title: Radiation dose and survival of patients with stage IV non-small cell lung cancer undergoing concurrent chemotherapy and thoracic three-dimensional radiotherapy: reanalysis of the findings of a single-center prospective study.
abstract: BACKGROUND
  The objective of this study was to evaluate the radiation dose and response in terms of local-regional progression-free survival (LRPFS) and overall survival (OS) of patients with stage IV non-small cell lung cancer (NSCLC) undergoing concurrent chemotherapy and thoracic three-dimensional radiotherapy.
  
  
  METHODS
  In all, we enrolled 201 patients with stage IV NSCLC in this study and analyzed OS in 159 patients and LRPFS in 120.
  
  
  RESULTS
  The 1-, 2-, 3-, and 5-year OS rates were 46.2%, 19.5%, 11.7%, and 5.8%, respectively, the median survival time being 12 months. The median survival times in differential treatment response of primary tumors were 19 of complete response, 13 of partial response, 8 of stable disease, and 6 months of progressive disease, respectively (P = 0.000). The 1-, 2-, 3-, and 5-year LRPFS rates of patients undergoing four to five cycles with doses ≥63 Gy and <63 Gy were 77.4% and 32.6%, 36.2% and 21.7%, 27.2% and 0, and 15.9% and 0, respectively (P = 0.002). According to multivariate analyses, four to five cycles of chemotherapy, gross tumor volume <175.00 cm3 and post-treatment Karnofsky Performance Status score stable or increased by at least 10 units were independent prognostic factors for better OS (P = 0.035, P = 0.008, and P = 0.000, respectively). Radiation dose to the primary tumor ≥63 Gy resulted in better OS (P = 0.057) and LRPFS (P = 0.051), both findings being of borderline significance.
  
  
  CONCLUSIONS
  Treatment of IV NSCLC with joint administration of four to five cycles of chemotherapy and three-dimensional radiotherapy may prolong survival, particularly in patients receiving ≥63 Gy radiotherapy, with gross tumor volume <175.00 cm3 and post-treatment Karnofsky Performance Status score not lower than pretreatment values.
authors.forename: Wei-Wei
authors.initials: WW
authors.lastname: Ouyang
authors.forename: Sheng-Fa
authors.initials: SF
authors.lastname: Su
authors.forename: Yin-Xiang
authors.initials: YX
authors.lastname: Hu
authors.affiliation: Department of Thoracic Oncology, Affiliated Hospital of Guiyang Medical College, Guizhou, Guiyang, China. lbgymaaaa@sohu.com.
authors.forename: Bing
authors.initials: B
authors.lastname: Lu
authors.forename: Zhu
authors.initials: Z
authors.lastname: Ma
authors.forename: Qing-Song
authors.initials: QS
authors.lastname: Li
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Li
authors.forename: Yi-Chao
authors.initials: YC
authors.lastname: Geng
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011881:Radiotherapy, Computer-Assisted; D016019:Survival Analysis; D016896:Treatment Outcome