Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 20:13:1236361.
doi: 10.3389/fonc.2023.1236361. eCollection 2023.

IMRT in the treatment of locally advanced or inoperable NSCLC in the pre-durvalumab era: clinical outcomes and pattern of relapses, experience from the Oscar Lambret Center

Thomas Le Roy  1 , Jennifer Wallet  2 , Maël Barthoulot  2 , Clémence Leguillette  2 , Thomas Lacornerie  3 , David Pasquier  1   4 , Eric Lartigau  1   4 , Florence Le Tinier  1
Affiliations

IMRT in the treatment of locally advanced or inoperable NSCLC in the pre-durvalumab era: clinical outcomes and pattern of relapses, experience from the Oscar Lambret Center

Thomas Le Roy et al. Front Oncol. .

Abstract

Background: Intensity-modulated conformal radiotherapy (IMRT) has become the technique of choice for the treatment of locally advanced or inoperable non-small cell lung cancer (NSCLC). Nevertheless, this technique presents dosimetric uncertainties, particularly in treating moving targets such as pulmonary neoplasms. Moreover, it theoretically increases the risk of isolated nodal failure (INF) due to reduced incidental irradiation.

Objective: The objective of this study was to evaluate the efficacy and safety of IMRT in patients with inoperable NSCLC and to describe the pattern of relapses.

Methods: Patients with locally advanced NSCLC treated with radiotherapy and chemotherapy between 2015 and 2018 at the Oscar Lambret Center were retrospectively included in the study. Overall and progression-free survival were estimated using the Kaplan-Meier method. The cumulative incidence of the different components of relapse was estimated using the Kalbfleisch and Prentice method. Prognostic factors for relapse/death were investigated using the Cox model. A comparison with literature data was performed using a one-sample log-rank test.

Results: Seventy patients were included, and 65 patients (93%) had stage III disease. All the patients received chemotherapy, most frequently with cisplatin and navelbine. The dose received was 66 Gy administered in 33 fractions. The median follow-up and survival were 49.1 and 39.1 months, respectively. A total of 35 deaths and 43 relapses, including 29 with metastatic components, were reported. The overall survival rates at 1 and 2 years were 80.2% (95% confidence interval 68.3%-88.0%) and 67.2% (95% confidence interval 54.2%-77.3%), respectively. Locoregional relapse was observed in 14 patients, including two INF, one of which was located in the lymph node area adjacent to the clinical target volume. Median relapse-free survival was 15.2 months. No variable was statistically associated with the risk of relapse/death in multivariate analysis. Seven patients (10%) experienced grade 3 or higher toxicity.

Conclusion: The use of IMRT for locally advanced or inoperable NSCLC led to favorable long-term clinical outcomes. The rate of locoregional relapse, particularly isolated lymph node failure, was low and comparable with that of the three-dimensional radiotherapy series, as was the rate of early and late toxicities.

Keywords: IMRT; NSCLC; isolated nodal failure; locally advanced or inoperable NSCLC; radiochemotherapy; radiotherapy; relapses.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
OS and PFS.
Figure 2
Figure 2
Cumulative incidence of local and metastatic relapses.
Figure 3
Figure 3
Comparison of overall survival with the RTOG 0617 study.
See this image and copyright information in PMC

References

    1. HAS . (2016). Available at: https://www.has-sante.fr/upload/docs/application/pdf/2016-05/rapport_dep....
    1. AURA . Référentiels Auvergne Rhône-Alpes en Oncologie Thoracique. (2021). Available at: https://ressources-aura.fr/wp-content/uploads/2021/03/CBNPC_2021_VDEF.pdf
    1. Aupérin A, Le Péchoux CL, Rolland E, Curran WJ, Furuse K, Fournel P, et al. Meta-analysis of concomitant versus sequential radiochemotherapy in locally advanced non-small-cell lung cancer. J Clin Oncol (2010) 28:2181–90. doi: 10.1200/JCO.2009.26.2543 - DOI - PubMed
    1. Eberhardt E, Lim E, Senan S, Felip E, Peters S, ESMO Guidelines Working Group . Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Vansteenkiste DDR W. Ann Oncol (2013) 24:vi89–98. doi: 10.1093/annonc/mdt241 - DOI - PubMed
    1. Nutting CM, Morden JP, Harrington KJ, Urbano TG, Bhide SA, Clark C, et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial. Lancet Oncol (2011) 12:127–36. doi: 10.1016/S1470-2045(10)70290-4 - DOI - PMC - PubMed

LinkOut - more resources