Clinical Research Papers:
A retrospective study of shrinking field radiation therapy during chemoradiotherapy in stage III non-small cell lung cancer
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Chenxue Jiang1,2,*, Shuiyun Han2,*, Wucheng Chen1,2, Xiaozhen Ying1,2, He Wu1,2, Yaoyao Zhu1,2, Guodong Shi2, Xiaojiang Sun2 and Yaping Xu1,2
1First Clinical Medical School, Wenzhou Medical University, Wenzhou, PR China
2Department of Radiation Oncology, Zhejiang Cancer Hospital, Hangzhou, PR China
*These authors contributed equally to this work
Yaping Xu, email: firstname.lastname@example.org
Keywords: lung cancer; chemoradiation therapy; dose escalation; adaptive radiotherapy
Received: April 04, 2017 Accepted: October 26, 2017 Published: January 03, 2018
Background and purpose: This retrospective study aimed to investigate the feasibility of shrinking field radiotherapy during chemoradiotherapy in non-small cell lung cancer (NSCLC).
Patients and methods: Ninety-seven patients with stage III NSCLC who achieved a good response to chemoradiation were analyzed. Computed tomography was performed after 40-50 Gy dose radiation to evaluate curative effect. Patients in the shrinking field group underwent resimulation CT scans and shrinking field radiotherapy. Acute symptomatic irradiation-induced pneumonia (ASIP), progression patterns and survival were assessed.
Results: Of the 97 patients who achieved response after a median total dose of 60 Gy, fifty patients received shrinking field radiotherapy. The incidence of acute symptomatic irradiation-induced pneumonia tended to be lower for the shrinking field group (18.0% vs. 23.4%, P = 0.51). The rate of disease progression was significantly higher in the non-shrinking than shrinking field group (95.7% vs. 66.0%, P < 0.001). Compared to the non-shrinking field group, the shrinking field group had similar overall survival (30.0 vs. 30.0 months, P = 0.58) but significantly better median progression-free survival (14.0 vs. 11.0 months, P = 0.006).
Conclusions: Shrinking field radiotherapy during chemoradiotherapy in stage III non-small cell lung cancer seems safe with acceptable toxicities and relapse, and potentially spares normal tissues and enables dose escalation. Prospective trials are warranted.
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