Oncology, Fourth Hospital of China Medical University, Shenyang, China.
authors.forename: Wei-Li
authors.initials: WL
authors.lastname: Wang
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Leslie
authors.initials: L
authors.lastname: Quint
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Thoracic Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jian-Xin
authors.initials: JX
authors.lastname: Xue
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Martha
authors.initials: M
authors.lastname: Matuszak
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Randall
authors.initials: R
authors.lastname: Ten Haken
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan. Electronic address: fkong@gru.edu.
authors.forename: Feng-Ming Spring
authors.initials: FM
authors.lastname: Kong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000473:pathology* / Q000528:radiation effects; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed; D047368:Tumor Burden