title: Predictive factors for survival and correlation to toxicity in advanced Stage III non-small cell lung cancer patients with concurrent chemoradiation.
abstract: OBJECTIVE
  Concurrent chemoradiotherapy is the standard treatment for locally advanced Stage III non-small cell lung cancer in patients with a good performance status and minimal weight loss. This study aimed to define subgroups with different survival outcomes and identify correlations with the radiation-related toxicities.
  
  
  METHODS
  We retrospectively reviewed 381 locally advanced Stage III non-small cell lung cancer patients with a good performance status or weight loss of <10% who received concurrent chemoradiotherapy between 2004 and 2011. Three-dimensional conformal radiotherapy was administered once daily, combined with weekly chemotherapy. The Kaplan-Meier method was used for survival comparison and Cox regression for multivariate analysis. Multivariate analysis was performed using all variables with P values <0.1 from the univariate analysis.
  
  
  RESULTS
  Median survival of all patients was 24 months. Age > 75 years, the diffusion lung capacity for carbon monoxide ≤80%, gross tumor volume ≥100 cm(3) and subcarinal nodal involvement were the statistically significant predictive factors for poor overall survival both in univariate and multivariate analyses. Patients were classified into four groups according to these four predictive factors. The median survival times were 36, 29, 18 and 14 months in Groups I, II, III and IV, respectively (P < 0.001). Rates of esophageal or lung toxicity ≥Grade 3 were 5.9, 14.1, 12.5 and 22.2%, respectively. The radiotherapy interruption rate differed significantly between the prognostic subgroups; 8.8, 15.4, 22.7 and 30.6%, respectively (P = 0.017).
  
  
  CONCLUSIONS
  Severe toxicity and interruption of radiotherapy were more frequent in patients with multiple adverse predictive factors. To maintain the survival benefit in patients with concurrent chemoradiotherapy, strategies to reduce treatment-related toxicities need to be deeply considered.
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju.
authors.forename: Yong-Hyub
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea ahnsja@chonnam.ac.kr.
authors.forename: Sung-Ja
authors.initials: SJ
authors.lastname: Ahn
authors.affiliation: Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Kim
authors.affiliation: Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: Kyu-Sik
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: In-Jae
authors.initials: IJ
authors.lastname: Oh
authors.affiliation: Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: Hee-Jung
authors.initials: HJ
authors.lastname: Ban
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju.
authors.forename: Woong-Ki
authors.initials: WK
authors.lastname: Chung
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: Taek-Keun
authors.initials: TK
authors.lastname: Nam
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: Mee Sun
authors.initials: MS
authors.lastname: Yoon
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju Lung and Esophageal Cancer Clinic, Jeonnam Regional Cancer Center, Jeollanam-do, Korea.
authors.forename: Jae-Uk
authors.initials: JU
authors.lastname: Jeong
authors.affiliation: Department of Radiation Oncology, Chonnam National University Medical School, Gwangju.
authors.forename: Ju-Young
authors.initials: JY
authors.lastname: Song
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology* / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000077143:Docetaxel; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D017239:Paclitaxel / Q000008:administration & dosage; D016016:Proportional Hazards Models; D011832:Radiation Injuries / Q000209:etiology; D020266:Radiotherapy, Conformal; D012189:Retrospective Studies; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome; D000093542:Gemcitabine
chemical_list: D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D016190:Carboplatin; D017239:Paclitaxel; D002945:Cisplatin; D000093542:Gemcitabine
keywords: concurrent chemoradiotherapy; locally advanced non-small cell lung cancer; prognostic subgroups; toxicity