title: Modern radiotherapy using image guidance for unresectable non-small cell lung cancer can improve outcomes in patients treated with chemoradiation therapy.
abstract: BACKGROUND
  To investigate the impact of advances in image-guided radiotherapy (IGRT) on the outcomes of patients with non-small cell lung cancer (NSCLC) treated with chemoradiation therapy (CRT).
  
  
  METHODS
  We retrospectively reviewed 91 patients with NSCLC treated with definitive CRT using image guidance with daily orthogonal kilovoltage (kV) imaging compared to standard weekly megavoltage (MV) portal verifications. Kaplan-Meier curves for overall survival and locoregional failure were computed and stratified by image guidance techniques. Log-rank tests were used to compare strata. Cox Proportional Hazards models were used to identify risk factors for worse mortality and locoregional control.
  
  
  RESULTS
  Fifty-four percent (n=49) of patients received weekly MV portal imaging, while 46% (n=42) underwent IGRT using daily orthogonal kV imaging. kV IGRT was associated with longer median survival (36.4 months) compared to MV imaging (14.9 months; P=0.01). kV imaging was also marginally associated with lower risk of locoregional failure. Median time to local progression in patients imaged with kV was 21.4 months compared to 10.9 months (P=0.065) for those treated with MV portal imaging.
  
  
  CONCLUSIONS
  Daily kV imaging appears to be marginally associated with better survival and disease control when compared to MV imaging. Given the small study size and the numerable factors tested, these finding require additional confirmation.
authors.affiliation: Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Deek
authors.affiliation: School of Public Health, Biometrics Division, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
authors.forename: Sinae
authors.initials: S
authors.lastname: Kim
authors.affiliation: Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Ning
authors.initials: N
authors.lastname: Yue
authors.affiliation: Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Rekha
authors.initials: R
authors.lastname: Baby
authors.affiliation: Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Inaya
authors.initials: I
authors.lastname: Ahmed
authors.affiliation: Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Wei
authors.initials: W
authors.lastname: Zou
authors.affiliation: Rutgers Cancer Institute of New Jersey, Division of Cardiothoracic Surgery, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: John
authors.initials: J
authors.lastname: Langenfeld
authors.affiliation: Rutgers Cancer Institute of New Jersey, Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Aisner
authors.affiliation: Rutgers Cancer Institute of New Jersey, Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA.
authors.forename: Salma K
authors.initials: SK
authors.lastname: Jabbour
keywords: Image guidance; chemoradiation therapy (CRT); lung cancer