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Abstract

Purpose Although intensity-modulated radiation therapy (IMRT) is increasingly used to treat locally advanced non-small-cell lung cancer (NSCLC), IMRT and three-dimensional conformal external beam radiation therapy (3D-CRT) have not been compared prospectively. This study compares 3D-CRT and IMRT outcomes for locally advanced NSCLC in a large prospective clinical trial. Patients and Methods A secondary analysis was performed to compare IMRT with 3D-CRT in NRG Oncology clinical trial RTOG 0617, in which patients received concurrent chemotherapy of carboplatin and paclitaxel with or without cetuximab, and 60- versus 74-Gy radiation doses. Comparisons included 2-year overall survival (OS), progression-free survival, local failure, distant metastasis, and selected Common Terminology Criteria for Adverse Events (version 3) ≥ grade 3 toxicities. Results The median follow-up was 21.3 months. Of 482 patients, 53% were treated with 3D-CRT and 47% with IMRT. The IMRT group had larger planning treatment volumes (median, 427 v 486 mL; P = .005); a larger planning treatment volume/volume of lung ratio (median, 0.13 v 0.15; P = .013); and more stage IIIB disease (30.3% v 38.6%, P = .056). Two-year OS, progression-free survival, local failure, and distant metastasis-free survival were not different between IMRT and 3D-CRT. IMRT was associated with less ≥ grade 3 pneumonitis (7.9% v 3.5%, P = .039) and a reduced risk in adjusted analyses (odds ratio, 0.41; 95% CI, 0.171 to 0.986; P = .046). IMRT also produced lower heart doses ( P < .05), and the volume of heart receiving 40 Gy (V40) was significantly associated with OS on adjusted analysis ( P < .05). The lung V5 was not associated with any ≥ grade 3 toxicity, whereas the lung V20 was associated with increased ≥ grade 3 pneumonitis risk on multivariable analysis ( P = .026). Conclusion IMRT was associated with lower rates of severe pneumonitis and cardiac doses in NRG Oncology clinical trial RTOG 0617, which supports routine use of IMRT for locally advanced NSCLC.
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Clinical trial information: NCT00533949.

https://clinicaltrials.gov/ct2/show/NCT00533949 

Author information

Chun SG1, Hu C1, Choy H1, Komaki RU1, Timmerman RD1, Schild SE1, Bogart JA1, Dobelbower MC1, Bosch W1, Galvin JM1, Kavadi VS1, Narayan S1, Iyengar P1, Robinson CG1, Wynn RB1, Raben A1, Augspurger ME1, MacRae RM1, Paulus R1, Bradley JD1.​

1Stephen G. Chun and Ritsuko U. Komaki, University of Texas MD Anderson Cancer Center, Houston; Hak Choy, Robert D. Timmerman, and Puneeth Iyengar, University of Texas Southwestern Medical Center, Dallas; Vivek S. Kavadi, Texas Oncology-Sugar Land, Sugar Land, TX; Chen Hu and Rebecca Paulus, NRG Oncology Statistics and Data Management Center; James M. Galvin, Imaging and Radiation Oncology Core, Philadelphia; Raymond B. Wynn, UPMC Cancer Center, Pittsburg, PA; Chen Hu, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Steven E. Schild, Mayo Clinic, Scottsdale, AZ; Jeffrey A. Bogart, State University of New York Upstate Medical University, Syracuse, NY; Michael C. Dobelbower, University of Alabama at Birmingham, Birmingham, AL; Walter Bosch, Clifford G. Robinson, and Jeffrey D. Bradley, Washington University in Saint Louis, St Louis, MO; Samir Narayan, Michigan Cancer Research Consortium Community Clinical Oncology Program, Ann Arbor, MI; Adam Raben, Christiana Care Health Services Community Clinical Oncology Program, Newark, DE; Mark E. Augspurger, Florida Radiation Oncology Group; Baptist Health, Jacksonville, FL; and Robert M. MacRae, The Ottawa Hospital Cancer Centre, Ottawa, Ontario, Canada.