title: Matched-Pair Analysis of High Dose Versus Standard Dose Definitive Chemoradiation for Locally Advanced Non-Small-Cell Lung Cancer.
abstract: Recent data have called into question the use of dose-escalated radiotherapy for locally advanced non-small-cell lung cancer and the effect of cardiac radiotherapy doses. We compared the outcomes after chemoradiation using standard-dose (SD; ≤ 64 Gy) or high-dose (HD; > 64 Gy) radiotherapy.
  
  
  
  A matched-pair analysis was performed of 178 patients with stage IIB-IIIB non-small-cell lung cancer for SD versus HD groups using age ± 5 years, gender, stage, tumor size ± 2 cm, yielding 86 patients. The clinical endpoints were estimated using the Kaplan-Meier method. Univariate and multivariate analyses were performed using the Cox regression method.
  
  
  
  The median follow-up was 16.8 months for the entire cohort (HD, 21.6 months; SD, 12.1 months; P = .06). No significant differences were found in disease stage, histologic type, age, performance status, gender, or tumor size between the 2 groups. The median overall survival was 23.1 months for the HD group (95% confidence interval, 20.6-25.5) versus 13.6 months for the SD group (95% confidence interval, 9.6-17.5; P = .03). The 2-year freedom from locoregional recurrence was 48.7% for the SD and 65.3% for the HD groups (P = .07). The 2-year freedom from distant metastasis was 46.7% for the SD and 70.3% for the HD groups (P = .05). A higher cardiac V30 dose (P = .03) was the strongest predictor of survival besides clinical stage (P = .02).
  
  
  
  Dose-escalated radiotherapy resulted in improved survival and recurrence rates. A higher cardiac dose was a significant predictor of decreased survival.
authors.affiliation: Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Johnson
authors.affiliation: Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
authors.forename: Karna
authors.initials: K
authors.lastname: Sura
authors.affiliation: Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
authors.forename: Victor S
authors.initials: VS
authors.lastname: Mangona
authors.affiliation: Department of Medical Oncology, Beaumont Health System, Royal Oak, MI.
authors.forename: Alexander
authors.initials: A
authors.lastname: Glick
authors.affiliation: Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
authors.forename: Michelle
authors.initials: M
authors.lastname: Wallace
authors.affiliation: Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI.
authors.forename: Hong
authors.initials: H
authors.lastname: Ye
authors.affiliation: Department of Radiation Oncology, Beaumont Health System, Royal Oak, MI; Oakland University William Beaumont School of Medicine, Rochester, MI. Electronic address: Inga.grills@beaumont.edu.
authors.forename: Inga S
authors.initials: IS
authors.lastname: Grills
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018287:Carcinoma, Large Cell / Q000473:pathology / Q000628:therapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D011879:Radiotherapy Dosage; D015996:Survival Rate
keywords: Cardiac radiotherapy; Concurrent chemoradiotherapy; Dose-escalated radiation; Locally advanced NSCLC; Stage III