title: The effect of tumor volume and its change on survival in stage III non-small cell lung cancer treated with definitive concurrent chemoradiotherapy.
abstract: BACKGROUND
  To investigate a prognostic role of gross tumor volume (GTV) changes on survival outcomes following concurrent chemoradiotherapy (CCRT) in stage III non-small-cell lung cancer (NSCLC) patients.
  
  
  METHODS
  We enrolled 191 patients with stage III NSCLC from 2001 to 2009 undergoing definitive CCRT. The GTV of 157 patients was delineated at the planning CT prior to CCRT and with a follow-up CT 1 month after CCRT. We assessed the volumetric parameters of pre-treatment GTV (GTVpre) post-treatment GTV (GTVpost), and volume reduction ratio of GTV (VRR). The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS) and locoregional progression-free survival (LRPFS). The best cut-off value was defined as that which exhibited the maximum difference between the two groups.
  
  
  RESULTS
  The median follow-up duration was 52.7 months in surviving patients. Median survival, 3-year OS, PFS and LRPFS rates were 25.5 months, 36.4%, 23.0%, and 45.0%, respectively. The selected cut-off values were 50 cm(3) for GTVpre, 20 cm(3) for GTVpost, and 50% for VRR. The smaller GTVpre and GTVpost values were associated with better OS (p<0.001 and p=0.015) and PFS (p=0.001 and p=0.004), respectively, upon univariate analysis. The higher VRR of > 50% was associated with a trend toward poorer OS (p=0.004) and PFS (p=0.054). Upon multivariate analysis, smaller GTVpre indicated significantly improved OS (p=0.001), PFS (p=0.013) and LRPFS (p=0.002), while smaller GTVpost was marginally significant for PFS (p=0.086). Higher VRR was associated with a trend toward poorer OS (p=0.075).
  
  
  CONCLUSIONS
  In patients with stage III NSCLC undergoing definitive CCRT, GTVpre was an independent prognostic factor of survival. Notably, improved outcome was not correlated with higher VRR after short-term follow-up with CT alone.
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. kootaeryool@gmail.com.
authors.forename: Tae Ryool
authors.initials: TR
authors.lastname: Koo
authors.affiliation: Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. shmoon@ncc.re.kr.|Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. shmoon@ncc.re.kr.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea. yujindw@naver.com.
authors.forename: Yu Jin
authors.initials: YJ
authors.lastname: Lim
authors.affiliation: Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. hontas0809@hotmail.com.
authors.forename: Ja Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. jane2000md@gmail.com.
authors.forename: Yeonjoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Proton Therapy Center, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. k2onco@naver.com.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. kwancho@ncc.re.kr.
authors.forename: Kwan Ho
authors.initials: KH
authors.lastname: Cho
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. jymama@ncc.re.kr.
authors.forename: Ji-Youn
authors.initials: JY
authors.lastname: Han
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. yjlee@ncc.re.kr.
authors.forename: Young Joo
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. hmotakyun@ncc.re.kr.
authors.forename: Tak
authors.initials: T
authors.lastname: Yun
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. htkim@ncc.re.kr.
authors.forename: Heung Tae
authors.initials: HT
authors.lastname: Kim
authors.affiliation: Center for Lung Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea. jslee@ncc.re.kr.
authors.forename: Jin Soo
authors.initials: JS
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D059248:Chemoradiotherapy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies