title: [Technical advancement improves survival in patients with locally advanced non-small cell lung cancer (LA-NSCLC) receiving definitive radiotherapy].
abstract: OBJECTIVE
  This study aimed to evaluate the impact of technical advancement of radiation therapy in patients with LA-NSCLC receiving definitive radiotherapy (RT).
  
  
  METHODS
  Patients treated with definitive RT (≥50 Gy) between 2000 and 2010 were retrospectively reviewed. Overall survival (OS), cancer specific survival (CSS), locoregional progression-free survival (LRPFS), distant metastasis-free survival (DMFS) and progression-free survival (PFS) were calculated and compared among patients irradiated with different techniques. Radiation-induced lung injury (RILI) and esophageal injury (RIEI) were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events 3.0 (NCI-CTCAE 3.0).
  
  
  RESULTS
  A total of 946 patients were eligible for analysis, including 288 treated with two-dimensional radiotherapy (2D-RT), 209 with three-dimensional conformal radiation therapy (3D-CRT) and 449 with intensity-modulated radiation therapy (IMRT) respectively. The median follow-up time for the whole population was 84.1 months. The median OS of 2D-RT, 3D-CRT and IMRT groups were 15.8, 19.7 and 23.3 months, respectively, with the corresponding 5-year survival rate of 8.7%, 13.0% and 18.8%, respectively (P<0.001). The univariate analysis demonstrated significantly inferior OS, LRPFS, DMFS and PFS of 2D-RT than those provided by 3D-CRT or IMRT. The univariate analysis also revealed that the IMRT group had significantly loger LRPFS and a trend toward better OS and DMFS compared with 3D-CRT. Multivariate analysis showed that TNM stage, RT technique and KPS were independent factors correlated with all survival indexes. Compared with 2D-RT, the utilization of IMRT was associated with significantly improved OS, LRPFS, DMFS as well as PFS. Compared with 3D-CRT, IMRT provided superior DMFS (P=0.035), a trend approaching significance with regard to LRPFS (P=0.073) but no statistically significant improvement on OS, CSS and PFS in multivariate analysis. The incidence rates of RILI were significantly decreased in the IMRT group (29.3% vs. 26.6% vs.14.0%, P<0.001) whereas that of RIET rates were similar (34.7% vs. 29.7% vs. 35.3%, P=0.342) among the three groups.
  
  
  CONCLUSIONS
  Radiation therapy technique is a factor affecting prognosis of LA-NSCLC patients. Advanced radiation therapy technique is associated with improved tumor control and survival, and decreased radiation-induced lung toxicity.
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: J B
authors.initials: JB
authors.lastname: Wang
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: W
authors.initials: W
authors.lastname: Jiang
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Z
authors.initials: Z
authors.lastname: Ji
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: J Z
authors.initials: JZ
authors.lastname: Cao
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: L P
authors.initials: LP
authors.lastname: Liu
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Men
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: C
authors.initials: C
authors.lastname: Xu
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: X Z
authors.initials: XZ
authors.lastname: Wang
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Z G
authors.initials: ZG
authors.lastname: Hui
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: J
authors.initials: J
authors.lastname: Liang
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: J M
authors.initials: JM
authors.lastname: Lyu
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Z M
authors.initials: ZM
authors.lastname: Zhou
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Z F
authors.initials: ZF
authors.lastname: Xiao
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: Q F
authors.initials: QF
authors.lastname: Feng
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: D F
authors.initials: DF
authors.lastname: Chen
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: H X
authors.initials: HX
authors.lastname: Zhang
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: W B
authors.initials: WB
authors.lastname: Yin
authors.affiliation: National Cencer Center/Cancer Hospital & Institute, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100021, China.
authors.forename: L H
authors.initials: LH
authors.lastname: Wang
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung; D018572:Disease-Free Survival; D006801:Humans; D008175:Lung Neoplasms; D015999:Multivariate Analysis; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D012189:Retrospective Studies; D015996:Survival Rate