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Clinical Trial
. 2012 Jan 1;82(1):425-34.
doi: 10.1016/j.ijrobp.2010.09.004. Epub 2010 Oct 25.

Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: an analysis of the Radiation Therapy Oncology Group

Mitchell Machtay  1 , Kyounghwa Bae, Benjamin Movsas, Rebecca Paulus, Elizabeth M Gore, Ritsuko Komaki, Kathy Albain, William T Sause, Walter J Curran
Affiliations
Clinical Trial

Higher biologically effective dose of radiotherapy is associated with improved outcomes for locally advanced non-small cell lung carcinoma treated with chemoradiation: an analysis of the Radiation Therapy Oncology Group

Mitchell Machtay et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: Patients treated with chemoradiotherapy for locally advanced non-small-cell lung carcinoma (LA-NSCLC) were analyzed for local-regional failure (LRF) and overall survival (OS) with respect to radiotherapy dose intensity.

Methods and materials: This study combined data from seven Radiation Therapy Oncology Group (RTOG) trials in which chemoradiotherapy was used for LA-NSCLC: RTOG 88-08 (chemoradiation arm only), 90-15, 91-06, 92-04, 93-09 (nonoperative arm only), 94-10, and 98-01. The radiotherapeutic biologically effective dose (BED) received by each individual patient was calculated, as was the overall treatment time-adjusted BED (tBED) using standard formulae. Heterogeneity testing was done with chi-squared statistics, and weighted pooled hazard ratio estimates were used. Cox and Fine and Gray's proportional hazard models were used for OS and LRF, respectively, to test the associations between BED and tBED adjusted for other covariates.

Results: A total of 1,356 patients were analyzed for BED (1,348 for tBED). The 2-year and 5-year OS rates were 38% and 15%, respectively. The 2-year and 5-year LRF rates were 46% and 52%, respectively. The BED (and tBED) were highly significantly associated with both OS and LRF, with or without adjustment for other covariates on multivariate analysis (p < 0.0001). A 1-Gy BED increase in radiotherapy dose intensity was statistically significantly associated with approximately 4% relative improvement in survival; this is another way of expressing the finding that the pool-adjusted hazard ratio for survival as a function of BED was 0.96. Similarly, a 1-Gy tBED increase in radiotherapy dose intensity was statistically significantly associated with approximately 3% relative improvement in local-regional control; this is another way of expressing the finding that the pool-adjusted hazard ratio as a function of tBED was 0.97.

Conclusions: Higher radiotherapy dose intensity is associated with improved local-regional control and survival in the setting of chemoradiotherapy.

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Conflict of interest statement

There is no conflict of interest for any of the authors.

Figures

Figure 1
Figure 1
BED and tBED formulae
Figure 2
Figure 2
Median Local Failure
Figure 3
Figure 3
Median Overall Survival
See this image and copyright information in PMC

Comment in

  • In Regard to Machtay et al.
    Healy J. Healy J. Int J Radiat Oncol Biol Phys. 2012 Oct 1;84(2):302-3; author reply 303-4. doi: 10.1016/j.ijrobp.2012.02.046. Int J Radiat Oncol Biol Phys. 2012. PMID: 22935387 No abstract available.

References

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